She had a one-year-old and a second child on the way when Trina found the five-and-a-half centimetre tumour in her breast.

It was an aggressive breast cancer, doctors told her, and they were concerned it would spread rapidly if not treated immediately and fought with equal vigour.

Pregnant and just 32 years old, Trina (not her real name) had her right breast removed and underwent radiation and chemotherapy – a frightening and nauseating process that caused the loss of her hair and put her unborn child at significant risk.

But her second daughter lived. And Trina had yet another reason to do the same.

After childbirth, the young mom made the decision to have her remaining breast removed as well, thus reducing the odds of another tumour cutting her life short.

• • •

Today, two years after her bilateral mastectomy, the now-34-year-old is in day surgery at Surrey Memorial Hospital (SMH) with Dr. Adrian Lee to complete the final stage in what has been a year-long process to completely reconstruct her breasts.

Last October, she had tissue expanders put in her chest which function like balloons, stretching the skin to allow enough room for implants. (Because she had received radiation on her right breast, the skin was much less elastic, so Dr. Lee utilized tissue from the lateral muscle on her back during the reconstruction).

Then in February, saline implants were inserted on both sides and nipples were formed.

Now seven months later, the doctor, who has treated Trina for about two years and knows her well, checks that her scarred breasts have healed well and are uniform.

“The number-one goal is for her to live long and see her kids graduate,” Lee says.

• • •

Trina proceeds to lie down on the exam table, her torso exposed.

She’s about to get her first tattoos.

“In terms of the stigma with breast cancer, until the nipple and areola is tattooed, it doesn’t look like a breast,” Lee explains. He encourages his patients to complete the full reconstruction process. It’s much more than cosmetic, Lee says, and can be a key part of a woman’s recovery from breast cancer.

He asks the patient what colour she would like to which she smiles and shrugs, “I don’t know. I trust you.” The process seems trivial to her in comparison to what she’s already endured.

The doctor mixes two colours, sets up his tattoo machine and gets to work, shading circles on Trina’s breasts with a six-pronged vibrating needle. It doesn’t seem to cause her any pain and the process is over quickly.

• • •

Whereas in the past, a woman would typically have a mastectomy and maybe return five or six years later for a reconstruction – when deemed cancer free – nowadays the service can be offered almost immediately after a mastectomy. It takes some close coordination between general surgeons and plastic surgeons, but is done regularly at SMH.

“We basically promise it,” says Lee, noting 70 per cent of his surgeries are breast constructions. “What we’ve seen over the last 10 to 15 years is how much better it is for the woman, psychologically, to wake up with a reconstruction done.”

(In Trina’s case, that immediacy wasn’t possible due to her pregnancy).

• • •

The plastics department at SMH consists of three surgeons (Lee, Dr. Rizwan Ahmad Mian and Dr. Paul Oxley), and Janet Hildebrand, a registered nurse who is a breast cancer survivor herself and has spent the last 14 of her 25 years at SMH as a clinical resource nurse with the hospital’s plastic and reconstructive surgical team. The surgeons perform more than 1,100 surgeries a year, 200 of which are breast reconstructions. A new breast health clinic is due to open in the new health care tower at SMH in 2014.

“More than anything, we’d like to be able to get a woman who’s found a lump in the shower in within two weeks,” Lee says.

• • •

Before he sees Trina off, Lee recites some care instructions for the patient’s new tattoos and arranges a follow-up appointment.

“I would like to thank you, Dr. Lee, for everything,” says the grateful patient.

She quickly hugs the doctor, but is soon on her way.

After all, there are two little girls waiting for her at home and she’s got a life to live.

Plastic surgery facts:

• There are three plastic surgeons at Surrey Memorial Hospital.

• They perform more than 1,100 surgeries a year.

• SMH offers immediate breast reconstruction surgery to many breast cancer patients.

• The three plastic surgeons take part in more than 200 breast reconstruction surgeries a year.

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