Not enough women know about breast reconstruction after cancer, doctor says

The Vancouver Sun
Erin Ellis
Tuesday, October 14, 2014

Trace Maloney says a fast-track system for diagnosing and treating breast cancer not only saved her life but also helped her feel like herself again. "My children have a mother, my husband has a wife. It was a difficult year, but it also had really great high points because I was proactive," said Maloney in her Tsawwassen home.

Last December, at age 37, she was diagnosed with an aggressive form of breast cancer at the Jim Pattison Outpatient Care and Surgery Centre in Surrey. The Breast Health Clinic there provides women with a physical examination, mammogram or ultrasound, and a tissue biopsy all at the same location, often on the same day. A diagnosis is made within 21 working days — usually sooner. Quick action was key to Maloney’s survival because she had a rapidly growing tumour in one breast with the likelihood of recurring cancer if she did not have an immediate double mastectomy. She had the operation within a month of diagnosis.

"At that point, you feel like you have bombs on you. Get them off!" Maloney says now.

The Breast Health Clinic opened at the same time as the outpatient centre in 2010 and is modelled on a European system to speed diagnosis rather than have women delayed by tests that are scheduled weeks or months apart. A key benefit of the clinic’s "triple assessment" is that it can quickly rule out cancer and end the angst that goes with delayed results.

As a young wife and mother of two preschool boys, Maloney said she immediately knew she wanted breast reconstruction after surgery. That puts her among the 15% of all women with breast cancer in Canada who choose that route, largely because it usually hits women who are much older — and also because it’s not well understood.

Dr. Adrian Lee, a member of the Plastic Surgery Group at City Centre in Surrey who also works with the Breast Health Clinic, says the rate is higher in big cities than in outlying areas where women don’t have the same access to both a general surgeon who removes cancerous tissue and a plastic surgeon in charge of re-creating the breast. One common misconception is that the operation isn’t covered by the public health system because it is cosmetic, Lee says, "the unfortunate thing is most people aren’t aware that it's possible. And most people believe you have to pay for it and that it will cost them thousands of dollars. But national-wide, breast reconstruction is covered." Surgeons used to wait years before offering implants because of the fear they could make it difficult to detect or treat recurring cancer but research has shown reconstruction doesn’t worsen health outcomes.

The Breast Health Clinic handled 156 breast reconstruction procedures between April 2013 and April 2014, about 90% of which used implants and 10% used the patient’s own tissue taken from another part of the body, usually the abdomen, which is a lengthier procedure.