The breast surgery question

Wednesday August 7 2019

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By Daily Nation

The modern-day woman is an amazingly confusing creature. The transition taking place in the female space around the world is mind-boggling. This has confused many, from parents who have raised them and continue to watch over them to men who have to interact with them daily at work, in social places or even in their private lives.

These are the women who can’t cook even if their lives depended on it despite the societal expectations of a “woman’s responsibilities”.

They will spend their whole youth focused on climbing the corporate ladder, instead of settling down in marriage or will spend months in a submarine, leading a testosterone-laden team in setting up technology systems without a care in the world.

While the world adjusts to the new female culture, the medical world has not been spared. My average first time mother is no longer in their 20s. Many are one step away from 40 and are having children on their own terms.

DEMAND BOTOX

A good number of clients are seeking information on services that enable them to preserve their eggs for future fertility. This is not because they are undergoing chemotherapy. It is because they don’t find it convenient to get pregnant right now, and they don’t want to miss the motherhood boat.

Many have opted out of normal birthing and prefer to have their babies via caesarean section simply because they want to exercise their right to choose. The vaginoplasty industry is thriving as some women demand vaginal reconstruction after childbirth.

While many conservative doctors are used to dealing with patients with life-threatening illnesses who are seeking relief, the demand for services in the medical cosmetics field is growing fast. This is no longer a service for the movers and shakers of Hollywood.

Cosmetic dermatology has grown over the last few years, with patients demanding botox, laser hair removal, dermabrasion and many other services. Cosmetic dentistry is also gradually expanding from just tooth alignment to whitening via various methods, capping, and expensive implants. Additionally, the number of trichology (hair and scalp) centres mushrooming around the city is a clear indication of their need.

BREASTFEEDING ABILITY

However, the one industry that has explosively grown is aesthetic plastic surgery. And women make up the highest number of clients. Several plastic surgery units have set up shop in Nairobi while aesthetic surgeries take up more and more theatre space in private hospitals around town.

At the beginning, few women would openly admit to going for plastic surgery as it was deemed to be a sign of vanity. Right now, women are openly seeking information on service providers and are happily going under the knife to modify every body part imaginable.

However, while the existing assumption has been that this is driven by a woman’s desire to be more attractive to men, there is an emerging species of women who couldn’t be bothered about public opinion.

These are high-achieving women, high up the social ladder, who do not aspire to please the dozens of suitors who may be interested in them. They will nip and tuck various parts of their anatomy for their own pleasure.

Cheryl* is one such lady. Well-endowed in the African sense, she causes ripples among the males on the table when she declares she would like to have breast reduction surgery. While to many she has an enviable bra-size, she prefers a much smaller fit. She does not suffer from back, shoulder or neck pain. She just wishes to reduce her bust.

SPARE NIPPLE

Cheryl can easily afford her surgery and so money was not her issue. Her main concern is that she wants to have her cake and eat it. She is seeking the opinion of the plastic surgeon on the table on the impact of breast reduction surgery on future capacity to breastfeed. She is not ready to have a baby right now and the doctors she had consulted advised her to finish with motherhood first.

Cheryl feels the doctors she had spoken to are failing her as a patient. She is concerned about the Cheryl of today. The one who wants a breast reduction surgery and feels good about herself. Not the Cheryl who may be a mum in the next decade. The future Cheryl may even change her mind about being a mum or even wanting to breastfeed. However, today, she does not want the procedure done to deprive her of the joys of breastfeeding in 2030, should she choose to have a baby then.

This is the reality of the practice of medicine today. It takes a lot of professionalism for the doctor to dissociate from their personal opinions and objectively provide a patient with information about their medical requests, the advantages, disadvantages, alternatives, expected outcomes of the interventions and complications that may arise. It is after provision of this information that a patient can make an informed choice, even if it is not the choice the doctor prefers.

Cheryl is scheduled for her breast reduction surgery in the next few months. She is informed that the surgeon will perform a type of surgery that spares her nipple, areola (the dark part surrounding the nipple) and some of the core tissue underneath the nipple, tracking all the way to the chest wall. The success of the procedure in sparing breastfeeding potential is about 75 per cent.

When she is ready to have the baby, we do hope she won’t have to struggle too much to feed her little one, most especially keeping in mind how important exclusive breastfeeding is for the little one for the first six months. Should she need support from us, our professional responsibility is to provide it without judgment!

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