Life after breast cancer in young adults: a reconstructive surgeon’s perspective

I am seeing younger patients coming in for cancer reconstruction, especially young adults in their 30s dealing with breast cancer. When I was growing up, cancer was something that happened to older people. Now I am seeing it in people in my generation.

Part of it is better diagnostics — we're catching cancers earlier. But there's no question there's been a rise in cancers among younger people. They are dealing with new stressors they didn't expect to deal with until much later in life. They are building careers and families, then they're blindsided by a cancer diagnosis. Suddenly they're concerned about leaving behind people who depend on them.

Concerns of younger breast cancer patients

I recently had a breast cancer patient in her mid-30s in my office. She asked whether reconstruction using tissue from her abdomen might affect a future pregnancy. I told her that the skin might feel tighter, but the surgery probably wouldn't restrict the growth of the uterus or the stretching of the abdomen. From an aesthetic standpoint, she might notice more stretch marks, but it wouldn't be a problem when having a baby.

That's just one example but there are many things younger cancer patients have to consider that may not affect older patients.

Time before returning to work and family

For a cancer patient in their 30s or 40s, returning to work and family are big concerns. Recovery time is a major factor in their decision on whether to undergo breast reconstruction.

For breast reconstruction, we can use the patient's own tissue to transplant and rebuild a new breast or we can use implants. There are different pros and cons to each option.

Pros of using implants:

• Outpatient procedure so people go home the same day
• Recovery is quicker
• If you don't have other health complications, you may be able to replace implants with your own tissue at a later date

Cons of using implants:

• Breast implants usually need to be changed out every 10 years

Pros of using your own tissue:

• More of a lifelong solution

Cons of using your own tissue:

• Hospital stay of about three days
• Slower recovery of three to four weeks

Using your own tissue is a bigger surgery with a longer recovery, which younger patients often can't afford. Younger patients with families and active lifestyles tend to choose implants for a quicker recovery, especially to get back to work, school or caring for children sooner. Older patients, who may be retired or have more flexibility, might choose to use their own tissue for a more permanent result.

Dating and body image

I have patients in the dating world who want to look like they never had breast cancer or surgery. That's a challenge, but it's my job to help them look and feel the way they want. It's especially important for breast cancer, which is very visual.

We use hidden scar techniques and microvascular surgery to restore appearance as much as possible. Some people want to look exactly as they did before; others may want to change size. The plastic surgery part is like a light at the end of a long tunnel — breast cancer patients have more choices at this stage.

Emotional support

There's definitely an emotional impact to breast cancer. Some worry about how a partner will react or about starting new relationships. Breastfeeding is another concern — if the surgery removes the nipple or much of the breast, breastfeeding may not be possible. We discuss options like lumpectomy and mastectomy, depending on the case, and try to be realistic with setting expectations.

As you're getting set up in life, it's hard to add more appointments and expectations to treat your cancer. If you're a parent, you're likely already putting yourself last, and now your whole world is flipped upside down. It can be challenging to put yourself first but our team at Main Line Health can help.

Care team to help and support you

Our nurse navigators are experts at helping patients navigate the unknown and being another shoulder to lean on. They can keep you on track by:

• Connecting you with help at home
• Getting you appointment times convenient to your schedule
• Coordinating your care from start to finish

Main Line Health has a very collaborative team that also includes home health nurses and occupational and physical therapists. It's important that we focus not just on the journey of the cancer diagnosis and treatment, but also on the journey of recovery.

Trustworthy resources

There are great support resources at Main Line Health and online. These include many support groups for younger people. I always encourage patients to look for credible sources, as there's a lot of misinformation online as well.

Our team can help you find resources that will be most beneficial. It's part of creating an environment that enables patients to stay close to home for excellent care that rivals the best in the country.

Understanding cancer in young people

Main Line Health's clinicians and care team have additional insights on their approaches to diagnosing, treating and supporting young people with cancer.

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Next steps

Learn more about Michael Tecce, DO

Learn more about breast cancer care at Main Line Health

Learn more about breast reconstruction

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