Breast cancer survivorship videos

Breast reconstruction

The decision to go through breast reconstruction is personal. In this video we discuss the collaboration involved in reconstruction and how personalized decisions early in your treatment can allow for the best result.

[MUSIC PLAYING] The decision to proceed with breast reconstruction is a highly personal one. The biggest advances in breast reconstruction have not come from techniques, but it's come from the fact that breast reconstruction is now part of the initial evaluation of the patient.

Not all patients choose to do their reconstruction at the time of their surgical care of the breast cancer, but very often it can be a very effective part of the overall treatment.

With the advent of breast centers like the Piper Breast Center, collaborating amongst the physicians-- the various different modalities-- is the reason we can get a different result-- not only in the effectiveness of the cure of the breast cancer, but actually in the effectiveness of the long term outcome of the physical results of the breast cancer.

Our breast reconstruction results are now significantly improved because we are part of the initial evaluation, whether or not we start our surgeries at the beginning. By making unique decisions that are individualized towards every patient, we can come up with a more individualized approach and individualized result.

In a way, breast reconstruction is about survivorship. It's about life after cancer. It's about trying to get to that place where there's a lack of awareness of the breast cancer-- where it's a part of your past, and not a part of your future. And by being involved in the beginning, we can help the other members of the team make decisions that help make that much more feasible and help create a form, and function, and sense of proportion that allows a patient to get to that end point.

In the early days of breast reconstruction, patients would go through their care, and when they got to a place where they felt that the disease was under control, it was then deemed reasonable to go consider breast reconstruction. At that point, many of the decisions were already made about the soft tissues, and some of the important landmarks of the breast were already sacrificed. So recreating them became much more difficult.

As we can get involved earlier and earlier, we can make a personalized decision for you, the patient, that allows for the best result without interfering with the important things which are, again, effectively treating the cancer and making sure that we don't create a functional problem.

So along the way, our other colleagues began to learn that because we are effective at treating breast cancer, survivorship is important. How a patient feels, looks, and presents themselves to the world after treatment is as important as being effective in treating the cancer in the first place. In a way, it's giving empowerment to you so that you're not a victim of breast cancer, but that it's a part of your past and not a part of your future.

Breast reconstruction obviously is not the most important thing at the initial point of diagnosis. And the patient should never feel pressured or obligated to consider reconstruction. And in general, we can use the same techniques on an immediate basis that we could do in a delayed fashion.

So if the enormity of understanding the impact of breast cancer is so much that it's difficult for you to understand the choices of reconstruction, those choices can be delayed. And we can, in general, use those same techniques sometime in the future.

There is some data to suggest that patients that undergo reconstruction do have a positive outlook, and do have-- they certainly don't hamper their ability to achieve long term cure. And so we know that breast reconstruction doesn't interfere with the treatment.

But it's important also to note that when you look at satisfaction after breast reconstruction, and if you define satisfaction as the lack of awareness of the mastectomy, the effectiveness of getting to that end point is the same whether you do immediate or delayed reconstruction in general. No matter what the choices are, you can get to that same place.

So it is a very individual decision. And it really is important to hear that at the beginning, because sometimes that allows a patient to put it off to the side knowing that it's still available. And sometimes it allows a patient to proceed as part of the initial treatment. And each of those is an empowering situation.

In any consultation with a plastic surgeon about breast reconstruction, we have to be really clear to make sure we send you a message that says, our goal is not to replace your breasts. We cannot make a normal breast. But we can get you to a place where our goal is to achieve size, position, and shape symmetry, and a proportion that allows it to become your breast-- to become a part of you and not something that's fixed to you.

It's important to note that there are patients who choose not to have immediate reconstruction. And the simplest form of reconstruction is to wear something externally in your clothing, in your bra. That can be very effective for some patients, and it can be just as important and intimate, and, in actuality, there are no complications from doing that type of a reconstruction. That is a reconstruction.

So if we're going to embark on a surgical reconstruction, we have to at least be able to achieve the success that we could have with an external prosthesis. As you go through the process of determining how to get to that place, we often have to consider how will we alter the opposite breast? What types of procedures are necessary to try to recreate some of the nuances of texture, of slope, of size, of shape? All of that goes into the decision-making process of how do you pick a technique that can help a patient get to that point. And by looking at you, the patient, we come up with that individualized plan.

