What is BRA Day, and Why Does Thaxton Plastic Surgery Have it?
BRA Day USA, October 16th, 2019 is a national day for raising breast cancer reconstruction awareness, thus the “BRA,” acronym, for “Breast cancer Reconstruction Awareness “. Dr. Thaxton hosts BRA Day annually for breast cancer patients and BRCA positive patients. Dr. Thaxton hosts the event to educate patients in order to hopefully ease their minds during this time of extreme trauma in their lives.
One in eight women is diagnosed with breast cancer. The disease is often curable if caught early enough, but historically, the course of treatment has typically included breast amputation, aka, mastectomy. As if dealing with the cancer diagnosis weren’t enough, women must deal with the loss of one or both of their breasts, and this is another difficult part of the disease. Some post mastectomy patients and their families are unaware that there are many options for restoring their breasts. Many are also unaware that due to a federal mandate, breast reconstruction must be covered under insurance as part of their breast cancer treatment.
So the American Society of Plastic Surgeons (ASPS) and their educational foundation, Plastic Surgery Educational Foundation (PSEF) and local Board Certified Plastic Surgeons such as Dr. Jeff Thaxton of Charleston, WV host BRA Day events to educate breast cancer patients and families on the many options for breast cancer reconstruction that are available today.
Breast Cancer Treatment
The standard of breast cancer treatment includes lumpectomy and mastectomy. Adjunct treatments of chemotherapy and radiation as indicated are aimed at reducing the risk of recurrence. The treatment does not end there, however. Complete treatment of the patient includes breast reconstruction to restore the patients’ physical form, emotional health and positive body image.
The same is true for patients at high risk of breast cancer (women with genetic mutations BRCA1 or BRCA2) who undergo prophylactic mastectomies. Their treatment also involves restoring the physical form to closely resemble its previous state.
Emotional Reactions to Breast Cancer
Womens’ often negative reactions to mastectomies are not surprising. Breast cancer diagnosis and mastectomies can lead to negative emotions, negative body image, and can cause damage to self-esteem (1, 2, 3, 4). These negative effects can be improved with breast reconstructive surgery (5, 6). That is Dr. Thaxton’s aim– to minimize the effect of breast cancer on self-image by recreating a normal appearing breast. This improves aesthetic and functional results to treatment and minimizes emotional devastation after the full breast cancer treatment ordeal . He sees this in his practice, and it motivates him to carry on in his passion of providing realistic solutions for these patients afflicted with the horrible disease.
Does Insurance Cover Reconstructive Breast Surgery?
Yes. The passage of the Women’s Health and Cancer Act of 1998 requires insurance plans to cover treatment of women with breast cancer, not just treatment of the cancer, but the patient as a whole, and this includes breast reconstruction procedures. As such, insurance plans must also cover reconstructive breast surgery for women who choose to undergo it. Dr. Thaxton’s patients are often relieved to understand this.
There are many options available for breast reconstruction, and the breast reconstruction can occur either immediately or many years after a mastectomy. This has been an important point for some of Dr. Thaxton’s breast reconstruction patients, that they can receive breast reconstruction surgery years after their initial breast cancer treatment. One patient in the practice had her breast reconstruction nearly a decade after her mastectomy. She said, “It’s the best thing I ever did. I wish I’d done it sooner.”
Reconstructive breast surgery is an option provided for the patients’ benefits. Some patients don’t want reconstructive breast surgery. These patients can try other options, such as breast prosthetics, or mastectomy bras. Dr. Thaxton has had patients who have tried these options. He says his patients tried to “look right” in their shirts and to “feel better” about themselves. Mastectomy bras work well for some patients. But some of his patients have told him these external prosthetics caused adverse side effects such as discomfort wearing a heavy bra at night, and “sucking sounds” during the day when the breast prosthetics move. They still had emotional difficulty viewing themselves in the mirror. For the most part, his patients want a permanent solution to these realistic issues.
