AFTER BREAST CANCER, A NEW APPROACH
More women are
choosing simultaneous
removal and replacement
during surgery
By JENNY DEAM
The words may not have been
completely unexpected, but
that did not soften the crash
when they finally came.
Last summer the phone woke Julie
Borgerding from a midday nap. The 33-
year-old Highlands Park mother of two
had been having trouble sleeping at
night in the weeks since she first found
the lump in her breast. There was a
quick mammogram, a technician's worried
face and then the biopsy.
It was the doctor's voice on the
phone, not the nurse’s. That is never a
good sign.
"Julie, you have cancer," the doctor
said.
It's funny how your mind processes
such information. Borgerding didn't cry
right away. That would come later. Her
first thoughts were how was she going
to tell her daughters. They were only 5
and 4. How could she explain the disease
racing inside her, the fear and tension
that would take hold of their
house, the loss of her hair that would
soon fall out in clumps until she shaved
her head completely, the operation that
would mutilate her chest?
Borgerding, a triathlete in supposedly
perfect health, kept thinking, "But
I'm too young." Breast cancer, she
thought, is an older woman's disease — something she later learned simply is
not true. Hers was a grade three tumor
that was growing rapidly. There was no
time to waste. She had watched her
mother battle ovarian cancer and go
through the devastating roller coaster
of remission and recurrence. Her mother
had already gone through three
courses of chemotherapy.
"I need to be as aggressive as possible,"
she and her husband decided.
Medical experts say for every year after
an initial diagnosis the risk of recurrence
goes up 1 percent. In other words, by the
time Borgerding was 53, she was facing
a 20-percent chance that the cancer
would come back in her healthy breast.
There was no real hesitation. She would
have both breasts removed, even though
only one was diseased.
She also made another decision —
one outside the way things are usually
done in the world of breast cancer and
reconstruction. Typically, women who
have breasts removed are given "expanders" to stretch the muscle and
skin before a breast implant is inserted
months later. During the interim there
are numerous doctor visits and treatments.
But Borgerding and a growing
number of women are choosing simultaneous
removal and full replacement
with implants without the need for a
second surgery.
"With breast cancer you deal with
so much loss," she says. "I went to
sleep with breasts and woke up with
breasts. It was one less thing I had to
worry about."
On Aug. 29, 2006, Dr. Joyce Moore
and plastic surgeon Dr. Lisa Hunsicker
worked as a tag team for six hours in
the same operating room. Moore
removed both of Borgerding's breasts
but left enough skin so that Dr.
Hunsicker could immediately insert two
silicone breast implants.
"You wake up done," explains Dr.
Hunsicker, one of a handful of plastic
surgeons around the country who is
skipping the intermediary step of
expanders and a second surgery. So far,
she has done about 50 such procedures
in the past few years. She got the idea while watching women go through months in limbo. "Why
wait?" she asked as she developed the procedure.
While not for everyone, especially women who might
want the same size or slightly larger breasts, the procedure
can work very well for others, says Dr. Christine Finlayson,
director of the University of Colorado Hospital's Breast
Center. And the psychological impact of emerging from a
mastectomy with breasts can be immeasurable.
"I wanted it done right then. After my diagnosis I just
cried and cried. Nothing could make it better," says Gina
Wilson, a 27-year-old Lander, Wyo., woman who underwent
the simultaneous procedure last year.
Certainly it is no quick fix for a difficult and serious medical
problem. Dr. Hunsicker cautions women she will have to
make the final call during surgery and might not be able to
do implants immediately. In those cases she will have to use
the more traditional expander method of reconstruction.
There is also some risk that if the woman needs radiation
as part of her cancer treatment, the radiation could harden
the silicone implants or even make it necessary to remove
them and start over.
Still, even with all the caveats, Dr. Hunsicker is surprised
by how quickly her patients embrace the option. "They are
so willing to gamble," she says.
Perhaps that simply fits into the bigger evolution of women
and health over the past generation. "Women today are not
the women of the past. Women in the past were treated like
such fragile daisies by their doctors," Dr. Hunsicker says.
Today's women, especially younger ones, are much more likely
to demand choices and to take charge of their own bodies. "It's very empowering," the plastic surgeon says.
Wilson's grandmother had a mastectomy 30 years ago. In
those days there was rarely reconstruction, and if there was,
it was a grueling process that many women skipped. So
when she arrived to take care of her granddaughter after her
surgery, the older woman was full of wistful wonder. "I wish
they'd had something like that when I went through this,"
she says.
Women who lose their breasts also lose their nipples.
They will have a scar roughly five inches across the center of
their breast. At a later date they can have nipples reconstructed
or have an areola tattooed on their new breasts.
Wilson joked she looked into the tattoo option but thought
they looked like pepperonis. Instead she chose a purple and
pink flower tattoo where her nipple used to be. "It makes me
feel pretty," she says, adding if it makes others uncomfortable,
she shrugs it off as their problem, not hers.
Borgerding has also found a new peace and strength she
never knew she possessed. "I feel like I have the wisdom of
a 65-year-old woman," the 35-year-old says. She tries not to
look too far down the road for herself but continues to
worry about her daughters, now 5 and 6. With their family
history, they will have to begin diligent mammograms in
their early 20s.
But she also hopes the experience has made them more
understanding and tolerant of those who look different. She
is most proud of the professional photo she had taken during
chemotherapy with her bald head and her two girls
snuggled next to her.
"One of my greatest fears is that they will have to go
through what I did," she says, "but who knows, maybe
there will be a vaccine or something. I can only hope if they
face it, it will be completely different.”
