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Paris Butler, MD, MPH, in honor of Breast Cancer Awareness Month

October 23, 2023

What inspires you to work as a surgeon?

I have the privilege of being an academic plastic and reconstructive surgeon. Like most plastic and reconstructive surgeons, I take a lot of pride in being able to restore form and function. This is exemplified by our post-mastectomy breast reconstruction patients, as I get to help restore their breast beauty, and in theory, help make them whole – not that we should focus purely on the physical. For many women being aware that we can help restore their breast beauty is beneficial to their outlook on their breast cancer journey, knowing that we can reconstruct what they previously had.

What advances in plastic and reconstructive surgery have made the biggest impact in the treatment of patients with breast cancer over the last five years,and what is the outlook for the next five years?

In the last five years, I think that, generally, we’re getting better at our reconstructive options. In the US, 70 percent of the time plastic surgeons are using an implant to reconstruct the breast mound and about 30 percent of the time we’re using another part of the patient’s body (autologous) to reconstruct the breast mound (also known as “flap surgery”). With both of those options, there have been significant advancements. The newest generation of breast implants, I believe, are more sturdy, have been thoroughly studied for safety, and are more lifelike and realistic than prior generations. On the flap surgery side, we have better imaging for planning, and we have enhanced the efficiency of our operative times. It was commonly 12+ to hours to complete these operations and now many plastic surgeons are doing it in 6 to 8 hours. Additionally, robotic surgery and other minimally invasive techniques have been adopted in breast reconstruction. This has significantly improved the donor site morbidity, which is most commonly the abdomen with rates of hernia or bulges greatly improving. And finally, because we have more surgeons than ever trained in micro-surgery, there is slowly improving access for patients to plastic surgeons trained in offering the full spectrum of breast reconstruction options.

What challenges does society face in reducing the disparities in breast cancer outcomes for minority women?

When I think about the challenges we as a country face when it comes to breast cancer care, we still have access issues. Where a person resides continues to play a large role in the overall care they receive. Whether it’s their medical oncology, their radiation oncology, their breast surgery, or their reconstructive surgery, all are impacted due to our country’s inability to create a system where everyone has equitable access. On the reconstructive surgery side, there are two subsets of the US population that do not receive post mastectomy breast reconstruction at the same rate of others. Those are women over 55 and women of color – Black and Latino women, in particular. You likely have read or been informed that, unfortunately, Black women, die from breast cancer at a higher rate than majority (white) women, and that Black women are diagnosed at later stages of breast cancer than majority women. But you are likely unaware that Black women receive breast reconstruction at about half the rate as majority women. So, as a plastic and reconstructive surgeon with an MPH who very much cares about healthcare disparities, I have been driven and committed to help mitigate that disparity. By helping to shed light on this disparity and promoting outreach efforts to underserved communities, we are beginning to see an uptick in the number of Black women receiving reconstructive surgery. Generally speaking, appropriate and equitable access is likely the biggest challenge I see in our country when it comes to the breast cancer journey.

Submitted by Eliza Folsom on October 23, 2023