By Alexander Zuriarrain, MD, FACS
In 2022, over 287,000 women will be diagnosed with invasive breast cancer, according to figures from the American Cancer Society. In fact, the chances that a woman in the United States will develop breast cancer over the course of her lifetime is 1 in 8. And because breast cancer is the No.1 reason for having a mastectomy, it doesn’t appear that this procedure will be going away anytime soon.
Many of these mastectomy patients will ultimately decide to then undergo breast reconstruction.
The point of this article is to emphasize that when a plastic surgeon has a patient in their office—whether discussing an immediate or a delayed breast reconstruction—the situation is complex. The patient will likely have a lot on their mind. Breast reconstruction is likely an emotional, even traumatic topic, and an empathetic response from a plastic surgeon is critical for the patient’s overall wellbeing.
For a reconstructive surgery to be successful, it needs to begin with a thoughtful conversation.
Setting Expectations for Surgery and Recovery
The simplest part of the conversation to prepare for is generally what the plastic surgeon is most comfortable discussing: the actual surgery.
Some patients will walk in having already done their own extensive research and with an idea of how they’d like to proceed. Others might not know anything more about reconstruction than what their breast surgeons have told them, which may have been very little. Neither situation is “right” or “better,” but plastic surgeons must be prepared for both. Indeed, most patients will be starting from somewhere in the middle, and the surgeon’s job is to meet them where they’re at.
Different surgeons may have slightly different opinions based on their own experience and expertise, and these will vary based on each patient’s circumstances. This is where a careful balance must be struck. Most patients want to know what their options are, but they don’t want to be overwhelmed.
Can I have reconstruction? When? Will it interfere with my treatment? What types of reconstruction are available? Will my breasts look the same? What are the risks? What’s the recovery time? How much will it cost?
These represent only a small sample of the immediate questions that can be expected. Most can easily lead to further questions. It can help to speak slowly, minimize the use of technical terms, and make natural eye contact. But how’s a plastic surgeon to know when their patient is feeling overloaded with information?
Simple. Ask them.
The Power of Silence
Plastic surgeons are people too, and people are notoriously uncomfortable with silence. But silence is one of the most powerful conversational tools available, and many surgeons will be surprised at what they discover when they start using it.
Consider this scenario: A surgeon tells a patient that reconstruction can be done either immediately after a mastectomy or sometime later. Now the natural tendency may be to follow this up with the details of each: differences in incisions and potential scarring, length of the procedures, effects on mobility, sensation, and cost.
Don’t. Start with a simple statement, like, “There’s pros and cons of each.” Then wait.
This does two things. First, it allows the patient a minute to process. The truth is that there’s always more to consider, and too much information in too short a time can cause psychological distress. Second, it allows the patient to guide the conversation. Remember that they have a lot on their mind, and they might be trying to figure out what questions are most important to them.
Maybe they respond with, “My child’s wedding is in a few months, and I want to look my best for the photos.” Not only does this open the door to discussing recovery times, range of motion, and even recovery clothing, but it gives an insight into the patient and humanizes them in a way that may have been otherwise missed.
Bedside Manner Matters
Being a proficient surgeon is necessary; that’s a given. But what really separates one surgeon from another is the relationships they form with their patients—aka, their bedside manner.
It’s part of a universal truth that applies not just to medical professionals, but throughout society. Empathy matters.
A mastectomy is not, as some have crudely framed it, a ticket for a free breast augmentation. It’s often a sudden and devastating necessity that comes with fear, grief, and a sense of loss. Breast reconstruction can be a part of those heavy emotions. Or it can be empowering, providing a way for the patient to reclaim a sense of control. It will probably be some of both. As surgeons, we have to keep in mind that what may seem like one of many routine consultations during the week is, to the patient, a life-changing conversation.
Plastic surgeons, like all medical professionals, must always remember not to treat the patient’s body, but to treat thepatient.