The cancer survivors left scarred by bungled operations to rebuild their breasts
00:28 GMT, 10 April 2012
When Kay Haslam was told her breast cancer had spread and she needed a mastectomy, her immediate reaction was to ask when she could have reconstructive surgery.
‘I wasn’t desperate, but I was interested in whether reconstruction would be possible as I have always taken a pride in my appearance,’ says Kay, 59, a former British Airways cabin service director.
She first discovered she had breast cancer in July 2007. Tests then revealed the cancer had spread to other parts of her breast.
Kay Haslam is one of a worrying number of women left disfigured by reconstruction procedures following breast cancer treatment
Her doctor told her it was possible to rebuild her left breast using muscle from her left shoulder at the same time as having a mastectomy — and give the cancer-free right breast a lift, too, so she had a ‘matching pair’.
‘I couldn’t believe I could have both done at the same time — I thought it was brilliant,’ says Kay, who lives with her husband, Redvers, in the Cotswolds.
But things went horribly wrong.
The surgery, in September 2007, left her breasts uneven, with the left smaller than the right and positioned so it was almost under her armpit.
Moving muscle from her shoulder to reconstruct the breast also caused nerve damage, leaving her in such excruciating pain that she has been on prescription painkillers and morphine patches ever since.
She has undergone seven further operations and attended more than 200 appointments with surgeons, pain specialists and physiotherapists to try to put the problems right.
It may sound like terrible luck, but Kay is one of a worrying number of women left disfigured by reconstruction procedures following breast cancer treatment.
Experts warn that many of these procedures are being carried out by surgeons with limited experience in cosmetic surgery — and hospitals, under pressure to meet targets, may be rushing women into making a decision and failing to offer them all the options.
Kay says she was like a ‘scared rabbit’ when her surgeon discussed her operation.
'Sadly, I was advised to have a type of reconstruction that probably wasn't right for my body,' said Kay
‘It all happened so quickly and decisions just seemed to be rushed through,’ she says.
‘I never received a leaflet about the procedure or information about any of the other types of reconstructive surgery, which I now know exist. I have taken more time deciding where to plant a tree in the garden.’
Around a third of the 14,000 women who undergo a mastectomy each year choose to have reconstructive surgery.
Two-thirds of these have it at the same time as the mastectomy.
Guidelines by the government health watchdog NICE (the National Institute for Health and Clinical Excellence) say all women undergoing a mastectomy should be offered the surgery as an all-in-one operation — unless there are medical reasons for not having a reconstruction.
This is because surgeons can achieve a better cosmetic result, as they are able to hollow out the tumour area and then use the woman’s skin to rebuild the breast, which is taken away if reconstruction is not done straight away.
Research shows that for many women, immediate reconstruction has physical, emotional and psychological benefits.
But a survey carried out in 2010 of 7,000 NHS and private patients — the third National Mastectomy and Breast Reconstruction Audit — found that around 15 per cent of reconstruction patients will have some kind of complication, and one in six women has further treatment or surgery.
One in five is not satisfied with the size of their reconstructed breast in comparison to their unaffected breast.
Fazel Fatah, a consultant plastic surgeon at City Hospital, Birmingham, and president of the British Association of Aesthetic Plastic Surgeons, says that since all women’s bodies are different, some operations will be more suitable than others.
‘It is vital that every patient is offered breast reconstructive surgery, and told about the range of possible procedures, with their pros and cons,’ he says.
According to a 2008 audit, only 28 per cent of hospital breast units have a plastic surgery unit working alongside them, with the expertise to offer the full range of reconstructive techniques.
The rest use general surgeons with a sub-specialty in breast surgery, who, while able to remove the cancer from the breast, may have limited reconstruction training.
‘Some women are being offered a basic reconstruction when there are more advanced ones available that would give them a better result,’ says Mr Fatah.
Around a third of the 14,000 women who undergo a mastectomy each year choose to have reconstructive surgery
Other experts agree. ‘We need more training for oncoplastic surgeons in breast reconstruction to raise the range of surgery options,’ says Professor Jerome Pereira, consultant breast surgeon at the James Paget University Hospitals NHS Foundation Trust in Great Yarmouth, and one of the audit authors.
NICE states that all suitable breast reconstruction techniques should be offered, even if they are not available at the local hospital.
These include using an implant, an expander (a deflated implant that is pumped up once inside the body), or skin, muscle or fat from other parts of the body to rebuild the breast.
But with doctors needing to provide the first definitive treatment within 31 days of a breast cancer diagnosis in order to meet government targets, there is a perception that decisions about reconstruction are rushed.
Indeed, while surgeons say they get the best results when women have immediate reconstruction, research from last year’s audit suggests that women who delay having the surgery tend to be happier with the results, possibly because they have a more realistic expectation of what the new breast is going to look like.
Anna Beckingham, who runs support group Keeping Abreast, says there is a postcode lottery in breast reconstruction. She had a mastectomy in 2007.
‘Luckily for me, we have really top plastic surgeons in Norfolk, where I live. I did a lot of research and I’m happy with my results.
‘As far as we know, the failure rate is low, but there are areas where people can’t access a plastic surgeon and they’re not told they can go somewhere else.’
Her group arranges ‘flashing’ sessions where women who have had a mastectomy show the group their breasts so they know what to expect.
‘We want to remind women that this isn’t a boob job — it’s surgery to remove a cancer, and so it can be a bit of a shock,’ says Anna, 42.
Elizabeth, 64, a retired businesswoman, says she was left with a ‘hideous’ lumpy mound after her left breast was removed in October.
She repeatedly asked doctors to remove both breasts, because their large size meant having just one removed would leave her lopsided, but she was told this wasn’t possible.
‘I feel I was railroaded into an operation I didn’t want,’ she says. ‘If my surgeon couldn’t do the operation I wanted, he should have sent me to someone who could.’
Kay Haslam says her surgery left her looking like ‘a Picasso painting’.
‘Sadly, I was advised to have a type of reconstruction that probably wasn’t right for my body.’
She has taken legal action against her surgeon, claiming the advice he gave her was sub-standard and the surgery itself was performed with substandard care.
She received an out-of-court settlement, though the surgeon did not admit liability for the surgery.
Jennifer Emerson from Irwin Mitchell solicitors, which represented Kay Haslam, says: ‘We are working with an increasing number of breast surgery patients (cancer surgery and cosmetic cases).
'The issues of poor advice and insufficient time to fully consider the available options is something that happens all too often.’