“It don’t really matter
What steps you choose to do
Only one thing matters:
That’s your attitude
Your attitude, attitude”
— Carly Simon

A diagnosis of breast cancer can summon up terrible fears. Will I require surgery? What are my options? What is my long-term prognosis? Will I live?

According to the Susan B. Komen Breast Cancer Foundation, the incidence of breast cancer has climbed slightly more than 1 percent annually since the 1940s. In 2006, more than 200,000 American women will be diagnosed with the disease.

Although the statistics are scary, it’s comforting to know that earlier detection and diagnoses are resulting in easier and more successful treatments, and increasing numbers of women are leading fabulous, fulfilled lives following surgery, chemotherapy, radiation or a combination of the above.

As with any illness or challenge, overcoming adversity depends to a large degree on attitude. The term “face your fear” is never more relevant than when it comes to fighting a disease such as breast cancer. Christine Rodgers, M.D., a Denver-based plastic surgeon with Denver Plastic Surgery Associates, has performed numerous reconstructive surgeries for breast cancer patients. She says taking control of your life and making positive changes following diagnosis and surgery can lead to faster, less stressful recoveries.

Dr. Rodgers, herself a breast cancer survivor, is a huge advocate of women taking back their lives following any type of treatment for the disease. “After all these diagnoses people are faced with, I was interested in giving something back to the patients. I’m not in the position to do research to cure cancer, but I am in the position to help women after they are diagnosed,” she says.

Her way of giving back is to push her patients to return to their normal lives, or perhaps to start living their lives anew. “I began taking patients with me to dance class in 1986. The first woman I took had just come back from having a mastectomy, to find her husband had locked her out of her house. I found that the physical activity really boosted my patients’ emotional and physical well-being, as well as their agility,” she says.

Dr. Rodgers references several studies and articles from institutions such as Harvard and Stanford, which point to a 30-percent reduction in the recurrence of breast cancer among women who take positive steps, such as moderate exercise for as little as three hours a week.

It’s not just the surgery, chemo and radiation that affect breast cancer patients, it’s also the procedures and medications that are used as follow-up. The drug Tamoxifen, which many women take following bouts with breast cancer, can trigger early menopause and significant weight gain. “Many women attribute weight gain to either chemo or Tamoxifen, and will tell me they don’t want to continue with these treatments,” Dr. Rodgers says. “I tell them, ‘Come to a class with me and work on your body.’ Whether it’s ballet, stretching, jazz dance, etc., I encourage them to try.”

Encouraged or not, many women remain adamant that they are simply not up to the challenge. “What they don’t realize is that the other adults in these classes simply don’t care. My ballet teacher got me through my whole bout with this, and I was back in class after 11 days and jumping on the ice three weeks following my surgery,” Dr. Rodgers says.

This may seem a bit excessive to many women facing a similar ordeal, but she explains that ultimately it became much more of an emotional issue than a physical challenge to herself. “I’m not that good at ballet, but it’s amazing how graceful people can be if they can just feel like they are. The music, art and dance take you out of the mundane, back to a more innocent and peaceful place,” she explains.

Typically, women who have faced this type of illness initially shy away from exercise, opting instead for the more palatable escape offered by food and wine. “I tell them, don’t tell me you want to eat and then complain that you don’t look good. You can look very sexy doing these classes,” Dr. Rodgers insists. Another movement she endorses is any type of wrist motion, such as that used in flamenco dance, because in addition to weight gain, some medicines can cause arthritis-like symptoms.

To help accomplish her goal of giving women a tangible method for feeling better, Dr. Rodgers is working on a women’s wellness project that is developing a line of cosmetics designed to alleviate many symptoms of chemo and radiation. Such treatments affect the skin and cause imbalances in estrogen and hormone levels. The result is dry, scaly skin and hyper- or hypo-pigmentation. Products in phase one of the project will focus on these problems; phase two will concentrate on products that help offset hair and nail loss caused by treatment.

“In the end, you have to look good to feel good. If you look good, you’re more likely to try new things and improve your life. It’s so hard for women undergoing chemotherapy to believe they look good,” Dr. Rodgers says. “But I’m coming at it from the other side, as someone who has been there. Physicians can tell patients, ‘I know how you feel,’ but no one can really know unless they go through it. I do know what it’s like, but in a way I’m tougher on my patients, because watching a patient give up or say it’s all over is just not in my vocabulary.”

