Breast reconstruction process 'needs to be more immediate'

Joan Helson considers herself lucky. After having her left breast removed in 2008, she only had to wait two years to start breast reconstruction surgery.

Then the Dartmouth woman, now 49, only had to wait one more year to finish the surgery with a second procedure.

A lot of breast cancer survivors have it a lot worse, judging by Helson’s friends and by provincial wait time numbers.

• Wrist surgery tops list of surgical wait times in Nova Scotia

"It's good that there's a certain period of waiting time, and the surgeons are good about this, to let you know you've explored your options," she said. "But once you've made that decision, I know people want that process to be more immediate."

People often think of plastic surgery as nose jobs and tummy tucks, says plastic surgeon Martin LeBlanc. In fact, LeBlanc spends much of his time doing breast reconstruction — a complicated surgery that can take a whole day. 

The surgery has the seventh-longest wait time in the province — up to 16 months for most patients, after they’re cleared for surgery.

LeBlanc says several more surgeons are needed. He often has to put aside breast surgery to repair serious burns, broken facial bones, broken hands, and other trauma that can’t wait.

"It's hard to keep up," he said. "Breast cancer is very, very common. But I think our generation ... is going to be wanting reconstruction."

As with several surgical specialties, the province will need to pay close attention to demand for breast reconstruction, because it could change quickly. Meanwhile, it can take years to recruit a properly trained surgeon.

In the past, women who had mastectomies didn’t have the option of reconstruction.

"You can take the breast away and close the skin, and the patient can live on to be healthy," LeBlanc said.

However, surgeons can now build breasts with implants or with the patient’s own body tissues. Nova Scotia patients have historically had very low rates of breast reconstruction: one study from 2001 found that only 3.8 per cent of mastectomy patients in the province had reconstruction between 1991 and 2001. 

In the United States, the rate of reconstruction was similarly low in 1990. But by 2002, it had risen to 42 per cent as techniques improved.

Breast reconstruction 'much more than just cosmetic'

Two or three surgeons do most of the province’s breast reconstructions, said LeBlanc. He has heard that the money isn’t there to hire more.

"I am aware of the need for plastic surgery, and knowing the work that goes on at the women's centre at the IWK, this certainly is one of those areas that ... need to be addressed," said Health Minister Leo Glavine.

However, he said finding qualified surgeons is as big a question as funding, with major hospitals across the country competing for in-demand sub-specialties.

Dalhousie’s medical school and the health department sometimes find a resident in plastic surgery and send them on a fellowship to be trained — exactly how LeBlanc was recruited.

That process, which can take years, "may be the only way of getting that person in the shortest possible time," said Glavine.

When it comes to medical urgency, breast reconstruction doesn’t compare to some other common post-cancer surgeries. For example, patients cannot function if the area around the bowels is not rebuilt right away, said LeBlanc.

However, wanting breast reconstruction is "much more than just cosmetic," said LeBlanc.

"I know that the real difficulty is that your first inclination is that you want to have that identity back," said Helson. "You feel like someone's stolen some part of you and you just want to put things back the way they were."

It is also stressful, and costly, to adjust to a series of body shapes after a mastectomy, she said. For example, the prosthetic breasts that women use while awaiting reconstructive surgery are about $450 and not covered by the province.

"I know for me that ... the hardest part I had was I had the two-step procedure, and the wait between the first step and the second step was really frustrating," said Helson.