R.icostruire is a simple verb, to build anew, to improve, perhaps, the only figurative meaning granted by the language. The perspective changes when the reconstruction has to do with the wound that a cancer always leaves, a watershed in life between the before and the after.Everything that rebuilds is not as it was before, it may not be better and it is certainly different. Women who have known breast cancer are well aware of this, an experience that goes beyond simple physical illness and affects the relationship with their own femininity and with others.
How it works today
Today, it is easier to operate and reconstruct than in the past, especially when the tumor is detected early. “Until the 2000s, the focus was on conservative surgery that allowed the organ to be safeguarded” explains Professor Paolo Veronesi, president of the Umberto Veronesi Foundation and Director of the Breast Surgery Division of the Ieo, in Milan. «Then it was discovered that the breast was often saved but the aesthetic result was not good or did not satisfy the patients. Furthermore, by improving the diagnostic techniques, it emerged that many apparently circumscribed tumors could be plurifocal and pluricentric, ie with more foci of disease, and that in some cases of cancer there was also a genetic component “.
Breast reconstruction
Today the most widespread intervention is the conservative mastectomy. «The diseased part and the mammary gland are removed, keeping the skin and the nipple. The breast is reconstructed during the same surgery, especially if you are dealing with a small tumor, a solution that avoids returning to the operating room. If this is not possible, as in the case of radiotherapy, it is possible to intervene in two stages, using a temporary prosthesis called an expander »adds the specialist. The expander is periodically filled with a physiological solution, which creates the space to insert the actual prosthesis, which is softer and more anatomical.
Emotional adaptation
Immediate reconstruction is also important from a psychological point of view. “It is more protective, because compared to the deferred one it avoids the time in which the woman is breastless, which would constitute a further period of stress” explains the doctor Anna Costantini, psychologist and director of the Department of Psycho-Oncology of the Sant’Andrea University Hospital in Rome. «However, there can always be complications due to a misalignment between expectations and aesthetic result. But also because it is one thing to feel comfortable wearing a suit and another to confront yourself, with nudity, with your partner and in all areas of intimacy that are inevitably affected when a disease strikes an organ with a high symbolic content like this one. . Reconstruction plays an important role in recovery, but overcoming the psychological sequelae that a tumor entails requires a physiological time of adaptation “ adds the expert.
An organ different from the others
Moreover, it is not just any organ. «The breast is full of social and psychological meanings, it marks the female identity, it is strongly associated with the representation of a desirable woman offered by the media and advertising, to the image of motherhood, femininity and fertility. To all this is added the fear of having to face, in addition to surgery, chemotherapy, with hair loss, another symbol of the feminine: cancer challenges the foundations of being a woman at 360 degrees »continues Dr. Costantini.
The temptation for drastic solutions
When cancer is diagnosed, most women favor a full breast removal and the cases in which one would also like to remove the healthy one are not rare. “Many associate radical intervention with prophylactic intervention, overestimating the risk of contralateral cancer, which studies confirm not to be tall, unless there are genetic reasons, as in the case of Brca1 mutation, the same as Angelina Jolie, who underwent a preventive removal operation »adds Professor Veronesi. “When there is no real risk, there is the danger of making decisions by being guided more by emotions than by rationality: the idea of radically eliminating the part with the diseased cells acts as a reassurance about the future, even if it is not always true, because sometimes one runs into relapses. This is why it is important to evaluate the psychological state of the patient and to reduce the emotional level that leads to a drastic choice when it is not appropriate »specifies Dr. Costantini.
“I made peace with the prostheses: the fight against the disease is elsewhere”, the testimony of Eleonora D’Angelo, Pink Ambassador Veronesi Foundation
She had no qualms about giving up her diseased breast, she says Eleonora D’Angelo: «I was operated on in July 2011, I should have had a conservative quadrantectomy, but in the operating room they preferred a total mastectomy because the breasts were invaded by small lumps. I discovered it after the fact, but I was happy because the reconstruction was carried out during the same surgery and because the alternative would have been chemotherapy, which however could not have solved the problem and led me to a new surgery “. It wasn’t easy. “At first I didn’t look at the reconstructed breast, it was smaller than the healthy one … The first time, in the shower, I saw it ugly” Eleonora adds.
The prosthesis immediately started giving her adhesion problems and eventually had to be replaced. “During the same surgery I underwent a breast reduction mammoplasty of healthy breasts, which became too large, also due to the side effects of the hormonal therapy I was following”. A new cancer then forced her to remove the other breast as well. “I already knew what to expect, at the same time, however, I was more angry, especially for the idea of having to start taking drugs again and for the stress that this brings with it.” The relationship with the new breast has improved today. «It’s a good job, I’m happy, the first time I had a rejection, I saw it and I was scared because there was a hematoma; I was also younger, now I face everything with greater maturity. What matters, always, is to prevent and not postpone the checks: I have never skipped a screening, it is what really saved my life “.
Women who prefer to keep the scar
Not all women are enthusiastic about the idea of reconstruction and there are also those who decide not to proceed. It is going flat, literally “staying flat”, widespread especially in the United States, which has different reasons. “Some put survival first, fear complications, refuse a prosthesis because it is foreign to their body. For others, however, femininity is everything »explains Dr. Costantini. You might think that a scar is more reminiscent of the disease than an artificial breast, but that’s not all. «A breast can be masterfully reconstructed but it will never be the same as before. The problem of remembering is not associated only with a scar, but various stimuli can bring back sensations and thoughts experienced in the course of treatment.
This is why we speak of an identity of those who survive. Those who have had the disease, even if cured, become sensitive to everything that remembers it, whether or not they have a prosthesis ».
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