Helping Women Look and Feel Complete Again after Breast Cancer
The black cloud of cancer looms every time a woman examines her breasts and frets: Is that a lump? Do I call my doctor? Will I need surgery? Should I worry? No matter how calm and logical her approach, the last question answers itself as anxiety manifests.
Two women, diagnosed with breast cancer (twice each), had asked those questions and received the answers no one wants. Once they knew they had cancer, each had to decide how to proceed, and ultimately both underwent mastectomies and state-of-the-art breast reconstruction surgery at Robert Wood Johnson University Hospital, an RWJBarnabas Health facility. Both women, pleased with their care and surgical results, shared their experiences after finding their way to Richard L. Agag, MD, associate professor of surgery and chief, division of plastic surgery, Rutgers Robert Wood Johnson Medical School.
“I want women to know they have options, and they should know all of them when they make a decision,” Dr. Agag says. “They should feel well informed and comfortable with the decisions they have made.”
With these life-altering determinations, complicated surgery, and sometimes-exhausting treatments behind them, the women have happily resumed their lives without defining themselves strictly as patients.
“It’s been almost a year and I am feeling great,” says Ana Costa, a mother of three in South River. “I never had to actually look in the mirror and see myself without my breasts, so every time I look in the mirror I feel normal.”
Costa completed her treatment and wants to return to her old job as a warehouse manager.
Despite radiation treatments, Patangi Amin, a mother of two, is remarkably upbeat and recently resumed her job at the Federal Reserve. Instead of commuting from Monroe Township to Manhattan’s Financial District, Amin is currently telecommuting and paving new paths. She transformed the diagnosis, surgery, and treatments into an impetus for personal growth.
“The surgery along with chemo has grounded me on discipline,” Amin says. “Before surgery, I had a Type A personality, but perhaps was not disciplined on the right things.” She’s concentrating on herself a bit more, keeping a food journal, setting goals such as walking a quarter of a mile a day on the treadmill, and reading.
All of this leads to the striking realization that “the quality of my life has definitely improved,” Amin says. “I still have to see my oncologists at Rutgers Cancer Institute of New Jersey. But I do not need mammograms anymore, which was one of my goals.”
It wasn’t only the discomfort and scheduling of mammograms but the anxiety of waiting for results that had been taxing for Amin. She knew she was high risk for breast cancer because of family history, and her first 3-D mammogram revealed ductal carcinoma in situ. After a lumpectomy, she mulled over whether a double mastectomy made the most sense. Amin eventually found her way to Dr. Agag. He arrived at Robert Wood Johnson Medical School in August 2016 after spending five years as the director of microsurgery at Albany Medical College. Dr. Agag brought in Jeremy Sinkin, MD, assistant professor of surgery, in September 2017, following Dr. Sinkin’s completion of a microsurgery fellowship at Memorial Sloan Kettering Cancer Center. Both physicians express similar goals of creating a practice where patients heal and the process is not part of the problem.
“I am interested in complex, oncologic reconstruction of the breast, specifically using patients’ own tissues to reconstruct the defects,” Dr. Sinkin says, explaining what drew him to the medical school. “It is a technique that not only requires a skilled surgeon but also an institution that can support this kind of surgery, including nurses who are skilled and can monitor the patients. And I wanted to work with residents. I enjoy the teaching that is possible at an academic institution.”
In addition to the more traditional breast implants after mastectomies, the physicians specialize in procedures where the patients’ tissue from their abdomen, thighs, or buttocks is used to rebuild the breast. The surgeons transfer the skin, fat, and blood vessels to reconstruct the breast; then, using an operative microscope, they reattach these vessels to blood vessels in the women’s chests. Although such procedures are commonly performed at larger academic institutions, they were not as accessible to patients in New Jersey.
“We are aiming to create an environment where patients can come and receive top care in the area they live,” Dr. Agag says of the team he has forged. “We need to let people know we are doing it here and they don’t have to travel to New York City or Philadelphia.”
The double mastectomy and tissue flap reconstruction take about 12 hours. Working collaboratively, the mastectomies were performed by Rutgers Cancer Institute surgical oncologists Lindsay Potdevin, MD, and the late Thomas Kearney, MD, and Dr. Agag and Dr. Sinkin completed the breast reconstructive surgery. The women continue to receive care at the Rutgers Cancer Institute from Dr. Potdevin, medical oncologists Deborah Toppmeyer, MD; Nancy Chan, MD; and Bruce Haffty, MD, professor and chair, Departments of Radiation Oncology, Robert Wood Johnson Medical School and New Jersey Medical School. The surgical procedure and medical care before and after surgery is reflective of the effectiveness of a multidisciplinary team approach.
“Our team is made up of residents, PAs, nurses, and surgical techs. Everyone has a role, and they do it well. The goal of the team is to make something complex feel routine, to some extent,” Dr. Agag says.
The physicians are keenly aware that women come to them at a devastating time in their lives. A cancer diagnosis rocks people to their souls, and surgical options are frightening.
“It is overwhelming, and if they have to go to different locations, it can be very troubling for the patient,” Dr. Sinkin says. “We want to integrate ourselves as plastic surgeons and work with oncologic surgeons to make it seamless for the patients and make it easy for them to get back to their lives.”
Now ensconced back in those lives, Costa and Amin revisit the paths each took to her choice of breast reconstruction. With one of her master’s degrees in decision sciences, Amin approached her medical care with the research-driven analysis she brings to her work. She checked doctors’ records, read voraciously, and sought additional physicians’ opinions before selecting Dr. Agag. Costa came from a different perspective: she did not question physicians. When a friend’s sister was diagnosed with breast cancer, Costa examined herself that night in the shower and found a lump. Her husband tried to provide comfort, reassuring her it was nothing to worry about. She saw a general practitioner, who told her the same thing. “The doctor said I was too young to have breast cancer and to not worry,” Costa recalls.
But she was so anguished that the doctor sent her for an ultrasound, which turned up nothing. “I didn’t see the doctor anymore because she already told me it was nothing,” Costa says. “She said if it grew or caused pain, I could get it surgically removed.”
That physician seemed unconcerned, leaving Costa with the feeling, “Who am I to disagree?” Because of this, she went on with her life—as the mass in her breast continued to grow, until the lump was visible through her bra. She was 27 and terrified. A friend who worked in a doctor’s office helped her navigate the process. Costa underwent chemotherapy, then a lumpectomy, followed by radiation. Six months later, her cancer recurred. A series of communication mishaps with a former physician’s office only left Costa more fraught.
Costa finally made her way to Dr. Agag—and as she recollects this, the relief in her voice is palpable. “He talked to me and said one of the options was to have surgery with reconstruction the same day, and it would be better if my own tissue was used,” she says. “I always try to do what doctors recommend. He is a wonderful doctor who did a wonderful job.”
She learned a tough lesson along the way. “You have to know your body,” Costa says. “If you think something is wrong and the doctor says everything is OK, don’t let the doctor tell you it is nothing. Get a second opinion. If I had listened to my gut, maybe I would not gone through as much.”
Amin, too, still gleaned lessons from this experience. “People have this view that cancer is all evil,” she says. “I am not going to argue; the journey sucks. It is not exciting, and nobody signs up for this. However, if you give yourself the opportunity to accept the very personal experience, you will get to know yourself at the deepest levels possible. Then you will find the good that can come out of it. I have learned to slow down and let go.”
Amin has also learned to live with her new self. “I feel very liberated,” Amin says. “The surgery has made me feel positive about what I look like. You have to learn to accept a new body. It looks different, but beautiful.”