Rights or Rhetoric? Breast Reconstruction Awareness

Breast reconstruction and the yet-to-be-tapped market of breast cancer survivors

Posted March 30, 2013

I get public relations pitches every day about the latest breast cancer fill-in-the-blank. I usually delete them as soon as they come in, but last week I lingered on one longer than usual. The pitch said that Dr. Allen Gabriel and The Pink Lemonade Project, along with Alaska Airlines and Starbucks, were inviting me to learn about "[my] rights as a breast cancer survivor by joining BRAVE day (Breast Restoration AdVocacy Education)." I guess the publicist didn't know I was never diagnosed with breast cancer.

In addition to flyers, the materials included a bookmark listing breast cancer survivors's rights. They/we have the right:

to seek advice from trusted health care professionals,
to have insurance companies pay for mammograms,
to access reconstruction following surgery (which may be paid by insurance),
to hope, healing, and happiness during the breast cancer journey.

I thought about what was missing from the list. Evidence based information, safe treatment, access to medical records, second opinions, information about my condition and treatment options in a language I understand, financial assistance, employment rights, mechanisms of redress, survivorship plans, insurance coverage, that politically contested notion of affordable care. More rights would come to mind if I thought about it. But I don't need to. The information and festivities for BRAVE day (food, entertainment, and pink swag) make it clear that one right, an unstated right, rules them all. The right of breast cancer survivors to be marketed to -- by a doctor, a nonprofit organization, and two corporations.

Poster for BRAVE Day, included in a pitch to the author

Breast Restoration Advocacy Education (BRAVE) Poster

Poster for BRAVE Day, included in a pitch to the author

Women Citizens/Pink Consumers

For more than 30 years feminist and women’s health advocates helped to transform the social and medical landscape for breast cancer. In addition to putting women's health on the map, they helped to de-stigmatize the disease, promote solidarity among some groups of women, change medical protocols such as the drive-through mastectomy, increase federal funding and consumer input for breast cancer research, and elevate the social status of the survivor. Throughout this arduous process, they promoted the validity and proliferation of resources for self-help, mutual support, and patient advocacy.

Knowing one's rights as a patient certainly falls within the advocacy framework. However as pink ribbon culture came to focus on the upbeat, life-changing aspects survivorship, it opened a new consumer market for survivors, supporters, and at-risk women. The empowerment/awareness context now easily commercializes almost every aspect of breast cancer (i.e., awareness, risk, prevention, diagnosis, treatment, survivorship, research, support, propped up with a seemingly endless plethora of pink products and a vast array of medical interventions. With the number of breast cancer survivors reaching nearly 3 million in the United States this year the market is large enough to absorb the marketing.

Plastic Surgery Advertisement Focusing on Well-Being After Breast Cancer

In addition to the personal and medical relevancy of cosmetic surgery, reconstruction services (framed as awareness, empowerment, well-being, or even rights) are a massive consumer market. Plastic surgeons conducted over 14.6 million procedures in 2012, up from only a few hundred thousand in the 1980s.

According to the BRAVE day publicist who sparked my interest last week, less than half of the patients diagnosed with breast cancer have reconstructive procedures. What she did not say is that the number of plastic surgery procedures increases 5 percent every year (up 98 percent since 2000), that the more than 96,000 breast reconstruction surgeries in 2011 represent a 22 percent increase from the 79,000 procedures done in 2000, and that women have 91 percent of all cosmetic procedures (with breast augmentation topping the list since 2006). The 232,340 new cases of invasive breast cancer plus the 64,640 new cases of noninvasive carcinoma in situ this year could mean record profits for an industry that relies on beauty ideals and women customers.

Breast reconstruction and reduction surgeries are the yet-to-be-tapped market

According to an article in the Journal of Clinical Oncology about 42 percent of women diagnosed with breast cancer between 1998 and 2003 in the United States had unilateral or bilateral mastectomy. Most women having these procedures would have the option of breast reconstruction through implants or tissue transfer using one's own body tissue to create a breast mound. The medical community has made strong claims about the psychological benefits of having such reconstructive surgeries. But some studies call this logic into question, finding no difference in psychosocial adjustment based on type of surgery, or learning that quality of life is more influenced by a woman's age or exposure to adjuvant therapy. If reconstructive surgeries are not necessarily the key to psychosocial adjustment and quality of life after breast cancer, are some women feeling pressure to have these surgeries when they might otherwise want to opt out?

A study in the Psychology of Women Quarterly reported that sexual minority women face considerable pressure to have reconstruction, and those who decide not to have surgery often feel like they have to justify their choices to their doctors. The researchers argue that these women's reasons for and against the surgeries highlight sexist and heterosexist assumptions within the medical management of breast cancer, and particularly mastectomy. As Naomi Wolf points out in The Beauty Myth such assumptions affect women in general. Wolf questions whether cosmetic surgery is really a choice in the context of a society that routinely reduces women to appearances and sexual usefulness. For women diagnosed with breast cancer, societal expectations to look and act the part of the thriving breast cancer survivor/fearless warrior (while appealing to some) may add to these pressures in ways that are just as disempowering as those from decades ago that forced women to keep breast cancer hidden beneath a veil of secrecy.

Ideally, medical decisions would be grounded in a clear body of evidence, access to quality care, and respect for patients’ personal values and preferences. I know women who have had reconstruction after breast cancer and women who have opted out. Is one group braver? More aware? More empowered than the other? No. Is one group more valued than the other? In this historical moment...yes.

Dr. Gayle Sulik is the author of Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. More information is available on the book's website.