The retired teacher and mum-of-two had had a routine mammogram nine months prior to her breast cancer diagnosis in 2019 and everything was clear.
I’ve had the mammogram looked at again by experts and it definitely was clear, there was nothing on it. Nine months later, I had stage three breast cancer, so it developed very quickly, which is quite scary,” says Helen (71), from Lisburn.
“I was away skiing, it was February 2019 when I found the lump, I was 68. I just happened to be in the shower the night before we were leaving to come home and found the lump.
“I knew immediately that it wasn’t good. I’ve had lumps before that were benign, so I knew in my heart that it wasn’t good. I immediately made an appointment with the GP.”
Cancer was detected in her right breast and Helen had a mastectomy plus chemotherapy and radiotherapy — her diagnosis came just 18 months after her husband Ian had died from cancer.
“It was such as shock to discover that I was ill and it was a shock to my son and daughter to think they were going to lose their mum,“ says Helen.
“My sister went with me [to appointments] and she was wonderful.
“But it’s not the same as having your partner beside you, that you can go home and talk about it. Once you go home, you’re on your own,” says Helen of missing her husband’s presence.
“There’s a big difference when you’re on your own and have nobody to share it with because when my husband had his cancer, at least the two of us could talk about it, we could cry about it. But it’s different when you’re on your own, you just have to get on with it.”
Helen did not have breast reconstruction immediately after treatment — her focus, understandably was to ensure she was healthy.
“All you want is the cancer to go away, you want it gone,” she says.
“It’s a very emotional thing to have to go through it. I was fine initially; you’re going through chemo and then radiotherapy and you’ve so much to concentrate on. You’re looking after yourself and everything else.
“You have the mastectomy; it doesn’t look that bad, you just have a flat chest. Some women don’t care but most women want to have two breasts and to wear a prosthesis is not very comfortable.
“Once the treatment was all over in September 2020, I started to think, I want to get back to normal. I want to look normal. I want to wear a bathing suit and I want to wear a lower top and things like that. That was the reason why I decided then that I was going for the surgery.”
Given the onslaught of Covid, her reconstructive surgery wasn’t deemed as urgent — it would normally have been completed at Belfast City Hospital — so Helen decided to proceed with it privately.
The DIEP flap reconstructive surgery took five-and-a-half hours and was completed for the first time in a private hospital setting, the Kingsbridge Private Hospital in Belfast in January 2021.
With this surgery, an incision is made along the bikini line and a portion of skin, fat, and blood vessels is taken from the lower half of the belly, moved up to the chest, and formed into a breast shape.
“Though I had it done privately, I could have waited maybe three or four years and I’d have been 75. I thought I wasn’t going to wait until I was 75 to get it done on the NHS,” explains Helen.
“At first it’s not easy but then, it’s not easy to get a hip replacement. I would put it probably on the same sort of basis.
“It’s painful, it does take quite a while, but three months later, I was playing golf. Three months is nothing.”
For Helen, feeling more like herself, more ‘normal’ was tied into opting for reconstruction.
“Every time I looked at my flat chest, I was reminded that I had cancer and all that I’d gone through. At least now, I know it doesn’t look exactly like the other one, it’ll never be like that, but [to] everybody else looking at me, I’ve got two breasts.”
The DIEP flap surgery is one that’s becoming more widely adopted says Ciara McGoldrick, consultant plastic surgeon at Kingsbridge.
“We were doing similar sort of procedures up to 20 years ago and they were taking 14-15 hours and had a reasonably high complication rate with a long stay in hospital,” she says.
“It’s only now that it’s become a relatively short procedure, four to six hours with a short stay in hospital, usually no more than three nights, and a quicker recovery.
“In years past when we would have compared it to using your own tissue, you were comparing a procedure that would have taken maybe three hours to one was going to take eight to 12 hours,” continues Ciara.
“That’s hard to compare for the patient and also for resources from the hospital.
“Nowadays it’s very hard to justify somebody staying in hospital for a week which is what used to be case whenever this first became popular.”
Because of surgical advancements and operational refinement, patients undertaking this particular procedure will not lose muscle.
“Your abdominal wall muscles, if any of us have tried to do sit-ups, when it’s sore, it’s really sore,” says Ciara.
“If you lose that muscle, as in the previous iteration of this procedure, when you lost a muscle, you got a lot of weakness in your abdominal wall and that could cause problems with bulging but also can cause problems with back pain because you’re sort of out of kilter because your front and your back aren’t as strong.
