Still beautiful after all these tears

Everything was looking up.

That’s how Kristi Teske felt. She was 30, happily married, and the mother to two adorable children. It was like turning the pages of a storybook life with her husband Brad.

Until three years ago, when the energetic Clermont resident discovered a lump in her breast.

“It was a lot of anger and a lot of fear,” Kristi says. “I was diagnosed on Feb. 11 and my mastectomy was March 4. It seems like an eternity when you fi nd something in your body that’s not supposed to be there.”

The doctor’s view:

Breast cancer is devastating not just because of the real possibility of death but as much — and sometimes more so — because of the disfigurement that typically accompanies treatment of breast cancer even when that treatment is successful.

Disfigurement, Kristi could accept. Dying, she could not.

After extensive research, Kristi chose the most drastic option — a full mastectomy, followed by chemotherapy and radiation, if needed.

“One out of four women diagnosed with breast cancer run a risk of recurrence,” Kristi said. “I chose the most aggressive approach because I’m young and my children were young.”

The doctor’s view:

Breast Reconstruction Awareness Day is Oct. 15. And that’s a good reason to pause and realize we’ve come a long way from the traditional Halstead radical mastectomy, in which all the breast, much of the skin, all of the lymph nodes in the armpit, and even the muscle of the chest wall were removed.

Radical is right. This procedure cured many women. But it was hideously disfiguring and produced many breast cripples: women with painful, unstable scars, and severe, chronic swelling of their arms.

When I trained in surgery, we had largely gotten away from the radical procedures and were doing a more conservative, “modified” radical mastectomy with less skin removal, no muscle removal, and a less radical clearing of the lymph glands in the armpit. The incidence of complications and long-term problems plummeted, but did not disappear. This led to a search for “breast-conserving” treatments.

The most popular option has been removal of just the cancerous lump in the affected breast and removal of the lymph nodes in the armpit, followed by radiation to the breast.

Breast conservation options didn’t change much until recently, with the advent of the SAVI: a way of placing the radiation right into the space in the breast where the cancer was. SAVI has some of the same problems that external radiation does except it’s more intense and confi ned to a smaller area. True “breast conservation” still has a long way to go.

Kristi considered going through life with one breast. She chose breast reconstruction for the sake of her children.

“I didn’t want them asking, ‘Why isn’t mommy the same as other women?’” Kristi said.

The doctor’s view:

Many physicians, unfortunately, downplay the importance of reconstruction, especially for older women, reasoning they won’t be so traumatized by loss of their breast(s); insurance companies reimburse so poorly for the surgery that many plastic surgeons simply cannot justify tackling such a technically demanding, time-intensive undertaking.

But studies have shown that women who successfully undergo breast reconstruction rapidly come to see themselves as essentially whole again in contrast to those who do not have reconstruction.

When reconstruction is decided on, there are many options. It can be started at the same time as the cancer surgery is done, with the general surgeon and plastic surgeon working closely together. This is known as immediate reconstruction. Reconstruction can also be delayed to begin any time after the cancer surgery.

Kristi waited a year after her surgeon placed an expander in her chest cavity to prepare the area for a new breast.

“The expand- ers push the muscles back and make sure the skin is ready for surgery,” Kristi said.

The tissue expander under her chest muscle effectively prepared the area for Kristi’s new breast. A saltwater solution periodically injected through a tiny valve mechanism inside the expander created a space slightly larger than the other breast.

The doctor’s view:

Reconstruction can be done using breast implants, the patient’s own tissue, or a combination of both. Each can produce good to excellent results.

Kristi is a believer. “Reconstruction was a piece of cake,” she says.

“The next day I took the kids to Disney.”

The doctor’s view:

Many factors must be considered in determining which technique will be most appropriate for a given patient — age, medical status, weight, whether one or two breasts will be removed, whether chemotherapy and/ or radiation therapy will come into play, and more.

Any discussion of breast reconstruction is incomplete without covering the limitations and risks. No operation is free of risks. A surgeon can guarantee only his or her best effort. The reconstructed breast(s) will have scars and may not be perfectly shaped or symmetrical. They will not have the normal sensitivity of a natural breast. Failure of the reconstructive effort, and even potentially life-threatening complications, must be understood as small, but real, possibilities.

Beating breast cancer is great. Beating breast cancer and coming out on the other side with two breasts is icing on the cake.

It is important — no, critical — to keep sight of the most important thing: The goal of breast cancer treatment is to cure the patient. All other considerations are secondary.

“I’m cancer-free,” Kristi says. “You always fear where and when cancer might recur. There were tears.

“Today there are no tears. I’m too busy. I focus on living, not surviving.”