Many people know that October is Breast Cancer Awareness Month, but do you know what BRA Day is? BRA (Breast Reconstruction Awareness) Day is an initiative designed by the Plastic Surgery Educational Foundation (PSEF) to promote education, awareness, and access regarding post-mastectomy breast reconstruction. BRA Day USA aims to educate breast cancer patients about their breast reconstruction options in a safe and timely manner, by advocating that patients are made aware of their options at the time of diagnosis and are provided with access to a plastic surgeon if desired. BRA Day USA will take place on October 16, 2013.
As many people know, breast cancer remains the most common cancer among women in the United States, other than skin cancer, and it is the second leading cause of cancer death in women, after lung cancer. While mammography will detect 80-90% of breast cancers in women without symptoms, 1 in 8 women will still be diagnosed with breast cancer during her lifetime.¹ Surgery to treat breast cancer frequently alters the woman’s breast(s) significantly, and can severely impact her quality of life.
The team approach to breast cancer aims to bring together a multi-disciplinary group of medical professionals who will work together at all stages of a patient’s care, beginning from the time of diagnosis to help develop an individualized treatment plan for each patient. These professionals include the patient’s primary care physician and/or gynecologist, pathologist, plastic surgeon, breast surgeon, radiologist, and a medical oncologist. A key member of the team is the patient herself, who can be presented with all of her options and be able to make an informed decision regarding her care. As a plastic surgeon, my job is to ensure that the patient knows all of her options for reconstruction, even prior to the treatment of her breast cancer.
There are a number of plastic surgery techniques available for patients requiring breast reconstruction. These include the use of implants, the patient’s own tissue only, and the patient’s tissue combined with an implant. Despite this, less than 20% of American women who undergo mastectomy also choose to undergo breast reconstruction. Only 5% of women choose to undergo reconstruction at the same time as their mastectomy. In 2004, I performed a study with my colleagues at New York Presbyterian Hospital – Weill Cornell Medical Center on aesthetic satisfaction following breast reconstruction. We found that aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure was a significant variable only in unilateral reconstruction.² In any case, reconstruction of the breast is highly significant in that it represents a return to self and a sense of normalcy.
The type of breast reconstruction that a woman may undergo is determined by the patient and her surgeon, and is influenced by the patient’s anatomy and her prior and adjuvant treatment. If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts. Under the Federal Women’s Health and Cancer Rights Act of 1998, health insurance plans that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to produce a symmetrical appearance, breast prostheses, and treatment of physical complications at all stages of the mastectomy.
The first BRA Day USA was held in 2012 under the leadership of the American Society of Plastic Surgeons (ASPS), and there are now 18 countries participating in BRA Day. BRA Day USA aims to educate breast cancer patients about their breast reconstruction options in a safe and timely manner, by advocating for the rights of patients to be made aware of their options at the time of diagnosis,and to be provided access to a plastic surgeon to further discuss those options.
About the ASPS and the PSF
The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world. Founded in 1931, the society is composed of board-certified plastic surgeons that perform cosmetic and reconstructive surgery. The mission of ASPS is to advance quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. The Society advocates for patient safety, such as requiring its members to operate in accredited surgical facilities that have passed rigorous external review of equipment and staffing. ASPS works in concert with The Plastic Surgery Foundation (The PSF), founded in 1948, which supports research, international volunteer programs and visiting professor programs. The foundation’s mission is to improve the quality of life of patients through research and development. The PSF accomplishes its mission by providing invaluable support to the research of plastic surgery sciences through a variety of grant programs.
¹American Cancer Society
²Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Shaikh-Naidu N, Preminger BA, Rogers K, Messina P, Gayle LB. Ann Plast Surg 2004; 52(5): 465-470.
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