This month, as the focus is on breast cancer awareness, we bring some stories which were published last year. This one is slightly different, as it explores medical options open to survivors who choose reconstructive surgery.
This article was published on October 30, 2022
For the past 15 years Dr Judy Ward has lent her expertise in reconstructive surgery. Today, she is the only Barbadian certified plastic surgeon in practice on the island. Ward performs all aspects of plastic and reconstructive surgery.
This comprises breast surgery including reconstruction, hand surgery, craniofacial reconstructive surgery, head and neck reconstructive surgery. She also provides services in burn management skin and soft tissue neoplasm, scar management and cosmetic surgery procedures.
However, it is in the area of breast reconstruction after cancer treatment that Ward wants to increase awareness. And she is fully qualified to do so.
A product of The St Michael School and the Barbados Community College (BCC), Ward studied medicine at the University of the West Indies Mona Campus, Jamaica from 1993 to 1996. She returned to Barbados to complete her clinical years from 1996 to 1998, followed by internship at the Queen Elizabeth Hospital (QEH).
She would later go on to the University of Toronto, Canada, where she spent five years. During the first two years she studied general surgery and the remaining three years were spent mastering the art of plastic and reconstructive surgery.
After completing her plastic surgery board examination which was given by the Royal College of Physicians and Surgeons of Canada in 2006, Ward spent a year at the Miami Children’s and South Miami hospitals where she further sub-specialised in craniofacial surgeries until her return to Barbados in 2007. She joined the team of surgeons at the QEH and shortly thereafter, opened her private practice which is now located at Pine View Medical Centre.
The board certified plastic surgeon pointed out that working with breast cancer survivors has been a major part of her practice.
Reconstruction breast surgery
She shared aspects of reconstruction breast surgery – an option that women sometimes chose after they have had a mastectomy (removal of the entire breast/s) or a lumpectomy (the removal of cancerous lump or other abnormal tissue from one’s breast/s).
Ward explained, “With the diagnosis of breast cancer there are two aspects of surgery. There is the surgery to eradicate the cancer which is performed by a general surgeon. The individual also has the option to have reconstructive surgery done on their breasts.”
She cautioned, “There are parameters to consider. We don’t ever want reconstructive surgery to interfere with cancer treatment. The cancer treatment must take priority and the reconstructive surgery should not delay this treatment.”
Ward further noted, “Sometimes immediate reconstructive surgery can be performed at the same time as the mastectomy or lumpectomy. And then there is delayed reconstructive breast surgery, which is done sometime after the mastectomy is performed, the patient has healed and has undergone all necessary adjunctive treatments (chemotherapy and/or radiation).”
According to Ward, there is no time limit on when an individual can have reconstructive surgery performed – even if it is years down the road.
Ward also stressed that many women opt not to have reconstructive breast surgery for varying reasons.
She shared, “Out of every ten women worldwide, only about two are likely to have reconstructive surgery. There are a number of deciding factors. You have to consider if they are a good candidate for reconstructive surgery – age, comorbidities, good chance of surviving after cancer and also if financially, they are able to have the surgery done.”
The good news for those who opt to have reconstructive breast surgery, is that insurance companies will cover a percentage of the cost. This type of coverage is consistent with insurance providers worldwide.
In explaining the procedures involved in performing reconstructive surgery, Ward disclosed, “Reconstructive surgery can be implant-based or tissue based. The implant-based surgery often requires two stages, and involves a tissue expander (a device) being placed under the chest muscle to stretch the muscle and skin in order to create the new breast pocket. The expander is later changed to the final implant.”
Ward further pointed out that there are also single stage procedures which require the insertion of additional tissue matrices to cover the implant. This, she said, is a less popular option.
The plastic surgeon noted, “The tissue-based reconstructive surgery utilises excess skin and fat usually from the lower abdomen, so patients get a two-for-one deal, with a tummy tuck and simultaneous breast reconstruction.”
If the patient has had a lumpectomy, surgery can be done to reshape the breast.
With any of the reconstructive procedures, surgery on the non-cancer side may be considered to achieve symmetry. Nipple reconstructive surgery can also be performed, where a tattoo is used to give colour to the nipple and the tissue is folded on itself to give projection.
Commencement of chemotherapy
Ward explained that it is ideal for women to be healed within six weeks of an immediate reconstruction to allow commencement of chemotherapy. Likewise, if a patient has completed chemotherapy there is a six-week interval before surgery can be performed.
Breast cancer survivors are usually referred to Ward by the general surgeon or oncologist.
She made it absolutely clear that reconstructive surgery did not delay any future diagnosis or detection if there is a recurrence of the breast cancer.
In addition, according to her, studies have shown that women who have had reconstructive breast surgery have better long-term cancer-free survival.
She made the point that this could have some bearing on their general psychological (mental) outlook.
And why would women opt to have reconstructive surgery?
According to Ward, “Some women say they want to have reconstructive surgery because of their lifestyles, their comfort in wearing clothes including low cut shirts or going to the beach, and to feel comfortable for sexual reasons.
“The truth is, reconstructive surgery makes women more confident. It makes a big difference,” Ward emphasised.
She disclosed that she tends to see younger patients – the vast majority in their thirties and forties but she has treated patients up to their mid– sixties.
Whatever decision women make after they have had a mastectomy or a lumpectomy, it is usually decided between them and their medical practitioners. Either way, Ward wants women to know their options and for them to do what is best for themselves in the long-term. (CH)