Angelina Jolie is not the first woman in Hollywood to have a mastectomy. Sharon Osbourne, Christina Applegate, Olivia Newton-John and others have all trodden that path. They've all gone public about having reconstructive surgery too – but why are so few Irish women choosing to reconstruct what they have lost?

Research shows that women who have had breast reconstruction either at the time of mastectomy or later were happier with how they looked, were more confident in a social setting and more emotionally healthy and more satisfied with their sex lives than those who did not have reconstruction.

The figures come from a 2011 National Mastectomy Breast Cancer Audit, which captured data from more than 18,000 women treated at 270 UK hospitals.

Yet while the satisfaction of those who have reconstructive surgery is higher, only about 21 per cent of women in the UK are doing so, says consultant plastic surgeon at St Vincent's University Hospital, Dr Colin Morrison. He says the figures for Ireland on breast reconstruction are likely to be lower.

“I suppose historically, the focus was always on treatment of the cancer. Medically, people would have been happy if we got rid of the cancer and the patient survived,” Morrison says.

In fact, the US is the only country in the world where doctors are required by law to discuss reconstruction. “Everywhere else it’s up to the discretion of the treating physician or family doctor. They are not obliged to mention it,” says Morrison. But things are changing.

"Now we are asking, are these women happy after their treatment for breast cancer, have they returned to all their normal activities, do they feel comfortable at work and at home?"

Restored body image
Morrison is a board member of Beautiful ABC – 'ABC' stands for 'after breast cancer' – a global foundation that provides information to patients and medics about returning to a full life with restored body image after breast cancer.

“The premise is to improve patient’s awareness of breast reconstruction and the techniques available,” says Morrison. He says for some women, if they are given enough information and feel reconstruction is not for them, they can still return their emotional and physical wellbeing.

“It’s about empowering patients to make the correct decision for them.”

For those choosing reconstruction, the options include implants or using tissue taken from the back or tummy to reconstruct the breast.

Whether the reconstruction is done at the time of mastectomy or later depends on the patient. A mother with young children may want to get out of hospital quickly rather than have the additional recovery period of reconstructive surgery. For others, it might be more prudent to complete their cancer treatment and have reconstruction at a later date.

But Morrison notes that reconstruction doesn’t interfere with outcomes.

“Reconstruction is entirely safe. It doesn’t interfere with your cancer treatment and it doesn’t increase the chances of it coming back.

“If you go for an implant, it won’t interfere with your mammogram. You don’t have to have a mammogram of the reconstruction, it’s the other side you continue to mammogram.”

But how close a match to their own breasts can patients expect? “We can get a very close match,” says Morrison. Reconstruction of the nipple using tissue, or using an adhesive or tattooed-on nipple is also a choice.

For some women, reconstruction can also be an opportunity to have their breasts made smaller or bigger, he says.

“A women who has small breasts may ask for the reconstruction to be made slightly bigger and then have the other side augmented to match,” says Morrison.

“And the restoration of symmetry after mastectomy is all funded by the public service and would be within healthcare plans.”

Shortly after a mammogram last May, Ann Murtagh (52) from Churchtown, Dublin was told she had breast cancer.

“I had DCIS [ductal carcinoma in situ] – at that point it hadn’t become invasive but mine was ‘extensive and high grade’. The doctor said he was recommending a mastectomy on one side.”

At first, she didn’t think losing a breast would bother her.

“With me, it was like, I’ll get this sorted and it will be fine.” She had the operation in early June.

While she met Dr Morrison and was informed about reconstruction a decision was made not to proceed as doctors weren’t yet sure if the cancer had become invasive.

“It was all quite quick. But they wanted to do it because they were afraid it would become invasive so I just went ahead and had it done.

“I’m a very practical person. I thought it’s not going to bother me. It doesn’t matter, just get rid of it, it will be fine. But that’s not how it played out ultimately,” she says.

Uncomfortable prosthesis
After the mastectomy the wound was sore. Experiencing nerve pain, the prosthesis for which she had been fitted proved uncomfortable, so she just stopped wearing anything. "I had loads of scarves," jokes Murtagh.

"My sister said, 'you don't notice it', but I did. Also people who I met, they wouldn't mean to, but they'd know I had the operation, and I don't think they knew they were doing it, but they'd look at my chest. So I was conscious of it. Plus I had pain so I was particularly conscious of it."

Breast reconstruction
Last December, she was referred again to Dr Morrison and she underwent reconstructive breast surgery just last month.

“It feels good already,” says Murtagh. “I can wear a bra, but not for too long yet, but it doesn’t ride up and it fits.”

She underwent a DIEAP flap, or “deep inferior epigastric perforator” procedure, where tissue from the lower abdomen was used for the breast reconstruction. While the operation was long, 14 hours in her case, and she has a scar from hip to hip which feels tight as it heals, she’s happy with the result.

“I feel more myself,” she says. The nerve pain she had has also subsided. “Overall I’m pretty good and I’m pleased to have done it.”

The procedure was covered by her health insurance and she praises the care she received from BreastCheck and Morrison's team. "I kind of feel I've been on hold the past year. I'm hoping now, once I've recuperated I'll be back to my proper self."

The Beautiful After Breast Cancer Foundation hosts "A Musician & Her Surgeon' at the Royal College of Surgeons on June 18th. All proceeds from the classical music event go to the foundation.