Breast reconstruction would make me feel whole again after cancer. Why have I been waiting nearly three years for surgery?

“I see breast reconstruction as something that would get me back to some sense of normality. I just want a sense of me again, to feel a bit more whole. I wake up in the morning and I immediately see a cancer survivor. I’m done with seeing that now.”

The effects of the Covid-19 pandemic are continuing to cause huge delays within cancer treatment, undoubtedly. When it comes to breast reconstruction, patients are usually offered an ‘immediate reconstruction’, which takes place at the same time as a mastectomy, or a ‘delayed reconstruction’ – when the reconstruction is undertaken at a later stage, usually determined by the type of reconstruction, by subsequent treatment, or by the patient’s preference.

Breast Cancer Now is calling on NHS England to develop a practical plan for breast reconstruction services to address the backlog, eliminate long waits by ensuring breast reconstruction is incorporated within the Referral to Treatment target of 18 weeks, along with removing barriers to ensure fair access to reconstruction.

Carlie-Ann acknowledges that the pandemic was an unprecedented time, but maintains that her situation could have been handled better, even just through communication. “Because I was rushed from diagnosis to surgery so quickly, pretty much nothing was spoken about [reconstruction] until after the surgery,” she says.

“I know obviously Covid had a massive effect on everything, and we didn’t know what was going to happen at that point. But I feel like we deserved a little bit more information, a little better care.”

She hopes that speaking out will raise awareness of breast reconstruction as a significant step in breast cancer recovery for many. “People tend to think once you’ve had cancer and you’ve had chemo and you’re looking better – that’s it. That’s the end of it. You’ve recovered and you’re fine. People don’t tend to think about the reconstruction. I think it should be definitely talked more about during recovery and  treatment. It shouldn’t be an afterthought.”

Breast reconstruction in the UK: what we need to know

GLAMOUR spoke to Sally Kum, Associate Director of Nursing and Health Information at Breast Cancer Now, to find out the facts about breast reconstruction surgery.

For those that choose it, why is reconstruction such an important part of breast cancer treatment?

“For women who choose breast reconstruction, we know it is a core component of their recovery – far from a solely aesthetic choice, this is the reconstruction of their body and indeed their identity after they have been unravelled by breast cancer treatment and surgery. 

“Through our Helpline and insight work, we hear of patients affected by delays to reconstruction surgery and the significant emotional impact this has on them, including altered body confidence, loss of self-esteem and identity, anxiety and depression, and hindering their ability to move forward with their lives, knowing their treatment is incomplete.

“This is why we’re so deeply concerned at our research revealing that women are too often being denied vital access to the type of breast reconstruction that is right for them and equally critically at the right time.”

What is there to think about when considering breast reconstruction options?

“Most women who have had a mastectomy, and some who have had breast-conserving surgery, can have either immediate or delayed breast reconstruction. National guidance says the choice of immediate breast reconstruction should be discussed with anyone having a mastectomy. However, a delayed reconstruction may be a better option for some people. All suitable breast reconstruction options should be offered and discussed, even if they are not available locally. Some people are advised not to have a breast reconstruction because of other existing medical conditions that might increase the risk of complications following surgery.”

How can patients empower themselves in this conversation?

“Patients should be supported and empowered in making choices about which type of breast reconstruction is right for them. The conversation between a woman considering reconstruction and her treatment team should be open and honest ensuring the patients support and information needs are met. The surgeon and nurse should assess that the patient fully understands the reconstruction process, relevant different choices, and have realistic expectations of how the reconstructed breast will look and feel.”

What are the different types of reconstruction available?

There are three main types of breast reconstruction:

 • reconstruction using only a breast implant 

• reconstruction using your own tissue (a tissue flap), which can be taken from a number of places in the body (the most common being the back or the lower part of the abdomen)

 • reconstruction using a combination of tissue and an implant

What can people experiencing delays do?

“For those who choose it, breast reconstruction is a vital part of treatment and recovery from breast cancer. However, concerningly, we know that too often, this access and choice is being denied – making it harder for people to rebuild their lives.

“We encourage women to discuss their surgery and reconstruction options with their treatment team and they can also speak to our expert nurses by calling Breast Cancer Now’s free Helpline.

“Our website has information and support available too about breast reconstruction and how to discuss breast reconstruction with your surgeon, or you can call 0808 800 6000.”