After breast surgery, a bare scarred chest can have an enormous impact on a woman’s confidence. It doesn’t matter how often their partners reassure them, some women may end up feeling worthless.
Mr Philip Ouma, a patient support manager at Faraja Cancer Support Trust in Nairobi, said some women feel like they’ve lost their femininity after mastectomy.
To address this challenge, hospitals are beginning to offer breast reconstruction surgery (BRS) which enables patients to get new breasts. Dr Radovan Boca, a plastic surgeon and breast reconstruction specialist at Aga Khan University Hospital in Nairobi, said that the procedure also provides comfort as the scar tissue following a mastectomy may cause some tightness and pain around the chest.
There are two main techniques used in breast reconstruction surgery. The first one involves inserting an implant which can be filled with saline (salt water), silicone gel or a combination of the two. The implant is then placed under the pectoral chest muscle.
The second technique is known as flap reconstruction. This involves use of tissue (skin, fat or muscle) from another part of the body — such as the belly, thigh or back — to create a new breast. Doctors mould the tissue into the shape of a breast and stitch it into place. This technique is popular as the breast often lasts a lifetime. Yet, implants will normally require replacement after 10 or 20 years.
Low awareness levels
Flap reconstruction also feels quite natural and may give the new breast some sensation. This is because tissue on the belly, buttock or upper thigh is quite similar to that of the breast.
‘‘But if the nerves were destroyed as the mastectomy or breast removal surgery was being performed, then the sensation will be lost,’’ Dr Boca said, adding that the technique chosen depends on many factors.
“If you are slim with small breasts but insufficient fat on the belly, an implant would be the best option,’’ he said. But bigger women with enough fat in their tummies or thighs can comfortably go for the flap technique.
‘‘Many prefer this procedure since it also gives a tummy-tuck once the fat is removed from the tummy,” he said. Due to its cost, over Sh100,000, breast reconstruction surgery is not common among most cancer survivors in Kenya.
In Europe, North America and other developed nations BRS is included in health packages offered to cancer patients after treatment.
Insurance companies that cover mastectomy are required by law to also cover BRS, including any procedures needed to achieve a balanced appearance between the two breasts (reconstructed and original). Sadly, just a few insurers offer the package in Kenya. ‘‘We have very few insurance companies that cover BRS. It’s always safe to check with your service provider first,’’ the plastic surgeon said.
Aside from low awareness levels and high cost, Dr Boca noted that the uptake of breast reconstruction surgery has been slow because of shortage of surgeons.
“The number of skilled plastic surgeons has grown tremendously over the years. So there’s no reason why Kenyan women shouldn’t benefit from BRS like patients in America or the UK,’’ Dr Boca said. Patients are the driving force of health care services, he said.
“They have the power to change how things work. If many people begin asking for the procedure, then hospitals will prioritise it. And once it becomes common prices will also become more competitive.”
Women who don’t like or can’t afford BRS can instead use a prosthesis (wearable artificial breast) which is usually slipped into pockets of specially designed bras known as the mastectomy bras.
The bras are sold at a subsidised price of Sh6,000 is some cancer support groups. Local boutiques rarely stock them. But a few entrepreneurs import them and sell to individual customers on a case by case basis.
‘‘These bras mean a lot to breast cancer survivors and we should reach a point where they can be given free of charge as part of the post-treatment package offered at hospitals,” said Mr Ouma.
“You can imagine the humiliation a woman feels when she has to stuff pieces of clothing in her bras so as to appear normal after a mastectomy. And she will constantly be worried about the embarrassment she could face if they slip and fall in public,” he said. Hospitals, he said, should put in place systems that follow up cancer patients once they complete their treatment.
“Many women feel like they’ve been abandoned with no one to turn to. Yet they lack sufficient information about what goes on after treatment,” he said.
For instance, cancer patients often need a special message (lymphatic drainage) done physically or by machine to help prevent body swelling. This is because lymphatic nodes that naturally perform this function are usually removed during mastectomy. Hospitals charge for lymphatic drainage services but they can be offered free of charge at patient support centres.
Patients are also trained on how to do it by themselves at home. This enables them to save on transport and other costs.
Counselling services and interaction with support groups are also important as women get to meet cancer survivors who give them hope. “Support groups have made me strong. It feels good to talk to someone who has experienced what you are going through,” said breast cancer survivor Innocent Mworia, 39.
Studies show that when cancer survivors participate in altruistic activities, where they voluntarily offer their time and other resources, their treatment outcomes and quality of life improve. Regular exercise and eating healthy are also recommended for effective management of breast cancer.