Current Trends in Breast Reconstruction Surgery
The current trend in breast surgery is nipple sparing mastectomy which involves performing a special mastectomy which leaves not only some of the breast skin, but also, ideally, leaves the nipple and areola complex. This removes the cancer while leaving behind as much natural tissue as safety allows. This is in keeping with the current state of reconstructive breast surgery. The current state of reconstructive breast surgery is to optimally reconstruct the breast using as much natural tissue as can safely be spared. Of course overall survival rate and cancer free survival would take first priority with any cancer treatment. Improved aesthetic result would not take precedence over optimal cancer treatment. (And again, the final aesthetic result goes toward overall patient emotional well-being after the cancer treatment ordeal.) To this end, medical literature is showing that there is no decreased survival rate and no increased distant disease with the nipple sparing mastectomy technique. (6, 8, 9) Numerous articles support that sparing the nipple areola complex is safe for the appropriately selected patient. (6, 10,9,11,10) A 6 year retrospective review showed no difference in survival or cancer recurrence for nipple sparing mastectomy or skin sparing mastectomy and that nipple sparing mastectomy does not increase the risk of recurrence or decrease survival. Stated another way, there is no difference in survival or cancer recurrence between the previous standard of care skin sparing mastectomy and nipple sparing mastectomy. Dr. Thaxton and his general surgery colleagues perform these technically difficult procedures in conjunction. If the patient is a candidate for this type of immediate breast reconstruction surgery, it is usually the best option as far as cosmetic result.
When to See a Breast Reconstruction Surgeon?
It is best to talk to a breast reconstructive specialist as soon as you are diagnosed with breast cancer. If you are a candidate for an immediate breast reconstruction and a nipple sparing mastectomy, this is usually the best option. And make sure your reconstructive breast surgeon is board certified by the American Board of Plastic Surgeons, such as Dr. Jeff Thaxton. This will ensure you are in good hands.
Some of Dr. Thaxton’s patients have graciously shared their breast cancer reconstructive stories on our YouTube channel. Contact us or call us anytime (304) 925-8949.
1 Brandberg, Y, et. al. Psychological Reactions, Quality of Life, and Body Image After Bilateral Prophylactic
Mastectomy in Women At High Risk for Breast Cancer: A Prospective 1-Year Follow-Up Study
Journal of Clinical Oncology: 2008 26:24, 3943-3949
3 Shekhawat L1, et. al. Patient-Reported Outcomes Following Breast Reconstruction Surgery and Therapeutic Mammoplasty: Prospective Evaluation 1 Year Post-Surgery with BREAST Q Questionnaire. Indian J Surg Oncol: 2015 Dec;6(4):356-62.
5 Shekhawat L1, et. al. Patient-Reported Outcomes Following Breast Reconstruction Surgery and Therapeutic Mammoplasty: Prospective Evaluation 1 Year Post-Surgery with BREAST Q Questionnaire. Indian J Surg Oncol:2015 Dec;6(4):356-62.
6 Smith, B.L., et. al., Oncologic Safety of Nipple-Sapring Mastectomy in Women with Breast Cancer. J Am Coll Surg. Vol. 225, No. 3, September 2017. 361-365.
7 Shekhawat L1, et. al. Patient-Reported Outcomes Following Breast Reconstruction Surgery and Therapeutic Mammoplasty: Prospective Evaluation 1 Year Post-Surgery with BREAST Q Questionnaire. Indian J Surg Oncol: 2015 Dec;6(4):356-62.
8 Poruk, KE, et.al. Breast cancer recurrence after nipple-sparing mastectomy: one inststitution’s experience. Am J Surg:2015 Jan; 209(1):212-217.
9 Fortunato, L, et. al. When mastectomy is needed: is the nipple-sparing procedure a new standard with very few contraindications? J Surg Oncol:2013 Sep;108(4):207-12.
10 Djohan, et.al. Patient Satisfaction following Nipple-Sparing Mastectomy and Immediate Breat Reconstruction: An 8-Year Outcome Study. Plastic & Reconstructive Surgery: March 2010 – Volume 125 – Issue 3 – pp 818-829. 9 Crowe, et. al. Nipple-sparing mastectomy update: one hundred forty-nine procedures and clinical outcomes. Arch Surg:2008 Nov;143(11): 1106-10.
11 Murthy, V. and Chamberlain, RS. Defining a place for nipple sparing mastectomy in modern breast care: an evidence based review. Breast J: 2013 Nov-Dec; 19(6):571-81.