Our rate of breast reconstruction after mastectomy is among the highest in the world. Our surgeons have recently published the results of their review of women having a mastectomy for cancer or DCIS (pre-cancer) at our centre. This showed that over a 3-year period from 2009-2011, 41% of women had a breast reconstruction after their mastectomy. In some centres around the world, the rate can be as low as 5%. Rates up to 80% have been reported, but only when women who are older or had more advanced cancer were excluded.
A/Prof Andrew Spillane, the senior author of the paper says “We are very proud of our rate of breast reconstruction. We believe that nearly every woman who has a mastectomy could have a breast reconstruction if she wanted to. We offer it to every woman when it is safe to do so and we find that around half decide to take up the offer.
Asked why the rates are so low in some hospitals, A/Prof Spillane said ”Breast reconstruction may not be locally available in smaller centres or in rural areas. These women can still be offered reconstruction as some may be willing to travel or to have a delayed breast reconstruction after the cancer treatment. However, often this discussion and referral doesn’t happen.”
“Another reason why many women don’t get the opportunity to have a reconstruction is that some cancer surgeons mistakenly believe that it is not safe to do reconstruction when radiotherapy is needed after the mastectomy,” A/Prof Spillane explains. “We have a lot of experience with using tissue expander and silicone implant reconstruction when radiotherapy is needed. There is a higher chance of implant-related complications and sometimes the cosmetic result from the reconstruction is not as good as it would have been if radiotherapy wasn’t given. We find that many women are willing to accept this and we believe that they should not be denied immediate breast reconstruction if they want to go ahead,” he says.
At our Surgical Oncology centre, we strongly believe that the reconstructive options should be talked about with every women who needs or chooses to have a mastectomy. In a small number of cases it may not be safe to do immediate breast reconstruction and of course not all women will want to have breast reconstruction, but the discussion should always happen,” A/Prof Spillane says. “Women, not surgeons, should make the choice.”