Since last year, breast cancer patients have been able to undergo mastectomies followed by immediate breast reconstructive surgery in Grand Cayman without having to travel overseas for the procedure.
Miami-based plastic surgeon Dr. Eduardo Barroso has been licensed to practice in the Cayman Islands since January 2011 and has been coming to Grand Cayman to work out of Chrissie Tomlinson Memorial Hospital in George Town and Dr. Sook Yin’s practice on a monthly basis.
The board-certified plastic surgeon, who has been in practice for 16 years, has worked with breast reconstruction patients from Baptist and South Miami hospitals, and has been visiting the Cayman Islands as part of Baptist’s international department since 2000.
“I have many patients from the Island that have come to Miami for surgery. Over the last several years, I had the great pleasure of meeting the Tomlinson family and they encouraged me to come to the Island in a more official manner. They offered me the opportunity to come as a visiting specialist to CTMH and … I have now been coming regularly on a monthly basis.”
Patients have the option of either going to his practice in Miami for surgery or having it done at Chrissie Tomlinson.
“The initial consultation on the Island saves the patient a trip to Miami and therefore is much more convenient. The patients also benefit since I can follow up on them after surgery on the island without an additional trip to Miami,” he said.
The first patient to undergo breast reconstruction surgery with Dr. Barroso at Chrissie Tomlinson was a 34-year-old woman who was diagnosed with ductal carcinoma in situ, the most common type of non-invasive breast cancer, in 2008.
The patient, a Health Services Authority employee who has asked not to be named, was told that she could not get both procedures – a mastectomy and reconstructive breast surgery – done at the same time because of the cost involved.
“I was walking around with one breast for two years,” she said. She finally had her breast reconstruction surgery done in November 2011, with another operation to lift the second breast and to reconstruct her nipple done in early March this year.
“The hospital gave me the option of going to Jamaica to get implants, but I didn’t want implants. I’d heard they have a shelf life of 10 to 15 years … The option was to go to Jamaica for the implants or live with one breast. I chose to live with one breast,” she said.
She looks back on that decision as a good one.
“I found out that Dr. Barroso at Chrissie Tomlinson was a visiting reconstructive surgeon. I made an appointment to see him when he came. He looked at me and asked why someone in the 21st century was walking around with one breast,” she said.
She says she is happy with the results of her surgery, saying she’s “perkier now than I was in high school”.
The operation involved removing fat from her stomach so that her own body’s tissue was used to create the breast. The upside of that aspect of the surgery is that she now has a totally flat stomach, she said.
“I’m very happy with the result. I am glad that I made the decision to wait,” she said, adding that she had not found the surgery painful and that being able to remain in Cayman and not travel overseas made recovery from the procedure easier.
Her cancer had been caught early enough so that she did not have to do chemotherapy or radiation.
Dr. Barroso advises the ideal time to perform a breast reconstruction is during the mastectomy, known as “immediate breast reconstruction following a total mastectomy”. “That procedure is performed during the same day and immediately following, or simultaneous to, the mastectomy,” he explained. “The advantages are numerous, including less overall time in the operating room, one less procedure, better aesthetic results, one less operation, and the patient waking up with a reconstructed breast.” He said doing both procedures in one operation helps with a patient’s recovery, both physically and psychologically.
“Countless studies show the patient’s overall recovery and ultimate outcomes are better. An immediate breast reconstruction is considered in the US the “Gold Standard” of care. Unfortunately, in Cayman, as in many other Caribbean islands, Central and South America, the resources are limited and the general surgeons resistant to performing immediate reconstructions. Therefore, it is more common to find patients who have undergone a mastectomy and seek reconstruction a later time, i.e. a delayed breast reconstruction,” Dr. Barroso said.
However, delayed breast reconstructions are still a viable option, the doctor said and he encourages all patients who have had mastectomies to seek a consultation regarding reconstruction of their breasts. “The benefits to patients are numerous. Not only is the body made whole, but patients’ self image, relationships with their spouses, confidence, ability to wear any garment, social life, sports activities, etc., all improve,” he said.
He has performed both immediate and delayed reconstructions at Chrissie Tomlinson Memorial Hospital. These included the procedure carried out on the 34-year-old patient, known as TRAM flaps (transverse rectus abdominus myocutaneous flaps), whereby a patient’s redundant abdominal fat and skin is used to reconstruct breasts.
“This is considered the “state-of-the-art” procedure in the US and, to my knowledge, we were the first in Cayman to successfully perform such procedures,” Dr. Barroso said. “This procedure is basically a “tummy tuck” where, instead of throwing away the excess tissue, we use it to reconstruct the breast. Patients get the advantage of a beautiful and trim abdomen with the added benefit of a new breast. The other technique commonly employed is reconstructing the breast with a temporary “tissue expander” and ultimately changing the expander for a permanent implant.
“I have personally experienced breast cancer in my family since my mother was diagnosed many years ago. Fortunately, she had the resources at hand to undergo the latest procedures and treatments available at the time. My mission is to ensure that all patients in Cayman are aware, informed, and educated as to the options available to them.
“No women should accept living with the unsightly chest deformity of a mastectomy when they can have a beautiful reconstruction. Insurance companies cover the procedure and now the procedure can be performed on the island.
“My hope is that as the information and knowledge of available reconstructive options spreads through the island, patients will seek consultations for not only delayed reconstructions but ultimately demand to see a plastic surgeon prior to their mastectomy for an immediate reconstruction. I think that if the island’s general surgeons knew that the option of an immediate reconstruction was available, many of them would take advantage of it,” he said.