WASHINGTON — Every year, more than 240,000 Americans will be diagnosed with breast cancer, according to the Centers for Disease Control and Prevention.
For anyone, a cancer diagnosis is a life-changing moment. For military beneficiaries within the National Capital Region, the John P. Murtha Cancer Center at Walter Reed National Military Medical Center serves as the focal-point of all cancer care.
Walter Reed Bethesda oncology surgeons perform on average 45 mastectomies and an additional 50 lumpectomies for cancer each year, according to Army Lt. Col. (Dr.) Lauren Turza, surgical oncologist at Murtha Breast Cancer Center.
Breast cancer survival rates at Murtha Cancer Center under the Clinical Breast Care Project-Walter Reed are better than national rates, according to retired Army Col. (Dr.) Craig D. Shriver, MCC director, the only Department of Defense Cancer Center of Excellence. This is partially due to significantly higher use of health care services within the military compared to their civilian counterparts, and the MCC team’s dedication to their patients, according to a recent MCC study.
The Murtha Breast Cancer Center success was recently highlighted when the National Accreditation Program for Breast Centers re-accredited the center, noting in their summary: “This is a superlative breast center, an incredibly well organized military based hospital with marriage of completely patient centered approach, top notch specialists, adherence to evidence based guidelines, combined with on-site breast cancer research center.”
Breast reconstruction is a vital part of breast cancer care in restoring a patient’s body to a natural, feminine form and giving patients a sense of normalcy after the grief of losing a breast to mastectomy or partial mastectomy, according to Navy Capt. (Dr.) Robert Howard.
In his nine years at Walter Reed Bethesda, Howard and his team have performed hundreds of plastic surgery procedures. Most of these have been reconstructive procedures, including trauma/wounded warrior limb salvage and restoration, peripheral nerve reconstruction and facial or extremity re-animation, congenital deformity repair (cleft lip and palate) and skin cancer reconstruction.
He also cares for approximately 40 new breast cancer patients each year, with the Plastic & Reconstructive Surgery Clinic seeing about 100 new patients per year on average.
“When patients choose breast reconstruction, they’re presented all the options,” explained Howard. “They have a long discussion with their surgeon about the pros and cons of each option. The vast majority of patients choose implant-based reconstruction using cohesive silicone gel implants. These implants are safe and have a natural shape and feel,” he said.
“Breast reconstruction surgery can begin at the time of mastectomy or lumpectomy, or it can be done months to years after mastectomy or lumpectomy,” continued Howard. “Plastic surgeons usually perform breast reconstruction in stages and patients may require more than one surgical procedure.” Whether implant or tissue based, reconstruction usually requires one major operative procedure and one or two minor procedures, he added.
The breast shape can be rebuilt with a number of techniques that include the use of implants or the use of tissue from somewhere else on the body (e.g. abdomen), or both. Breast reconstruction rebuilds the shape of the breast and nipple, but it does not restore breast sensation or function, explained Howard.
“We always work in a coordinated effort with oncologic surgeons before, during and after breast reconstruction,” Howard said. “During the initial mastectomy surgery, the oncologic surgeon and plastic surgeon both operate together. We both meet the patient beforehand, the oncologic surgeon starts and the plastic surgeon follows in the same room.”
However, not all patients opt to undergo breast reconstruction following a mastectomy or lumpectomy.
“About 40 percent of mastectomy patients do not request a plastic surgery consult for reconstruction, and there are a number of reasons why some women choose to live with a mastectomy defect,” explained Howard. “However, those that visit with a plastic surgeon usually go forward with an individualized plan for reconstruction and restoration.”
For those beneficiaries who opt to move forward, options include “implant-based breast reconstruction” or “autologous breast reconstruction,” which means using a patient’s own tissues to reconstruct the breast. According to Howard, the cutting edge procedures now being used are “pre-pectoral implant reconstruction,” and the “Deep Inferior Epigastric Perforator flap” autologous reconstruction. Most autologous reconstruction is “microvascular tissue transfer” or “free-flap” surgery.
During the actual breast reconstruction procedure, the surgical team normally consists of a staff plastic surgeon, a scrub tech, resident assists, anesthesia provider, circulating nurse and many times another staff plastic surgeon for the micro-surgical procedures.
“Recovery varies based on reconstructive technique, as well as any necessary adjuvant therapies to treat the cancer … which is the primary goal,” Howard continued. After two years, regardless of technique, more than 80 percent of women have noted their satisfaction with their reconstruction and the positive effects on their quality-of-life, he added.
According to Howard, many breast reconstruction patients feel a sense of normalcy — in clothes, in front of the mirror, in all facets of life.
“It helps them move forward beyond the trauma and grief of cancer,” he said.