Personal Journeys

• By Sharon Steinhoff-Smith, Neal Megonnell
• Jun 01, 2004

Today, breast-conserving surgery (BCS) is the treatment of choice for breast cancer instead of mastectomy.

Everyone is touched in some way by breast cancer. Most people know someone's mother, sister, spouse, daughter, close friend or acquaintance with breast cancer. Women facing breast cancer today embark on a personal journey to wellness and a return to normality. The National Cancer Institute estimates that one in eight women will develop breast cancer in the United States. Statistics from the American Cancer Society predict an estimated 215,990 cases of invasive breast cancer to occur in women in the United States this year. The National Breast Cancer Coalition estimates that in the United States there are 3 million women living with breast cancer and only 2 million women have been diagnosed.

A woman with breast cancer will be confronted by many new medical terms that she may or may not be familiar with such as chemotherapy, mastectomy, breast conserving surgery, radiation therapy, hormone replacement therapy and many others. Determining the appropriate surgery and treatment options can be overwhelming at the time of diagnosis. First instinct for most women is just survival. Am I going to live?

Women who opt to undergo breast conserving surgery or reconstruction surgery generally do not have a good grasp of what the cosmetic outcome will be. Most have not grasped that breast symmetry could continue to be a challenge for them either immediately after surgery, or a few years down the road post treatment. At the time of their surgery, it does not occur to them, that their breasts may not age symmetrically, that the good cosmetic outcome of the reconstruction will not remain the same over time, or that additional surgery may be required to maintain symmetry. These issues are difficult to conceive of and face until you are confronted with them.

Today, breast-conserving surgery (BCS) is the treatment of choice for breast cancer instead of mastectomy. BCS comprises more than 50 percent of all new surgeries for breast cancer in the United States. Women who opt for BCS will generally undergo radiation therapy as part of their treatment. Some women who have mastectomy surgery also choose reconstruction surgery. Common reconstructive procedures include transverse rectus abdominis muscle flap also called a TRAM flap and implant surgery. Reconstruction can be performed at the same time as the mastectomy or later, after a woman has completed her treatment. Often, women will require surgery on the unaffected breast to adjust symmetry.

Women undergoing BCS will be left with breast deformities that vary greatly depending on the type of resection, radiation therapy, tumor location, breast size and shape. Breast asymmetry may occur immediately after surgery or treatment (breast shrinkage after radiation therapy) or several years later as the body ages naturally or weight is gained or lost. In many cases, the breast that was not operated on changes shape or size over time more than the breast that was operated on. This can happen because over time breast tissue naturally tends to become less dense. Due to the removal of tissue and radiation, density of the breast that was operated on is different and therefore does not age the same, which results in asymmetry. Breast asymmetry also can occur with breast reconstruction. Like breast conserving surgery, many women find that the reconstructed breast does not change as much over time as their natural breast.

Many women are not aware that these changes can occur over time. They are no longer being treated and often do not have a good information resource to ask for advice. Many of these women try to get by and make due with shoulder pads or enhancer products. Many patients do not know there are external silicone products that are designed specifically to help them regain lost symmetry.

Based on body image after breast cancer surgery research conducted in June 2002, women with breast asymmetry often compromise their choice of clothing and activities. Women often do things subconsciously, not even realizing they have changed what they are wearing.

Some take to wearing baggy shirts and others routinely wear sports bras to flatten the breast shape. Some women are so uncomfortable in a swimsuit, they will no longer go to the beach or participate in swimming. Creative solutions such as foam shoulder pads, push-up pads and wadded up tissue are common. Partial symmetry shapers have been around for many years, however, women who could benefit from these products are often not aware that they exist. In addition, since the asymmetry is a result of their breast cancer surgery, insurance companies often provide coverage. Many products like symmetry shapers can help women restore symmetry and feel confident about the way they look again. Partial shapers work by filling in the missing tissue. Partial shapers are the ideal product when:

plastic surgery is not an option because of irradiated skin.

it is the expander phase of implant reconstruction surgery.

adjustment is needed for weight gain or loss.

you need to offset the imbalance that results from the natural aging process.

used as an alternative to multiple surgeries.

used to even out naturally uneven breasts.

Symmetry shapers are generally offered in three styles: full, top and bottom. Full shapers give overall breast coverage for larger lumpectomies and reconstruction imbalance. These products add even fullness over the entire breast area. They can be rotated in the bra for optimum coverage as needed. Partial shapers, top and bottom, provide partial coverage for smaller lumpectomies and slight reconstruction imbalances. They also can be rotated to accommodate missing breast tissue or any deformities in the breast. Partial shapers are ideal for women who do not want the nipple and areola covered but still need to fill in a tissue deficiency.

High quality symmetry shapers are made of a weighted soft silicone enclosed in a polyurethane film covering that has a realistic feel and texture very similar to natural breast tissue. Look for varying colors to meet the needs of different skin tones and ethnic groups. Symmetry shapers are currently available in a variety of different styles providing a wide selection and size range to meet the needs of most women. They are hollowed out in the back to provide coverage over the existing breast and thin edges to transition smoothly to the skin so they are not noticeable under the bra. Some symmetry shapers can be adhered using the water-soluble roll-on adhesives.

Prosthetic nipples that can be used by women in place of further reconstruction surgery or nipple tattooing are also available. They come in pairs, are made of silicone and come with a small bottle of water-soluble adhesive. Nipples can be attached safely directly to the skin of the breast or to most symmetry enhancer products.

New on the horizon are attachable products that are now in product trials at Amoena. These products attach directly to the skin and stay in place. This allows a woman to wear a regular fashion bra and not worry that the shaper will shift in their bra. Early previews of this product to health care professionals at the Oncology Nursing Society national conference and American Society of Plastic Surgery Nursing national conference resulted in positive feedback.

It is evident that women who undergo BCS or reconstruction are looking for femininity and normality in their everyday lives. Asymmetry can hinder a woman's return to her life before surgery. Symmetry shapers offer a solution and can prove to be a valuable revenue stream to your business if you reach your target market. Educating health care professionals that the body image issues they address with mastectomy patients also exist with many BCS and reconstruction patients is key. Women need to know that their needs are likely to change over time as their body naturally ages and as many choices become available to them. With the proper knowledge, women will no longer have to make up solutions.

Today, women take charge of their lives. They eat right, exercise and focus themselves to maintain health and balance in their daily lives. Particularly after breast surgery, maintaining a positive body image is essential. It is important for you to equip women with knowledge about symmetry shapers while you have a strong communication channel through their health care provider. It will help them in knowing how to maintain their positive body image for many years to come and will help you grow your business.

This article originally appeared in the June 2004 issue of HME Business.