TMC PULSE

t m c » p u l s e | o c t o b e r 2 0 1 8 30 After meeting with her recon- structive plastic surgeon, Margaret S. Roubaud, M.D., assistant profes- sor in the department of plastic sur- gery at The University of Texas MD Anderson Cancer Center, Williams- Scott decided to be aggressive and have both of her breasts removed entirely. "I always thought of myself as not caring about my breasts. They were just a part of me. They weren't very large. I'm not really a girly girl," Williams-Scott said. "I was a little fascinated by people's body image because I thought I was immune to that. This made me look at myself differently." As her double mastectomy date drew closer, Williams-Scott grew increasingly torn between choosing to go flat or reconstructing her breasts. "I realized that there really is something about your identity that goes with your [breasts]," she said. "I would have days when I would think, 'I don't need reconstruction.' … Then, I'd have other days when I'd think, 'No, I want to get the ones I always thought would be nice to have.' I went through the whole gamut of that, but I realized that I just want to be healthy and the size I was before. I want to be comfortable in my skin. My biggest desire, if possible, was to only [use] my tissue." Williams-Scott scheduled her double mastectomy and tissue flap reconstruction for January 2018. Prior to her surgery, she got undressed at home, stood in front of the mirror and stared at her body. "It was like I wanted to memorize what [my breasts] looked like at that moment because I knew they'd never be the same again," she said. "When we look in the mirror, we expect things to always look kind of the same. Yeah, we're going to get wrinkles, gray hairs, lose and gain weight, but things were always going to be sort of the same. I was afraid that would upset me." Breast reconstruction Breast reconstruction closes the loop in a patient's breast cancer journey, Roubaud said. "In the beginning, women are just really focused on surviving the cancer," Roubaud said. "As that immediate danger passes, what they realize is there's a huge part of their identity that was wrapped up in their body. All of us have it. Women, in particular, are brainwashed early in life to pay attention to what they look like. There's a grieving and a loss." Some women worry that their partner may look at them differently. Some fret over how their clothes fit. Others, who nursed their children, view mastectomies as having their motherhood stripped away. "Until women are reconstructed, we haven't finished their treatment. We haven't finished restoring them," Roubaud said. "We know now more than ever in the medical community that you can't cut people's bodies and ignore their soul. You can't do surgery and not pay attention to their emotional needs. This is defi- nitely addressing both." There were 106,295 breast recon- struction procedures performed in 2017 by members of the American Society of Plastic Surgeons (ASPS). Researchers have observed a steady growth in breast reconstruction rates, with a 35 percent increase since 2000. There are two main approaches to breast reconstruction: breast implants filled with silicone or saline inserts, and tissue flap procedures using the patient's own body tissue. Although implants are a popular option for mastectomy patients and entail a less invasive opera- tion, implant reconstruction may not be possible for every patient. Additionally, with time, some patients may need to undergo revi- sion surgery to replace the implants. Tissue flap reconstruction is a much more complex and extensive procedure, but the benefit is that the results are "for life," Roubaud said. "You're basically recreating yourself with yourself," she said. "We know the anatomy of the body and we're stealing from Peter to pay Paul—where we can borrow, where we can move it to, etc. It's really about using the body to heal itself." Plastic surgeons take skin and fat, sometimes muscle, from one part of the body and move it to the chest wall to form a breast. Under a high-powered microscope, micro- surgeons connect all the blood vessels in the tissue graft—usually Breast cancer survivor Melissa Willams-Scott stands in front of MD Anderson. Williams-Scott underwent surgery after finding out she had ductal carcinoma in situ (DCIS), a type of stage 0 breast cancer that forms in cells inside the milk ducts. Feeling hopeless? At the Behavioral Hospital of Bellaire, we believe the road to recovery begins with understanding, hope and healing. We offer mental health and addiction treatment for teens and adults, including a specialized Women's Program. Call 832-761-4450 or visit bhbhospital.com to start your path to wellness. BEHAVIORAL HOSPITAL of BELLAIRE 5314 Dashwood Drive, Suite 300 Houston, TX 77081 800-423-0017 bhbhospital.com With limited exceptions, physicians are not employees or agents of this hospital. For language assistance, disability accommodations and the non- discrimination notice, visit our website. 183416 For GPS Directions, use 6638 Clarewood Drive, Houston, TX 77081

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