Due to advances in the diagnosis and treatment of breast cancer, there are more than 2.8 million breast cancer survivors living in the United States today, according to the American Cancer Society.

But survival at what cost? Susan Love, MD, president and medical director of the Dr. Susan Love Research Foundation and author of several books, including Dr. Susan Love’s Breast Book, and others are trying to get a better handle on the unavoidable “collateral damage” that results from current breast cancer treatment options. Some of this is physical, such as chemo brain, early menopause, or lymphedema, and some is emotional and related to the change in self-esteem that can follow a cancer diagnosis. The Collateral Damage project, an initiative started in 2013 by Love’s Foundation, aims to help survivors identify ways to better prepare for and cope with collateral damage after breast cancer treatment.

Plastic and reconstructive surgeons can, and should, play a role in helping breast cancer patients understand the pros and cons of available breast reconstruction methods as well as their potential long-term effects.

Help The Cause

Direct breast reconstruction patients to Dr. Susan Love Research Foundation’s ongoing Health of Women [HOW] Study.

Answers to study questions will be used to develop a questionnaire to document the collateral damage of treatment.

“We do have to be very aware of the collateral damage that we can cause with our choice of reconstructive method,” says Susan Downey, MD, a plastic surgeon in Los Angeles.

For example, breast implants require less invasive surgery than flap procedures, but the results may look and feel less natural. “The risks, benefits, alternatives of immediate/delayed/autologous versus implant reconstruction are complex, says Jane Petro, MD, a plastic surgeon in Boston. “Evidence supports free flap over other choices with a huge up front commitment of operating room time and recovery with a considerable long-term advantage in satisfaction and reduced reoperations,” she says.

“We tend to focus on collateral damage from surgery, but “breast-conserving” treatment with radiation can leave deformities that have few good options for correction,” points out Seattle plastic surgeon Richard Baxter, MD. “So part of minimizing collateral damage is to have good information about treatment options before deciding. Consulting with a plastic surgeon at the beginning can be helpful in that regard.”

Breast cancer patients are understandably overwhelmed, anxious, and afraid, says Gary D. Breslow, MD, FACS, medical director of The Breslow Center For Plastic Surgery in Paramus NJ. “They are generally very concerned about what the reconstruction will look like and feel like, and how that will affect their self-image,” he says. “The great news is that, unlike years back when breast cancer surgery left patients with large, unsightly defects, there are now so many great options for reconstruction—many patients will actually look better after their reconstruction than they did before they had their mastectomy or lumpectomy,” Breslow says. “And the majority of those that don’t look ‘better’ still look very nice to the point that patients satisfaction is extremely high.”

Downey calls this “finding the silver lining”—ie, “reconstructed breast which actually are ‘better’ (smaller, lifted, larger) than the original breasts,” she says.