2023-05-08 15:09:50
One less piece of oneself and one more fight to fight. When Catherine Cuvelliez Zarka had her breast removed seven years ago, her surgeon left her with these words: “Everything is fine now, you can go back to your life as before. “For her, it was over, since I was saved from cancer. But for me, it all started or almost, remembers this general practitioner installed in Savoy. Some women have to learn to live with a pocket after bladder cancer; I had to learn to live without a breast, with all that that symbolizes for femininity. »
Before being ill, the doctor always thought that if such an ordeal were to happen to her, she would choose breast reconstruction without hesitation. “But when the time came, I was lost”says Catherine Cuvelliez Zarka, who then began to read everything she could on the subject. “Being a doctor, I knew which sites to go to, but most women rely on forums, where the information is not always accurate”she regrets.
According to a survey of 1,179 women by the French National Authority for Health (HAS), a third of patients who started a breast reconstruction process had to make do with information they found out for themselves. It is to avoid this wandering that the HAS and the National Cancer Institute (Inca) have developed a shared decision support platform for patients and care teams. The aim of this tool unveiled at the end of March: to give “access to clear and educational information on all the possibilities offered” to promote dialogue.
Avoid regret
“When you see the patients, they are a bit drowned in information and emotion, emphasizes Doctor Jean-François Honart, plastic surgeon at the Gustave-Roussy Institute in Villejuif. In a few days, they had examinations, a biopsy, experienced the announcement of the diagnosis and the treatments to be undergone, seen the oncologist, the radiotherapist… The temptation is to go for the simplest. By giving them exhaustive and reliable information, this platform gives them a better chance of not regretting later,” he rejoices.
Far from being incidental“breast reconstruction is an integral part of the care to be offered after a mastectomy”, insists Professor Norbert Ifrah, president of the Inca. However, only a third of women use it. And the older they get, the more they give up this step: “between 30 and 50 years old, it’s one in two women, then one in three women between 60 and 69 years old”, reports Professor Ifrah. Sometimes by choice, often by default. “Today, we are young and later. No woman should deprive herself of this gesture if she wants to. is indignant the president of the Inca, who also underlines the weight of the rest to be borne. According to Catherine Cuvelliez Zarka, “many women don’t dare ask what their options are. I remember a patient who, ten years after her operation, still wore a foam prosthesis”she says.
Beyond the choice or not of reconstruction, there is the question of the technique used: implantation of a prosthesis, use of the patient’s own tissues to restore breast volume with or without microsurgery. “Each has its advantages and disadvantages and not all are possible depending on the location or the inflammatory character of the cancer, emphasizes Professor Ifrah. The fight against cancer remains the main objective. However, it is not because a technique is not possible that it should not be explained to the patient. »
The point on the techniques
A pedagogical work which, on the ground, is not always done. According to the HAS survey, 35 to 41% of women had no say in the technique used. “Most often, the women we meet did not have surgery because they did not want a prosthesisand have not been informed about the other techniques or have not had access to them”, assures Ester Lynne, co-founder and president of the Reconstruction sein info association. She herself went through this in 2005. She was then 33 years old and the firm intention of having a reconstruction by Diep (for « deep inferior epigastric perforator flap »), a technique that uses a combination of skin and fat along with blood vessels from the lower abdomen to reconstruct the chest.
“My surgeon was used to another method, the Tram, which uses muscle from the abdomen. Il explained to me what it was all about, but if I hadn’t asked him, he wouldn’t have told me that this technique prevented having children”is still moved by the president of the association, who ended up benefiting from the technique she wanted in another center – and giving birth to twin girls a few years later… “Sometimes the technique that suits you best is not in the establishment you attend but in the clinic opposite, it’s very unfair”deplores Ester Lynne, who therefore welcomes the development, by the HAS and the Inca, of an interactive map listing the establishments according to the techniques they practice.
For the time being, the offer remains unequal from one territory to another. “The techniques without implants have the advantage of being more natural, but they require a technical platform and microsurgical experience which are not present everywhere, even if this is developing more and more”says Doctor Jean-François Honart.
Immediate or delayed reconstruction
Another crucial question for women: temporality. If some patients have to or prefer to wait several months before reconstruction, “we favor immediate reconstructionwhen it’s possible “, explains Doctor Honart. « Not only does this have no impact on the management of cancer, but it allows the skin envelope to be kept and, in some cases, the areola and the nipple to be preserved, which was not done there. five years ago. »
This is what Adeline, just in her forties, was able to benefit from last March, a few months after being diagnosed with triple negative breast cancer, one of the most dreaded forms of the disease. “For me, staying with nothing was not possible, but if it had been necessary to wait three or six months, I might not have made up my mind”, she testifies, while acknowledging that the process was not easy. “When I woke up, I discovered a breast that was a little misshapen and smaller than expected because my skin was too thin for the size above. » A week later, he will have to change his prosthesis because of an infection. New operation, new awakening… But Adeline does not regret her choice. “Today, I find this breast beautiful”, confides the young woman, who plans to have her nipple tattooed.
Catherine Cuvellier Zarka, she finally kept a flat bust. “Whatever the technique used, the reconstruction involved going back to the operating room, experiencing new suffering, risking superinfections, does she expose. I was afraid that it would slow me down to resume my activities, go kayaking again, carry my backpack on hikes, live life to the fullest as I had always done. » As in mourning, denial gave way to tears and anger. “And then I ended up accepting, put my lingerie in the trash, gave up the strappy tops. » But not to swim in the lake on sunny days. The first few times, she hid a little behind her towel. Not anymore.
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Breast cancer, more common but a little less deadly
According to the National Cancer Institute (Inca), breast cancer represents 33% of female cancer casesmaking it the most common in this population.
In 2018, almost 59,000 new cases were counted, i.e. 0.6% more than in 2010 and almost twice as many as in 1990.
Breast cancer is the leading cause of cancer death in women. Between 2010 and 2018, the number of deaths fell by 1,2 %, but remains very high with 12,100 victims to be deplored in 2018.
In 80% of cases, breast cancer develops after the age of 50. The median age of diagnosis is 63 years old.
The five-year survival rate after diagnosis is 87 %. It climbs to 99% when the disease is detected at an early stage.
Environ 22 000 mastectomies are performed each year in France following breast cancer. Ablation is followed by breast reconstruction in approximately 30% of cases.
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