No surgery is free of risks or complications, as breast reconstruction study reminds

breconstruct-300x200Cancer and surgery — it’s little wonder that even the most resilient patients can buckle a bit when their doctors talk to them about these two issues together and urgently. That’s why new research may be  valuable to women with breast cancer, providing them with better evidence-based insight about challenges in their reconstructive options.

The information, which experts said surprised them and may change their views on frequently performed procedures, yet again underscores that surgery can carry significant risks and complications.

In fact, 1 in 3 women who undergo cancer-related breast reconstructive surgery develops a postoperative complication over the next two years, 1 in 5 requires more surgery, and in 1 in 20 of cases, reconstruction fails, the New York Times reported of the published findings of medical researchers, most from the University of Michigan.

The newspaper reported that women whose own body tissues, as opposed to artificial implants, are used in reconstructive procedures had higher rates of surgical-related complications. But they also eventually reported greater degrees of sexual well-being with their natural and re-built breasts.

The Michigan study, the New York Times reported, will be taken seriously by patients and surgeons because:

[It involved] 2,300 women who had breast reconstruction surgery between Feb. 1, 2012, and July 31, 2015, at 11 medical centers in the United States and Canada. More than half of the women had artificial implants inserted. About a third had reconstructions using their own tissue, a procedure known as autologous reconstruction. The patients were followed for two or more years after the surgery. During this time, researchers tracked all medical complications and evaluated quality of life using a questionnaire called the BREAST-Q, which looked at satisfaction with the breasts as well as psychosocial, physical and sexual well-being. The researchers defined complications broadly, including even minor problems like a wound that took extra time to heal and required an antibiotic ointment.

The researchers said their results should not steer women toward one kind of surgery over another. Patients still must consult with their own doctors about their individual cases. But the researchers said their study emphasizes the necessity and challenges of informing patients at a time of high stress about complex medical decisions.

Surgeons quoted by the newspaper said they had not realized how many breast cancer patients suffered complications from reconstructive procedures, and some expressed surprise that they were so much higher in operations in which women used their own tissue. Other experts noted that any consideration of breast reconstructive surgery complications also needed to consider that implants may require replacement or repair a decade later.

In my practice, I see the harms that patients suffer while seeking medical services, including the devastating problems due to botched surgeries and post-operative complications. Not counting various kinds of skin cancer, breast cancer is the most common form of the disease afflicting women. Approximately 237,000 cases of breast cancer are diagnosed in women and about 2,100 in men each year in the United States, with 41,000 women and 450 men dying annually from the disease.

More than 100,000 women are estimated to undergo breast cancer reconstructive surgeries each year, and that number is rising. Costs for the procedure vary widely, from as little as $5,000 to at least $150,000, depending on factors such as whether patients use their own tissue or implants, the extent of reconstruction, the surgeon and facility, and, of course complications.

Patients and their families may benefit from help with the surgeries’ cost under the law: The Women’s Health and Cancer Rights Act of 1998 (WHCRA), a federal law, requires group health plans and health insurers that offer mastectomy coverage to also pay for reconstructive surgery after mastectomy. This coverage must include all stages of reconstruction and surgery to achieve symmetry between the breasts, breast prostheses, and treatment of complications that result from the mastectomy.

It’s good to see cancer research like the study from the Michigan experts, but more, much more is needed. Doctors and hospitals have made strides in changing cancer care — including with surgery, radiation and chemo therapies — so that many forms of the disease have gone from sure killers to chronic conditions. At the same time, oncologists and surgeons have been forced to confront the reality that their aggressive, costly treatments have proven harsh and even “toxic” to patients, their loved ones, and their family finances and well-being. Not only surgeries but also chemotherapies and oft-prescribed drugs, particularly for early-stage breast cancer patients, are undergoing rigorous research re-examination. This is a good thing.

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