“When patients got a lovely breast reconstruction result, they really suffered further down the line in terms of the complications as a result of losing that muscle.
“Whenever we were able to refine it further so that we just took the blood vessel and left the muscle behind, largely undamaged, then patients got the benefits of having a nice soft reconstruction using their own tissue that they weren’t going to reject or lose.”
A patients’ stomach tissue can be used to create two breasts, explains Ciara, but it cannot be used in stages.
“If you’re doing a bilateral reconstruction, we’d use their tummy tissue. You can’t take half the tummy and leave the other half for another day.
“If somebody uses their tummy tissue to reconstruct one breast and years down the line, they develop breast cancer in their other breast, and want to use tissue again, we can’t use the tummy but there are other options. Usually, the upper inner thigh is a good option for those patients or there are other options we can use.”
Breast reconstruction is, says Chris Hoo, consultant plastic and breast surgeon at Kingsbridge, remains a very individualised decision.
“When it comes to reconstruction, the concept I always try to get across is the fact that there is a cost to reconstruction, not necessarily a financial cost, but physical cost,” he explains.
“Whether the patient’s fit enough to sustain a long operation, like a six-hour operation, whether the patient has the right amount of tissue. If you’ve a completely flat tummy with zero fat, you can’t have the operation [Diep flap] because you have no donor site.
“If the patient cannot meet the cost — not fit enough, not enough fat, not enough tissue — then you have to see other costs. You will give other forms of reconstruction, such as an implant reconstruction, which is a really good option for some women.
“It’s not a one size fits all. Most women will be able to have this form of reconstruction, as long as the blood vessels are there, as long as they are fit enough, and as long as they have the tummy, and they have the mental fortitude to know that they’re going to go through a big operation and recovery afterwards because some women just can’t put up with that. They choose other options, and some don’t want any reconstruction.
“The key here is choice, it’s a decision that’s taken between the surgical team and the patient.”
“I think that there are some things that you might think would exclude you from having that sort of surgery, things like a Caesarean section is obviously very common procedure,” says Ciara.
“You can have this form of reconstruction even if you’ve had a Caesarean section. We do do a form of scan to look at the blood vessels in the tummy.
“If you’d had very extensive surgery on your abdomen in the past, a scan would show if you’re suitable. But even with those groups of patients, we usually initiate the conversation and start exploring the options.
“There are some occasions where someone would like to have this form of reconstruction as part of their cancer treatment but for some patients, their cancer treatment has to take priority. That’s a small number of patients. If that’s the case, [there’s] the view to do the reconstruction maybe four or five months down the line.”
Both surgeons want to debunk the myth that reconstruction is mainly completed for the sake of vanity.
“There are patients who do say, I’ve had my cancer treated, and I should be grateful, I shouldn’t be seeking reconstructive surgery for my vanity,” says Chris.
“It’s a huge amount of survivor’s guilt which is just not right because there’s so much societal pressures for women to look a certain way, never mind for her own benefit, psychologically, physically and so on.
“Reconstruction is not just for vanity’s sake.
“Yes, we are living in a part of the world that is privileged, that we can offer this surgery. Because this is not just years of life after surgery but quality of life after cancer.”
Helen, who is a seasoned traveller, is looking forward to skiing again and can’t wait to get back on a plane.
“I love it. I’ll go anywhere, just give me the opportunity and I’ll be away,” she says of travelling.
“Once you’ve been ill, I think you have to have the attitude of, as people say we’re only here once.
“Get out there and enjoy it if you can because you don’t know what’s around the corner. We did not have any inkling that my husband was ill, none.
“It’s like breast cancer because when a woman finds a lump in her breast, she hasn’t been ill. This is the awful thing about it; you don’t feel ill, you’re just doing what you normally do and then it’s a shock.
“It didn’t stop me going out and enjoying myself.
“My friends were all very supportive and would have phoned me up and asked I wanted to join them at the pub for example or going out for a meal.”
For anyone faced with a cancer diagnosis and subsequent health journey around the possibilities of reconstruction, Ciara reflects on what a patient should ask a surgeon.
“I would ask a surgeon, could you put me in touch with any of your other patients? That’s probably the best,” she says.
“We haven’t gone through this journey; we see it from a very specific angle.
“And so being able to speak to someone else that’s been under their care and the experience they have would probably be the best barometer of how those patients are how you will fare with what’s ahead of you.”
For more information on Kingsbridge Private Hospital, see kingsbridgeprivatehospital.com. If you are worried about a lump or changes to your body, please make an appointment to see your GP
