Published
5 minute read
by Dr. Ron Somogyi
When a woman is told she has breast cancer, every conversation turns to survival. That's how it should be. But I've spent my career as a reconstructive surgeon trying to bring another conversation to the forefront: what happens to her body, and her sense of herself, once the cancer is gone.
That's what Breast Reconstruction Awareness Day is for. It falls on the third Wednesday of October, which is October 21 this year, and it exists so that every woman facing a mastectomy knows she has options before she has to choose.
It's extraordinarily hard to go to sleep for cancer surgery and wake up missing a part of your body. Even when you know exactly why it's happening. When reconstruction is done at the same time as the mastectomy, much of that trauma can be avoided or softened.
There's a technical reason too. Without reconstruction, a mastectomy removes the breast skin and nipple so the chest skin can lie comfortably flat. Rebuilding that skin later is far more difficult than preserving it from the start, which immediate reconstruction often allows, and in many cases the nipple can be kept as well.
For these reasons, at North York General Hospital, we consider immediate reconstruction for every woman who wants it, unless there is a medical reason not to.
Sometimes there is a reason. Poorly controlled diabetes or blood pressure, a significant smoking history, or anything else that affects healing can make a longer operation riskier. Radiation, chemotherapy or hormone therapy can also mean it's safer to finish treatment first. These decisions are nuanced, and delayed reconstruction can still give an excellent result.
Reconstruction generally falls into two approaches.
Implant-based reconstruction can be done in one stage, with the implant placed at the time of mastectomy, or in two, with a tissue expander placed first and exchanged for the final implant four to six months later. Which one makes sense depends on your anatomy, your other treatments and your cosmetic goals.
Reconstruction with your own tissue most often uses tissue from the lower abdomen. It's a bigger operation with a longer recovery, but the result is natural tissue that changes and ages with you. Implants don't, and they are more likely to need revision over time.
When a woman is a good candidate for both, the choice is usually personal. Some would rather avoid the larger surgery. Others would rather take it on once and not think about implants again. Both are valid choices.
And choosing not to reconstruct is a valid option too.
Picturing life without breasts is very difficult. That's why we encourage patients to talk this through not only with me, but with their partners, their families and, most helpfully, with women who have already been through it. This is another key feature of BRA Day events – it’s often an opportunity for new patients to speak with recent patients about their experience.
I also make sure patients understand the practical side: the loss of sensation, and how a mastectomy affects everyday things like clothing and swimsuits. An external prosthesis is an option, but it doesn't suit everything a woman might want to wear. These details matter, and they deserve to be discussed honestly before surgery, not discovered afterward.
In Ontario, virtually all aspects of breast reconstruction after cancer, including future revisions, are covered by OHIP. That applies whether reconstruction is immediate or delayed.
This message matters, because it removes the financial barrier. What remains are other barriers: geography, wait times, and access to a surgeon trained in reconstruction. Most large Ontario cities offer at least some reconstruction options. Many smaller centres still don't.
Over the years I've seen real progress. More surgeons are trained in reconstruction, techniques have improved, established procedures are safer, and specialized centres can now take on more complex cases. That means more women have reconstruction as a real option.
But system constraints still limit how much reconstruction we can offer, in large centres and small ones alike.
That's why BRA Day matters. We hope it empowers women to ask about reconstruction and to seek it out, whether at their own hospital or in a nearby community. And we hope it reminds all of us, surgeons, cancer teams and patients alike, to keep advocating for the resources that will let every woman in Ontario, and across Canada, have that choice.
If you or someone you love is facing a mastectomy, please join us at the BRA DAY Know Your Options event at North York General on October 19. Bring your questions. You deserve to know every option you have before you make the decision.
