After surviving cancer, a Chicago woman joins her surgeon to study racial disparities in breast reconstruction

After surviving cancer, a Chicago woman joins her surgeon to study racial disparities in breast reconstruction

Dr. Tokuya Williams wanted to become a heart surgeon when she began her medical studies.

But when she was diagnosed with breast cancer during her final year of medical school — which led to chemotherapy, a double mastectomy and breast reconstruction — she had to put off that plan.

But from that experience a new idea for her future emerged.

“As I progressed through my journey with breast reconstruction, I realized that’s what I wanted to do for the sake of my career,” said Williams, of Hyde Park. “The reconstruction was the only part that made me feel happy again.”

She decided to pursue plastic surgery to help other women rebuild their breasts after cancer, including black women like her who tend to undergo reconstruction at lower rates than white women. Now, about 10 years after she first discovered a lump in her breast, she’s working as a postdoctoral research fellow for one of her plastic surgeons, Dr. Robert Galliano, at Northwestern Medicine. It aids his research on racial disparities in breast reconstruction.

Breast reconstruction is surgery to recreate the breast after a mastectomy, which occurs when one or both breasts are removed, often due to cancer. It is a procedure that is covered by health insurance after a mastectomy and has, in many cases, been shown to be important for a woman’s mental health after breast cancer. About 43% of breast cancer patients underwent breast reconstruction in 2014, according to an article in The Breast.

Patients seeking breast reconstruction have several options, including the use of implants or the use of tissue from elsewhere in their body. As part of the decision-making process, patients often view pictures to get an idea of ​​what each option might look like.

Williams noted, however, while considering the path she should take to rebuild herself, that it was difficult to find photos of women of color who had undergone these procedures.

“I found that I really struggled to find representative images of different types of reconstruction for me,” Williams said.

Galeano also noted a lack of portraits of women of color. He already knew that black patients underwent reconstruction at lower rates than white patients. A 2017 study from the University of Pennsylvania found that even when women of color had private health insurance and lived in areas with many plastic surgeons, their breast reconstruction rates were 25% lower than white women.

Galeano, his students, and residents looked at the lack of images, and found that only 6.7% of the 2,580 breast reconstruction images posted by plastic surgeons on social media and websites were of non-white patients, according to a paper published in the peer-reviewed journal. Plastic and reconstructive surgery late last year.

“It impedes a black patient’s ability to make a fully informed decision if you can’t see the images that represent what they might look like at the end of this,” Williams said.

Williams and Galliano suspect that issues with scarring may be part of the reason for the lack of photos. Galeano said that for reasons that are still not fully understood, black patients often have more visible scarring after surgery than light-skinned patients.

“I think as plastic surgeons, we’re basically focused on the image,” Galeano said. “We really put in our best efforts. … The only thing that makes the result visually appealing is if the scars are of good quality and are not prominent and invisible. The problem is that women of color, judging only by biology, tend to have more noticeable scars. At least early.”

He said posting pictures of only white women who have undergone reconstruction is “harming our patients”.

Now, Williams is working with Galliano on studying ways to address the disparities between patients of different races in breast reconstruction. In his paper, Galeano and his residents and students speculate that it is possible that black women may have reconstruction at a lower rate than white women due to more visible scarring, socioeconomic factors, and a feeling in some societies that plastic surgery is a taboo, or a lack of appropriateness. Consultation before surgery.

Williams is now working on a computer program that patients can watch as they consider options for reconstruction, and consider how that program might help women of color in particular. It works with Galliano to improve scarring.

“When you feel like you have a mission in life, you work hard and you get emotional,” Galliano said of Williams. “She makes the most of her illness, of her trials and tribulations and tries to make it easier for the women who live behind her.”

Williams also hopes she can help address the disparities in part by becoming a plastic surgeon herself. Only about 3.5% of plastic surgery residents were black as of 2014, according to a study published in the Journal of Surgical Education.

“I think if we had more color-suckers who belong to those groups, that would be one way to get rid of that disparity,” Williams said.

She’s still working towards that goal – although it took longer than I initially expected.

Williams, who grew up in the southern suburbs of southern Holland, knew she wanted to be a doctor from a young age. As a violinist, she appreciated the versatility required of a surgeon.

After Williams was diagnosed with stage 2 breast cancer, she underwent chemotherapy, which necessitated her sabbatical from medical school.

“The chemo was horrible,” Williams said. “It really affected me, and I just had to put myself back together again after that year.”

Breast reconstruction was one of the few things she was looking forward to. For her, it represented a possible end to her cancer experience and filled her with hope for the future.

“I was like, ‘This is where I want to be when I interact with patients, this happy moment,'” she said.

However, its reconstruction was not without challenges.

Williams experienced a number of complications, including capsular contracture, which occurs when a hard scar forms around the implant, causing pain and other problems. She’s had more than six revisions, most recently in 2019 Galeano, who is an associate professor at Northwestern University Feinberg School of Medicine in the department of plastic surgery. Galliano did not rebuild the original.

In the end, Williams graduated from the University of Illinois School of Medicine at Chicago a year later than I expected. Generally, people who want to become plastic surgeons can go directly to plastic surgery residencies after medical school or do general surgery residencies and then go on to plastic surgery training.

After medical school, Williams completed initial training in general surgery and research at Stanford University and a fellowship in burn surgery at Cook County Health. She now hopes to finish her training in plastic surgery. Spots in plastic surgery residency programs are very competitive.

When Galliano mentioned earlier this year, in one of Williams’ appointments, that he was looking for a research fellow, Williams knew he would be a good fit. She hoped this would help her progress toward becoming a plastic surgeon. It has been researched on a topic you are interested in.

“When you have to come back and have more and more surgeries, it can be difficult to fall behind psychologically, so it takes a lot to stay strong and continue to achieve your goals in life,” she said. “Now I feel like I’ve finally come to a place where the work I do can be impactful.”

lschencker@chicagotribune.com

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