There is no one recipe to this. And it is often quite valuable to get a number of opinions, because we all have-- as surgeons-- have our biases how to get to that place. But the choices are not to create a different endpoint.

So there may be many paths, but the end point is the same. And the end point is not the picture. The end point is the patient saying they're glad they went through reconstruction because they have a lack of awareness of breast cancer. They don't think about their breasts because that's the way they were before they were diagnosed.

There's a plethora of information that's available about breast reconstruction. That has been an incredible service to patients. There's some great resources. There's a website by the American Society of Plastic Surgeons at that has a wonderful description of a lot of these procedures.

Because of that, and because of that very honest approach talking about complications, talking about expectations, talking about what we can't achieve, patients can be much better prepared when they want to consider breast reconstruction. The information is there. It's available. It needs to be shared.

There's a disturbing statistic that says that about 30% of patients actually are aware of their reconstructive options when they're diagnosed in this country. That number should be 100%. It does not mean that every patient needs to undergo breast reconstruction. It means that every patient should be aware.

With the internet, with the ability to easily transfer knowledge, if you're in a small town in out-state America, this should be something that you have access to. It doesn't necessarily mean that the surgery can be immediately available, but that the consideration of the surgery should be there. That knowledge should be there just like the knowledge of what are the chemotherapy agents, what are the surgical options.

Most patients at the beginning will be worried more about the cancer and saying, I know I want reconstruction, but it doesn't have to be perfect. I know a patient is at the right place in terms of their head being in the right place and being cured of breast cancer when a year from there, they're worried about a little scar or a little contour deformity. Because then it's really about the art. It's really about the shape of the breast and they're not worried about cancer.

In breast reconstruction, we follow patients forever. Because gravity is forever. Because life is forever. And there are changes that go on forever. So we often have to change the breast to continue to create a symmetry.

That's the wonderful part of this. Because I usually tell patients, I meet you in the middle of a crisis. And I really get to know you a year from then and the rest of your life.

An important logistical consideration is that from an insurance point of view, anything that I have to do to create symmetry, or maintain symmetry in the future because of changes, is mandated to be covered by law. In general, everything that I have to do is covered by the insurance process. And so we really can try to push the envelope.

Very often I see patients that are five and 10 years out, and as our techniques have changed and we've developed new things like fat grafting and some very innovative things to help continue to raise the bar for our results, patients that I've taken care of a long time ago now can have their result improved over time because our techniques have improved. And that's quite an empowering thing to be able to offer patients.

And the relationship that develops between the plastic surgeon and the patient is such a privileged one that I like to say you graduate from everybody else on the team, but you never graduate from the plastic surgeon.

Care coordination

Cancer care coordinators are an integral part of a person's cancer care at Allina Health. Here we explore the many ways these individuals provide guidance and assistance throughout the journey.

The cancer care coordinators at Allina Health are here to ensure that patients are getting the right tests done at the right time, that they're having the right care delivered at the right time. And they do this by virtue of having relationships with the patients. They also work with our specialists very closely.

So like the lung cancer specialist, the breast cancer specialists, to really make sure that if a patient needs a test prior to seeing one of our surgeons, that those tests are done. They take a lot of that uncertainty out of that technical side of care for our patients.

The cancer care coordinators follow patients through the entire journey of care. Ideally, they'll meet a patient soon after a patient knows that they have cancer to begin to put the pieces of the puzzle together to figure out what are we going to do and what are the next steps.

And then as the patient gets into their treatment, the cancer care coordinator will tailor the relationship to what the patient needs. So if a patient needs the coordinator to attend maybe that first visit with a medical oncologist because that's a complicated appointment.

They talk about a lot of different treatment options and what that means to the patient, the coordinator will go with and sit and take notes and then meet with the patient afterwards to talk about what did we just hear and what questions do you have detailed to your treatment plan.

It's one thing as a healthy person to navigate you're going to see your primary care and making an appointment and doing all of that. But when you're diagnosed with a condition and an illness as complicated as cancer can be, you're now meeting with multiple specialists.

