by: PAMPLIN MEDIA GROUP PHOTO: JAIME VALDEZ - Emily Hu who is a board certified plastic surgeon in Lake Oswego is on the board of the BRAVE Day on the Pink Carpet fashion show. Julie Goodwin never ended up getting reconstructive surgery after undergoing treatment for breast cancer in 2003. But she wants you to know she could have.

As director of clinical and support services at Legacy Meridian Park Medical Center, Goodwin strives to make sure patients know what all their options are during every phase of treatment. And that’s what the annual BRAVE Day — celebrating Breast Restoration AdVocacy Education — is all about.

The BRAVE Day festivities at Legacy Meridian Park last month included a fashion show featuring eight breast cancer survivors, all of whom have undergone double mastectomies. Of those, six of the models have undergone reconstructive surgery or are in the middle of it and two have chosen instead to wear prosthetics.

These models represent the spectrum of choices made more widely available under the Women’s Health and Cancer Rights Act of 1998, which requires insurance policies covering mastectomies to also cover reconstruction, whether that means implants, tissue surgery, a procedure on the unaffected breast to achieve symmetry or nonsurgical options like prostheses. Reconstruction is widely seen in the medical community as a quality of life issue, but few who have never dealt with a breast cancer diagnosis know about this mandated access. And in this case, knowledge can at least bring comfort.

“Sometimes our patients can be overwhelmed by the options, but at the same time are so grateful at the options they have at their fingertips,” Alivia Cetas, a surgical oncologist at Legacy Meridian Park, said.

The options have improved as treatments have become more focused.

“In the past, breast cancer was treated all the same, regardless of the type of breast cancer or the receptor status,” Cetas said. “Women were all offered a modified radical mastectomy: removal of entire breast and the majority of the lymph nodes in the armpit area.”

But invasive surgery is not appropriate in every case, she said, and many patients suffered complications and painful side effects.

by: SUBMITTED PHOTO - Reconstructive plastic surgeon Emily Hu specializes in a number of breast reconstructive procedures and works as part of the tumor board at Legacy Meridian Park Medical Center."About 30 years ago, there was some very important work looking at lumpectomy,” the focused removal of the tumor instead of the entire breast, Cetas said, “and then breast conservation therapy, where we try to conserve as much breast tissue as appropriate, depending on the type, the breast size, lymph node involvement.”

More than cosmetic

As the law emphasizes, reconstruction isn’t merely a cosmetic procedure. Emily Hu would agree. The board-certified plastic surgeon specializes in reconstructive procedures and often works with Cetas on a tumor board.

“We have multidisciplinary conferences every two weeks,” Hu said, explaining that she often meets with surgical, radiation and medical oncologists, as well as radiology and pathology departments. “We’re all together in one room. We have the occupational therapist, physical therapist, social worker, research person, so we can all get our collective brains around cases, and think, ‘What’s the best recommendation?’”

Cetas said recurrence risks can be minimized with radiation and hormone therapy, but there’s been an uptick in patients choosing more pre-emptive measures.

“With some women, their pendulums swing a bit more to mastectomy with reconstruction,” Cetas said. “Although there is not a survival advantage, there is a somewhat lower (rate of recurrence).

“(Many patients) overestimate their risk of another breast cancer, but a lot of women choose that for symmetry and for decreasing the need for future mammograms, fear of recurrence,” she added.

“It’s a little mixed in the (surgical) community as to how much people should be doing that,” Hu said. “The trend has definitely gone toward bilateral mastectomies, but there’s no survival benefit shown in studies, so you’re subjecting your body to an additional side of surgery that didn’t need to have it.”

Hu has seen an increase in women exploring reconstructive options. She largely credits what she calls the “Angelina Jolie effect,” referring to the actress’s widely publicized decision to undergo a bilateral mastectomy as a preventative measure after finding out she was genetically predisposed to develop breast cancer. Jolie simultaneously began reconstructive surgery by having temporary, saline-filled spacers implanted during surgery.

by: PAMPLIN MEDIA GROUP PHOTO: JAIME VALDEZ - Cary Goldberg who is a cancer survivor from Lake Oswego will be a model for the BRAVE Day on the Pink Carpet fashion show at Legacy Meridian Park Medical Center. Goldberg will be wearing a dress provided by Grapevine and will be wearing shoes from Soletta Show Boutique.  “Sometimes we can do a mastectomy and go directly to an implant right away, so they don’t have to do the staged expander process,” Hu said.

But patients’ choices vary by their own anatomy and the degree of their treatment’s invasiveness.

“Oftentimes, if one has a mastectomy and there’s good clearance, they don’t need radiation afterward,” Hu said, “versus with breast conservation treatment, they get a lumpectomy, but it’s automatic radiation after. Those are the trade-offs.”

Recent advances in the field of plastic surgery are jaw-dropping: Now, women can choose to simply tighten up the loose flesh left after mastectomy, while others opt for implants to restore shape. Women with enough fatty tissue on their lower abdomens can actually have that tissue redirected to their breasts, in a procedure that then involves a more intensive “tummy tuck.”

“Women with tissue-based construction have slightly higher satisfaction because it’s their own tissue and looks a bit more normal,” Hu said.

During reconstruction, women can go without nipples, in some cases keep their own — or opt for nipple reconstruction.

“That’s the coolest surgery,” Hu said with a grin.

Taking to the runway

Goodwin ultimately decided to wear prosthetics, but it wasn’t an immediate or obvious decision.

“When I was diagnosed 11 years ago, I had a 4-year-old daughter and an 8-year-old son,” she said. “I ended up having my surgery within two weeks within diagnosis. In retrospect, I think that’s the best time to do that. Then I had to go through chemo, and then after I recovered from that, I sort of got back to life, which was very busy. The more I thought about it, the more I wore my prosthesis.”

She met with a couple reconstructive surgeons over the years, but taking into account that she was slender and had adapted well to her post-mastectomy body, Goodwin decided to live with prosthesis that give the appearance of breasts under her clothes.

“One day I was in such a rush, I felt something was missing when I got to work,” she said, adding she realized she’d forgotten to put on her prosthesis. “No one even noticed.”

More significant than the physical loss, Goodwin said, was the loss of sensation to her chest.

by: SUBMITTED PHOTO - Alivia Cetas, surgical oncologist at Legacy Meridian Park Medical Center with an office in West Linn, counsels patients recently diagnosed with breast cancer about their reconstruction options.“Putting implants in doesn’t bring (that) back,” she explained.

But she recognizes she had access to a range of options, and now more than a decade out, she’s committed to bringing awareness that women with breast cancer diagnoses have choices as they transition into the survivor phase of treatment.

Part of that lifestyle involves celebration, Goodwin said — like taking to the runway in a wardrobe provided by Grapevine Womens Fashions (310 N. State St., Lake Oswego) and Garnish (404 NW 12th Ave., Portland), with shoes from Soletta (390 N. State St., Lake Oswego).

“It’s about celebrating women’s choices and helping women feel good,” Goodwin said. “Breast cancer changed my life, and most of the ways have been positive, because of the breast cancer community. We all love each other and we all know each other. Last year, we did (BRAVE Day) quickly. It was such a celebration and such a sisterhood.”

“This town — with the doctors, the social workers — it’s a great town to have breast cancer in,” she added.

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