When Sarah Sharpe was diagnosed with stage 3 breast cancer in 2020, she was immediately faced with a critical decision regarding breast reconstruction. Due to the size of her tumor, preserving her breast was not an option, and her surgeons urged her to decide on reconstruction almost as soon as she began treatment.
“The decision came in the midst of chemotherapy and the panic of diagnosis, making it incredibly emotional and challenging,” Sharpe told ABC RN’s Life Matters.
Sharpe’s experience is not an isolated case. Among the 21,000 Australians diagnosed with breast cancer annually, approximately 40 percent will require a mastectomy, the surgical removal of one or both breasts. Many patients feel pressured to make quick decisions about reconstruction.
Vicki Durston, Director of Policy Advocacy and Support Services at the Breast Cancer Network Australia, highlights the urgency faced by many patients. “Patients are often told that surgery must be done quickly, but they need time to make an informed decision,” she says.
Sharpe, who opted for implant reconstruction to facilitate a quicker recovery and return to her active lifestyle, feels she was not fully informed about all available options. She recalls that “remaining flat wasn’t really presented as an option.” Her choices were limited to implant reconstruction or DIEP flap surgery, which uses tissue from elsewhere on the body.
Durston confirms that this lack of awareness about the option to remain flat is common. “Clinicians sometimes fail to present all choices, and women may not be aware of their right to choose,” she notes.
A 2021 study by the Breast Cancer Network Australia of over 3,300 individuals who underwent breast reconstruction revealed widespread issues. Respondents reported decision regret, insufficient time to make choices, misunderstandings about costs, and lengthy wait times in the public health system.
Charlotte Tottman, a clinical psychologist and founder of the podcast Upfront About Breast Cancer: What You Don’t Know Until You Do, underscores the importance of thorough discussion. She notes that some medical professionals might inadvertently rush patients through their options, often reflecting cultural assumptions rather than patient needs.
Tottman, who chose not to undergo reconstruction following her own double mastectomy, describes her decision as deeply personal. “Breasts mean different things to different people,” she explains. For her, the loss of sensation associated with reconstructed breasts made the option less appealing.
Tottman, who made the choice to remain flat, emphasizes the emotional complexity of such decisions. Despite not regretting her choice, she acknowledges the significant loss she feels. “The absence of sensation and intimacy is a profound loss,” she says.
The assumption that all women will opt for reconstruction can sometimes undermine patient autonomy. Tottman warns against dismissing a patient’s decision, citing instances where doctors have expressed skepticism about choices to remain flat, thus diminishing the patient’s agency.
Durston reinforces the necessity for informed decision-making. “It is crucial that patients receive comprehensive information about all available options and understand the implications of each choice,” she asserts.
For those navigating breast cancer treatment and reconstruction options, ensuring access to complete and transparent information remains a critical aspect of care.
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