The Düsseldorf-born Berliner works in the promisingly named Brustzentrum in the gynaecology department at the Mitte campus of Charité – one of Europe’s largest university hospitals.
After 17 years of study, the breast cancer specialist now practices as an oncologist, surgeon, researcher and university lecturer – and unofficially, as a breast therapist for women facing cancer, the loss of their breasts and reconstructive surgery.
Dr. Richter-Ehrenstein has dedicated her lifework to breasts – and to those 58,000 women who are diagnosed with breast cancer in Germany every year.
Is Berlin reputed for breast research?
Not so much for research – compared to the scientific work being done at Nottingham or Milan or Amsterdam, we are a small team. There were major breakthroughs at Charité, with cervical cancer for example in the 1920s and 1930s, but with breasts we are not so specialised.
Do you get a real breast in your hand or is it all books?
It’s a mix. I spend about 30-40 percent of my time operating, then also conferences, research and management. Some days I spend all my time talking to outpatients; other days I’m in the operating theatre and it’s physically exhausting, but I’m mentally sharp because I don’t have to do any talking.
How do you separate breasts between your work and private life?
Breasts for me are very normal. I do a lot of psychological work with patients – I meet young women who want to have plastic surgery to make their breasts bigger or look different, and I think that breasts are over-focused on. They belong to women, but all this stuff about breasts is male-dominated. They belong to you, but you are a woman even without breasts. They’re as normal a part of your appearance as your eyes and hair.
Can you remember the first time you operated on a breast?
Oh yes. It was a long time ago, but it’s something you take to heart: “Oh, this is the breast.” My patients wear a bandage, and then after the operation we take off the bandage together when the woman says it’s okay. Many women cry. It used to be really hard for me. It’s part of my routine now, but it’s still difficult.
What do you like about your job?
I like the personal interaction. Oncology is a very personal field, a very broad field that affects the whole population. You have a long period of contact with patients, seeing them for 5-10 years sometimes as they return for check-ups. You know whose husband left them, who had kids, and you try to give them very open, honest information about the disease. These are women who are thinking, “I have cancer – I’m going to die,” and you tell them that only 25-30 percent of women die, that actually 70 percent are cured, you give them a feeling of trust.
So you feel like a therapist?
Oh yes. But you have to do it in a way that allows you to sleep at night. It becomes easier over time. Though you feel more vulnerable when patients are dying as you’re getting older.
How many women are diagnosed with breast cancer each year in Berlin?
About 3000-4000.
Is that a good survival rate compared to other countries?
It’s never nice to have breast cancer, but Germany is a good country. There is more cutting-edge research being done overseas, in countries like the US or Japan, but the level of care in Germany is much higher, because unlike a gynaecologist who might pop in for 10 minutes and then disappear, I work with my patients for long periods of time through all stages of treatment and recovery.
Do you remove and ‘replace’ breasts often?
About 80 percent of women have conservative surgery, and only 20 percent have breast ablations [removal]. Of that 20 percent, about 25 percent choose to have reconstructive surgery.
That’s not many…
Taking the breast away is the physical stage, but the scar is in your soul. So reconstructive surgery is a part of feeling physically healed. It helps a little, but if you already feel that way, it doesn’t do much in the end.
How is it to deal with women who’ve lost a breast or both?
A patient’s mental state is very important. It’s interesting though: studies have shown that often woman who don’t have reconstructive surgery resume their sex life just as quickly. Other women are suffering a lot. They feel that without a breast, they are not women.
About 25-30 percent suffer – the majority cope quite well though. They think, “I have to cope with this and I can.” I also work with a number of women – it is a special feature of Charité – who have generations of mothers, grandmothers, sisters and aunts who have had breast cancer and who have up to an 80 percent risk of getting it, and choose to have their breasts removed before anything happens.
How do your patients cope?
I think that women in Berlin are very emancipated and self-confident with a strong self-image. They don’t need to wear a fancy bra with two breasts in it to feel like a woman. They feel they’re complete in their personality. When they first find out, they are upset. They cry a lot and we give them time, but very quickly they are quite clear-minded and tough. They ask lots of questions and are very capable of dealing with their situation.
There are also practical everyday issues. For example, you can get swimsuits with inbuilt breasts. At the swimming pool, no one would notice any difference. That said, German women are quite private about their breasts. There is less sexualisation than in, say, America. I often go to Chicago for conferences and there, I see women wearing badges that say “I’m A Survivor.” That would never happen in Germany.
Does breast cancer scare you?
Not really. Everyone has some likelihood of getting breast cancer – one in 10 women get it… I get my check-ups regularly, and I know I have wonderful, qualified staff around me!