As a plastic surgeon, she believes that women will go to great lengths to look beautiful. Therein lies the great dilemma, because breast cancer patients, particularly those who have had mastectomies, are often overwhelmed and consumed by the outcome. “It’s such an emotional thing because it’s not hidden from the public, and is very much a part of a woman’s overall self-image,” she notes. “But it shouldn’t be the defining thing, because everyone can look beautiful if they have nice skin, makeup, hair color, etc. You don’t have to have breasts to feel sexy and beautiful,” she adds.

More and more, women who have undergone either unilateral or bilateral (single or double) mastectomies are opting to have reconstructive surgery to create a new breast and take back their bodies. These procedures are usually done immediately following the mastectomy, with the cancer surgeon leaving the operating room and the plastic surgeon coming in to do his or her work.

Two types of reconstruction are commonly available to patients who have had a mastectomy. The first type uses artificial implants filled with saline or some other solution; the second uses skin from the woman’s body to rebuild the breast.

“When a patient comes to my office to discuss reconstructive surgery, I talk about it in four stages,” says Philippe Capraro, M.D., a reconstructive plastic surgeon working with Grossman Plastic Surgery in Denver. This can take anywhere from six months to one year, depending on whether a patient is receiving chemotherapy or radiation therapy. The stages are:

• Inserting a tissue expander or doing some type of flap.

• This is done immediately following a mastectomy. The plastic surgeon creates a new pocket for the tissue expander and inserts a deflated implant. Over a period of weeks and months, the implant is filled with saline to stretch out the skin. Once it has been sufficiently stretched, the tissue expander is removed and replaced with a permanent implant. The implants are generally saline or silicon. This procedure offers the quickest recovery.

• Flaps — reconstructive surgery using skin and tissue from the woman’s body, usually from the back (latissimus dorsi flap) or stomach (transverse rectus abdominis myocutaneous (TRAM) flap.

• When skin is removed from the back, it is placed over the breast area, and usually a tissue expander is inserted, followed by an implant. This procedure allows for more cushioning over the breast, providing more protection for the implant.

• When the abdominal (TRAM) flap is used, skin, fat and muscle are transferred to the breast, a procedure that normally eliminates the need for the expander.

* assumes double mastectomy

• A third, less commonly used flap is known as the deep inferior epigastric perforator (DIEP) flap. In this procedure, only stomach tissue is used. Because the stomach muscle is not touched, abdominal strength is preserved. However, only highly trained surgeons can perform this type of procedure, making it much less common. This surgery can take from 8 to 18 hours and requires a team of surgeons to perform.

• Removal of the tissue expander and inserting an implant.

• Creating a new nipple and areola complex.

• Tattooing of the nipple and areola complex.

According to Dr. Capraro, most of the surgeries he performs in Colorado involve placing a tissue expander and implant. Interestingly, on the East Coast, where he did his training, most women opted for the flap surgery. “The weather is great here, and people in Colorado enjoy the outdoors all year round. So I think that although the flaps may give a better ultimate result in terms of overall appearance and feel, the recovery time associated with them causes women in Colorado to go for the surgery that has a shorter recovery time,” he says.

In addition, much of a patient’s decision will rest largely on which procedure a particular surgeon is most comfortable performing. Dr. Capraro is a huge advocate of patients obtaining second and even third opinions before deciding which route to go. “When I’m working with patients, I tell them what I believe will provide the best result for their body. Many of my patients have already researched their options before they come in, so they don’t need to start from the beginning,” he says.

Dr. Capraro adds that most patients who come to see him are understandably distraught, and he does his best to help them see the clear picture of what they’re facing. “I tell them I will support them both mentally and aesthetically with the goal of providing the best possible result. As surgeons, we’ve made great strides over the past 10 to 15 years to improve the outcome of this type of surgery. We now artistically try to shape the breast and attempt to end up with something perhaps even better than the original,” he comments.

In the end, Dr. Capraro says, women need to understand that this is a very difficult process to endure. “Often, the chemo and radiation are harder than the surgery itself. But keep one thing in mind,” he adds. “One hundred percent of the women get through this, and all of them do well.”

Regarding the recovery, some of it is clearly time-dependent; the rest is up to the individual. “Mentally and physically, this is tough the first year,” Dr. Rodgers says. “You’re confronted with your own mortality, and you’re not prepared to face it. I once had an Italian biking coach, and on a particularly hard ride he told me something I never forgot. He said, ‘Stop looking at the top, just look a little bit ahead, and you will get there.’”

Which type of reconstructive surgery is best?
There are a number of factors that help determine which course of reconstructive surgery will help a woman achieve the optimum results. These include:

• Is the woman going to be radiated?

• Body weight.

• Is the woman a smoker?

• Are there other serious illnesses (i.e., severe diabetes, heart disease, pulmonary problems)?