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What is breast reconstructive surgery?
Delayed breast reconstruction within the public health system – are women being given the choice?
The Reconstructles' Black Pearls Calendar
Artist Shirley Strom’s fund raising exhibition

What is breast reconstructive surgery?
Breast surgery for breast cancer may involve the removal of one or both breasts (a mastectomy or bilateral mastectomy) or part of the breast (partial mastectomy or lumpectomy). Reconstructive surgery can re-create the breast and there are different techniques and options involved More info » (www.breastcancer.org).

The process of deciding whether or not to have a reconstruction is intensely personal and takes time. World wide health care standards dictate that every woman should be offered the option of reconstruction and adequate time to consider it, if reconstructive surgery is applicable to her situation.

Delayed reconstruction in New Zealand? Depends where you live ...

Background
A New Zealand Ministry of Health (MoH) directive to District Health Boards (DHBs) in June 2006 culled waiting lists to delete all patients waiting more than six months for either first specialist assessment or surgery. It was made clear that funding would be withheld if DHBs failed to comply.

BCAC was concerned that the Ministry decision would force a woman within the public system to decide at diagnosis whether she wanted breast reconstruction because the reconstructive surgery would have to be done at the same time as breast cancer surgery or it would not happen at all.

In a BCAC media release (8 June 2006) Chair Libby Burgess (pictured) said: “Some women are considered by their specialists as unsuitable for immediate reconstruction because of the need for ongoing treatment (radiation and/or chemotherapy). Many women prefer to delay their decision because it is emotionally too difficult to make at the time. Breast reconstruction is a major surgical procedure and options must be thoroughly investigated. During surgery, clinical decisions are sometimes made where further treatment may be necessary and so, even if a woman has requested breast reconstruction beforehand, such surgery is impossible at the time. Breast reconstruction is deemed ‘low priority’ and a woman doesn’t have a hope of being seen in public within six months. She must choose reconstruction at the time of her initial surgery and if further treatment is needed or initial surgery reveals unexpected problems, she’s just out of luck. It is standard practice worldwide to offer women access to reconstructive surgery after a single or double mastectomy for breast cancer. It is barbaric to deny breast reconstruction to women in order to tidy up hospital waiting lists. It places even more pressure on women who are struggling to cope with the stress of a breast cancer diagnosis.”

Women take action - The Reconstructables
Cambridge-based Raewyn Calvert (pictured) was so angry over the Ministry decision that she decided to take action. She gathered together a group of women who shared her concerns, sought support through BCAC, and 'The Reconstructables' became a group to be reckoned with. Some of the Reconstructables women had been waiting for reconstructive surgery and were removed from surgical lists during the MoH cull. The Reconstructables joined with BCAC to launch a project to raise awareness of this inequity within the public system - the 2007 Black Pearls Calendar. Raewyn traveled to Wellington with copies of the Calendar and ensured that every MP received one. The Calendar features images of women who have had breast cancer surgery without reconstruction and is now a keepsake and testament to the commitment and courage of the women who took part. Copies can be purchased through the BCAC website.

The situation in 2008
Since the June 2006 press release, the MoH subsequently allocated additional funds for surgery. Some women are now being seen within six months and have the choice of delayed reconstruction - but not all. It depends where they live.  BCAC has been monitoring the situation and is aware that not all DHBs are offering delayed breast reconstructions, particularly as they have been given the lowest priority ranking. Raewyn and The Reconstructables want the same opportunities to be available for women in all parts of the country.

“1 in 8 women will be diagnosed with breast cancer at some point in their lives,” said Raewyn. “Many will have a mastectomy. This is how they will see themselves in the mirror every day for the rest of their lives if they are not given the choice of reconstruction within our public health system. The goal of the Reconstructables is to ensure that every New Zealand woman who chooses to have a breast reconstruction following breast cancer surgery is guaranteed that option. Some of the Reconstructables have since had their breast reconstructions because they have the good fortune to live within the two DHBs where this is now possible – Auckland and Waikato. We want the same opportunities to be available for women no matter where they live.”

Raewyn is planning to contact those DHBs not offering this option for women. She welomes enquiries and also wants to hear from women who have encountered difficulties receiving reconstruction through the public health system.

To contact The Reconstructables please phone or email:
Raewyn Calvert
Ph/Fax: (07) 823 3955
Mobile: 027 248 4204
Email: rian.calvert@xtra.co.nz

The Black Pearls Calendar
by Raewyn Calvert
(Visit BCAC's shop to order your keepsake copy!)

The 2007 ‘Black Pearls’ Calendar was put together by a group of breast cancer survivors to raise awareness of every woman’s right to breast reconstruction following surgery for breast cancer. The women who posed for the calendar did so from the heart with the support and blessing of their loved ones. It took immense courage and was not done for the good of the individuals, but for the well being of all New Zealand women. The women featured in this calendar believed in the importance of choice being available for all New Zealand women who find themselves in this situation.

Many women, including some of those pictured in the calendar, were deleted from hospital waiting lists for their breast reconstruction surgery and sent back to GPs.  In some cases they had been on a list for two years and believed their surgery to be imminent. It was a devastating blow. For women who had been through surgery, radiotherapy, chemotherapy, hormonal and other treatments and wanted to put breast cancer behind and get on with their lives. 

Sadly, many women are still confronted by the disease every time they look in the mirror. We know that not all DHBs are offering the option of delayed reconstruction.

The goal of our group, the Reconstructables, is to: “Ensure that every New Zealand woman who chooses to have a breast reconstruction following breast cancer surgery is guaranteed that option.”

Artist Shirley Strom and her fund raising exhibition (opening 19 June 2008, 6pm)
(See Shirley's work 19 June - 2 July 2008 at Gallery Frames Ltd, 14 Ganges Rd, Khandallah, Wellington).

Wellington woman Shirley Strom was caught up in the 2006 waiting list cull. She also faced the shock of a Her2 positive diagnosis and the prospect of having to pay thousands for Herceptin – something she could not afford. “Breast reconstruction after a mastectomy is not just cosmetic,” says Shirley. “It is a crucial step in a woman’s wellbeing and recovery from fighting cancer, both physically and psychologically. I had already accepted that I was unable to have Herceptin because of the unaffordable $100,000 price tag. I was recovering from my own mastectomy at the time, with a second lot of chemotherapy plus radiotherapy still to come. I was utterly devastated when my specialist then informed me that the likelihood of getting my three times promised reconstruction was now extremely slim, because of the cut-backs on waiting lists.”

To raise funds for her reconstruction ($25,000 - $30,000 is needed) and to heighten awareness of those women who are still being denied the choice of delayed reconstruction within the public system, Shirley is holding a Breast Reconstruction Fundraising Exhibition from 19 June – 2 July at Gallery Frames Ltd, 14 Ganges Rd, Khandallah, Wellington. The show will feature Shirley’s art and works donated by other New Zealand artists.

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