It’s BRA Day! Yes, you read that right. While much of October is focused on raising awareness around research and education for patients or families at risk for breast cancer, today is the day we pause to promote education, awareness, and access regarding post-mastectomy breast reconstruction. Breast Reconstruction Awareness Day is collaboration between the American Society of Plastic Surgeons, The Plastic Surgery Foundation, breast centers, nurse navigators, corporate partners, and breast cancer support groups.
It was created in 2011 as a day to raise awareness about the different types of breast reconstruction options for women who have or are going to have a mastectomy. Throughout the day today, Penn Medicine’s division of Plastic Surgery is hosting a BRA donation table to collect gently used, unwanted bras for Philadelphia-area breast cancer survivors and women transitioning from domestic violence situations. This evening faculty and staff from the division will host a special celebratory and educational event on closing the loop on breast cancer, with remarks by Joseph Serletti, MD, FACS, chief of the division of Plastic Surgery.
Over the last 30 years, breast reconstruction has become widely considered a significant part of the treatment and recovery process for breast cancer patients. In 1998, this was underscored by the passing of the Women’s Health and Cancer Rights Act that mandated insurance plans provide breast cancer patients with coverage for reconstructive surgery and other benefits related to a mastectomy.
“There’s the diagnosis of cancer, and then there is the incredibly traumatic thought of having to lose a breast, and that has both [a] physical component and obviously a very strong emotional component,” Serletti said. “If we can get the patient through her treatment of breast cancer and at the same time reconstruct her breast, it will have a very, very profound effect on her overall recovery.”
Though some brands have made strides in helping patients post-mastectomy, and now offer special bras, bathing suits, and lingerie for these women, without reconstruction, Serletti notes that it’s very difficult to find clothes that fit correctly, which leads to trouble moving and performing daily activities.
Also, while companies and non-profit organizations work to raise awareness around the importance of reconstruction, and research makes strides toward improving surgical options for these women, a significant disparity with respect to race and ethnicity persists. In fact, numerous studies have identified substantial differences in breast reconstruction rates along racial and ethnic lines with approximately 50 percent of Caucasian women receiving reconstruction, while only 30 percent of African-American and Latina women undergo reconstruction.
More than a decade ago, a 2004 study showed that African-American women were less likely than Caucasian women to be offered referrals to plastic surgeons, less likely offered reconstruction by plastic surgeons, and less likely to elect reconstruction even if it was offered. The statistics still hold true today, though some states, such as New York, now require that breast cancer patients have a referral to a plastic surgeon for reconstruction. A more recent study
found that African-American patients reported more likely to be discouraged by their physician to seek out breast reconstruction.
Over the years, there has been a lot of speculation as to why this disparity exists and many suggest it is physician referral patterns or bias, socioeconomic status, patient knowledge about reconstruction options, and patients’ cultural preference. Others suggest the increased risk for comorbidities among African-American patients may be the cause of decreased rates of reconstruction.
However, earlier this year, Paris Butler, MD, a resident in the division of Plastic Surgery at Penn Medicine, led a research team in the first study to assess the outcomes of autologous (or “free flap”) breast reconstruction – where the patient’s own tissue, usually from the abdomen, is used to create the reconstructed breast – according to race. Butler’s team hoped to address and dispel misconceptions that these procedures are unsafe or ineffective in the African-American patient population, despite the populations increased risk of comorbidities.
The study, published in the American Journal of Surgery in April, included more than 800 patients who had undergone the procedure. Though results showed that African-American patients had a greater number of comorbidities including hypertension, anemia and obesity – they did not have a significantly greater risk of surgical or medical complications after reconstruction compared with Caucasian patients. More specifically, according to race, African-American patients were no more likely than their Caucasian counterparts to experience complications of reconstruction including venous thrombosis (i.e., blood clots), breast flap loss, abdominal hernia, or delayed wound healing.
“Prior research has alluded to a major contributing factor being the lack of consistent referral of African-American breast cancer patients to plastic surgeons by their breast oncologists, presumably out of concern for pre-existing comorbidities and suboptimal health status,” explained Butler. “However, the results of our study show that despite an increase in risk factors, African-American patients have equivalent outcomes to the majority population when it comes to autologous free flap breast reconstruction.”
Considering recent findings suggesting that a documented discussion between a physician and the patient about breast reconstruction is the single greatest predictor of whether a patient will actually undergo reconstruction, Butler says the new research could be beneficial in further educating and reassuring African-American breast cancer patients and their providers of the safe and effective option of autologous tissue transfer for breast reconstruction.