When Ana Karanović, a bank manager, was diagnosed with breast cancer, she was operated on within two weeks of her diagnosis. She says she wasn’t fully cognizant of her predicament. At the time she wasn’t thinking about the aesthetic appearance of her body following the mastectomy, she was only interested in saving her life. However, she remembers being in a state of shock following discharge from hospital.
No woman deserves to be left without the fundamental symbol of femininity.
These questions were going round and round in my head, how will my husband, my children and even my extended family accept my new appearance” – recalls Ana her traumatic experience.
Her surgical treatment took place more than two decades ago, when medical institutions in Serbia didn’t offer primary breast reconstruction surgery, or rather at a time when that particular surgery was not standard procedure after a mastectomy.
Today it is, and both patient experience and medical opinion agree that it has a huge contributory part to play in women’s recovery from cancer.
Fortunately, women are now able to have breast reconstruction surgery after a mastectomy and so leave the operating theatre less psychologically traumatised than before, and cope with the whole course of treatment more effectively. It is true that I had the support of my family, but all the same it wasn’t easy to explain to my children what their mother has been through. They noticed that I was inserting a prosthetic into my bathing suit when we were on holiday and they would ask questions. That was the first trigger for me, when I started thinking about breast construction surgery which at the time was starting to be offered at the Oncological Institute in Belgrade. Today, ten years after my breast reconstruction surgery I enjoy a good quality of life, I’m much happier and more satisfied in general – says Ana.
It is with special gratitude that she mentions doctor Olivera Kosovac, specialist in cosmetic and reconstructive surgery, who together with her colleagues managed to effect change at the Oncological Institute, so that breast reconstruction surgery following a mastectomy is carried out as standard procedure in cases where it is deemed appropriate.
While previously this type of intervention was viewed as aesthetic in nature and done on request of female patients, Dr Kosovac believes it is absolutely justified as a procedure because it prevents psychological traumas from developing in women because of a significant change in physical appearance, and in this way it restores them to normality.
“At the time many experts believed that the aesthetic result is not crucial to good recovery in patients, so that after breast reconstruction surgery a follow-up assessment was not possible. A few believed that this could become a standard procedure after mastectomy, but we were determined and persistent with our arguments and we managed to bring into practice a procedure which is routine globally in breast cancer treatment. With crucial support of Professor Džodić who back then was the clinical surgical director at the Institute of Oncology and Radiology in Serbia, we managed to make a globally practised procedure also routine practice in breast cancer treatment domestically” – says Dr Kosovac.
Dr Olivera Kosovac emphasises that every surgeon practising reconstruction surgery has to have adequate oncological training, so that the result of their operations is a positive one both for the physical and mental health of their patients. “If an institution does not have adequate prosthetic equipment or for example the reconstruction is undertaken by practitioners lacking in expertise, the aesthetic result can fail to meet the patient’s expectations. Reconstructive breast surgery relies on correct diagnostic and indicative assessment depending on the operative treatment required. This depends firstly on the stage of the illness, secondly the size of the breast and finally the patient’s wishes. It is not uncommon to have to perform several operations, sometimes even on the healthy breast so that we can achieve a symmetrical appearance of the chest. Only then have we achieved our aim. The patients are happy, they are satisfied and can function normally”, says Dr Kosovac.
After 17 years of experience and 2,000 completed reconstructions, she is of the view that any clinical practice performing breast cancer treatment has to comprise a certain number of reconstructive surgeons. Today, in her clinical practice, Dr Kosovac continues to help her female patients.
She points out that women have the option to have reconstructive surgery even in cases where they have had previous mastectomy and no reconstructive treatment. If they are currently in good health, and are cancer-free, they are able to have so-called delayed reconstructions done at any stage following the operation.
An aesthetically pleasing appearance and symmetric chest contribute to the overall holistic recovery of patients – emphasises Dr Kosovac, who over many years of practice has been witness to countless worries and fears that women have when it comes to mastectomy operations.
After finding out that they have breast cancer, women suffer additional stress and worry generated by the possibility their breast will be amputated, and with this comes the fear of the loss of femininity and sexuality attached to the breast. Women find this loss particularly difficult. Some have told me they shower and change their clothes in the dark. They don’t want to look at themselves, even less so to be seen by others. There is also a fear that their partner will reject them, however it frequently happens that they isolate themselves and avoid intimate contact believing themselves to be unattractive.