News of Angelina Jolie's prophylactic double mastectomy and breast reconstruction has many women wondering about their own risk and what they might do given the same diagnosis. But not every woman facing breast cancer has identical surgical options. Some women undergo lumpectomies (partial removal of breast tissue), bi-lateral mastectomies (loss of one breast), any of a number of breast reconstructions, or no breast reconstruction at all.
Jolie's surgery involved the insertion of expanders to hold breast implants. Not all women are good candidates for expanders. Their breasts might be rebuilt from skin taken from their stomachs or muscle moved from their backs. Healthy breasts will be lifted or augmented to match a reconstructed breast. Today's aesthetically familiar breast mounds can be created using techniques that result in very different scar sites on women's bodies.
After the operation, patients wear sturdy post-surgical bras with a place to attach drains. Additional procedures may still need to be done. Women often have faux nipples tattooed onto their newly-created breasts. It could be weeks, if not months, before a patient can wear a normal -looking bra.
Reconstructed breasts look perky and symmetrically perfect, but they have no feeling. They don't have the same bounce, making it easy to go braless, but more difficult to wear certain styles of lingerie. They are not simple cosmetic boob jobs. They often involve multiple surgeries and make some women feel as if they are carrying around water balloons on their chests.
Only 30% of mastectomy patients choose breast reconstruction. Since the average age of a woman diagnosed with breast cancer is 61, it could be that many don't want to deal with additional surgical risks. Those women can choose to wear silicone breast forms that will slip inside specially-pocketed bras. Anita, Amoena and Royce are some of the lingerie brands that cater to these women's needs. Others, like Marlies Dekkers, offer one or two-pocketed bras in their regular collections. There's even an Internet campaign petitioning Victoria's Secret to make a pocketed bra. But most women seek out the individual assistance of a well-trained lingerie retailer specializing in fitting post-surgical patients.
One other option for women is to choose a custom made breast prosthetic. These can be cast prior to surgery and are designed to replicate the lost breast in shape, feel and weight. They can also fill in sunken areas where tissue was removed during a lumpectomy. A custom silicone breast prosthetic fits a woman's unique body and scar site. Many insurance companies cover their cost, as they do surgical reconstructions, breast forms, and pocketed bras. Surprisingly, the breast is the only body part not covered by Medicare for replacement with a custom made prosthetic. There is an online petition to change this law, but it has received few signatures and legislation is stalled in Congress. Customized breast prosthetics would allow many women to continue to wear their familiar lingerie without having to buy either forms or special bras.
What do you think? Should women have more choices after mastectomies and lumpectomies? Should lingerie brands do more to help meet their needs?