You might need to meet with a surgeon, or radiation oncologist, an oncologist, genetics, a nutritionist, a psychologist, depending. I mean, cancer rehab is another critical component of our cancer program here and that's a lot. It's a lot to digest. It's a lot to keep track of. It's a lot to even know who to see and when to see them and all of those sort of things.

And so the cancer care coordinator is critical and sort of being that thread that we have the whole journey together for a patient. The other thing that can be complicated in a system as large as Allina is that we've got specialists that practice within our facilities and specialists that practice in the independent practices.

And our coordinators can actually go to visit the independent offices with the patients to, again, just be a partner with them throughout that entire care journey.

Usually the coordinators will see that patients in the hospital. So if a patient needs to go into the hospital for a surgery related to their cancer, the coordinator will oftentimes visit the patient while they're staying in the hospital to make sure that everything is going as expected, to answer any questions that they may have.

Sometimes pathology reports come back when patients are in the hospital and there's often questions that go along with that. And the coordinator can help the patient to understand what does their pathology report mean, what does this mean again to those next steps in my care, and how are we going to approach this.

After the patient goes home from the hospital, the coordinator oftentimes call the patient one or two days after leaving the hospital to just ensure that everything is going well once the patient gets home. And just check in with them to see how they're feeling and see what other questions they might have about their care.

The cancer care coordinators think about the whole patient, so yes they have expertise in their clinical area of competence, like breast cancer, lung cancer, cancer in general. But we know that cancer affects more than the physical part of a patient.

Going through treatment for cancer might mean you're not at work as much as you were before being diagnosed. And that oftentimes can cause financial stress and other things that impact just generally a patient's quality of life.

And so the cancer care coordinators actually do assess patients. They check in with them to see, not how are you doing just physically, but how are you doing emotionally. How are you doing with finances? Are there any areas that you need assistance with? And once they do those comprehensive assessments, again, throughout their care journey because those needs will change as a patient goes along, they'll get them access to the resources and the services that they need at the time.

So it's really getting patients the right care at the right time on their entire care journey. One of the unique things about the cancer care program at Alline Health is that we have cancer care coordinators across our entire health system.

And so a patient can find out that they have cancer up in Cambridge, Buffalo, New Ulm, United Hospital Area, Abbott Northwestern, and there's a cancer care coordinator there to meet, to partner with them and to help them process what's happening to them.

Sometimes at some of our regional locations they can't provide all of the care that a patient needs. And so they may need to come to Abbott Northwestern or the United Hospital or Mercy or Unity, if there's maybe a specific procedure that needs to happen. And the wonderful thing is that the cancer care coordinators in our regional areas know our cancer care coordinators that are specific to programs in our metros.

And so the patient has the seamless care feeling of coordinator to coordinator with a patient being held that entire care journey. And sometimes it can be frightening to have to leave your home to receive care somewhere else. Maybe you've never been to Minneapolis. Maybe you've never been to St. Paul.

But the thing that we can do through our program is to ensure that you feel well connected. So when you do get here, there's a coordinator that knows your coordinator up at your regional or local facility that can really, again, continue that partnership while you're here.

And then when you're ready to go back, they have that same connection back to your regional coordinator so there's never a gap in care. You're always taken care of, even if your own coordinator can't be physically with you.

Yeah. I mean this is a lifetime relationship. I mean, once you've been diagnosed with cancer, the minute you're diagnosed, I mean, you are in a network of people that care deeply about you. Our cancer care coordinators run support groups. And so that's an opportunity to stay connected not only with the cancer care coordinators but also other people that are going through a similar situation throughout their entire, again, into survivorship.

Our coordinators are always a phone call away. So whether a year has passed or two years have passed, they're a phone call away. And they'll be here to help if something changes, if a question comes up, if patients want to know something about maybe their past history or something changes in their current life that they just need to connect with.

Or sometimes what we see is after treatment is all done, you're kind of going along, going along, fighting the cancer. And maybe you're a patient that you're done with chemo, and you're done with everything. Then that becomes a time of reflection. And so that's also a time where our coordinators can really step in and help people process everything that just happened to them for the last six months to the last year.