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Recent advances in breast cancer diagnostic and management allow for
breast preserving treatments. However, a large group of patients require
mastectomy which adds significantly to the emotional and physical stress of
breast cancer diagnosis and treatment. Depression after mastectomy is very
common and resembles mourning in the same way as individuals would mourn
the loss of a loved one. Negative psychological consequences of mastectomy
can be significantly reduced by breast reconstruction.
Breast Reconstruction is physically and emotionally a rewarding
procedure for a woman who has lost one or both breasts because of cancer or
other disease. Breast reconstruction is possible through several methods.
These procedures attempt to restore a breast to near normal appearance.
These techniques may include:
1-
The use of patient’s own tissue (autologous) reconstruction to
create or cover the breast mound.
2-
Expansion of the remaining skin and tissue over the chest area to
provide coverage for a breast implant.
3-
Placement of an implant to create a breast mound.
4-
Various techniques for recreation of the nipple and areola.
Breast reconstruction typically requires more than one procedure. It can
begin at the same time as mastectomy or can be delayed until a patient has
healed from mastectomy and recovered from any additional cancer treatment.
Patients need to be emotionally ready for breast reconstruction. Similar
to losing a breast it may take some time for a woman to accept the results
of breast reconstruction.
At times, additional procedures may be required for the unaffected side
to achieve better symmetry. These procedures include breast lift, breast
reduction or augmentation.
Through hard work of the American Society of Plastic
Surgeons (ASPS®) and many breast cancer support groups, health insurance
companies are required by law to provide coverage for breast reconstruction
and related procedures to adjust the opposite breast.
Ideal Candidates
Breast reconstruction can be performed at any time following mastectomy. Most frequently it is performed immediately following tumor removal (mastectomy). This enables the patient to wake up from surgery with a breast mound in place, sparing a woman the experience of seeing herself with no breast at all. Virtually any woman who must lose her breast to cancer is a candidate for reconstructive surgery.
Reconstruction has no known effect on recurrence of disease in the breast, nor does it impair the detection of recurrent disease. Breast reconstruction also does not generally interfere with postoperative chemotherapy or radiation treatments, if needed.
Bilateral breast reconstruction is possible is certain candidates. Both
implant and autologous methods may be suitable for this purpose.
The Preoperative visit
The patients are usually referred to the plastic surgeon as soon as they are diagnosed with breast cancer. Consultation for breast reconstruction is usually performed in conjunction with the other physicians involved in the treatment of your breast cancer. This team approach usually involves your primary doctor, surgeon and oncologist. The Consultation consists of a thorough discussion of the patient's history, expectations and concerns. A thorough physical examination and evaluation of the patient's breasts will be performed. A discussion of the available reconstructive options, including their advantages and disadvantages, will be reviewed, including possible results, limitations, and risks involved. Certain variables affecting patient’s options, risks, and outcome are discussed. These variables include the patient's medical history, age, height and weight, body shape, and the size and shape of the breast to be reconstructed. Photographic examples of the possible procedures will be reviewed with the patient at the time of her consultation.
Options:
Implant
reconstruction combines the technique of skin expansion with subsequent
insertion of a permanent implant.
Autologous
Reconstruction (Flap reconstruction) involves creation of the breast mound using
the patient's own tissue. This tissue may come from the back or, more commonly
the abdomen. The tissue remains healthy because it has its own blood supply.
When a woman's abdominal tissue is used to reconstruct the breast, it is
referred to as a TRAM flap. The abdominal wound is then closed, giving the woman
a "tummy-tuck". There are variations in the surgical technique used to transfer
the tissue. Please refer to the sections under
TRAM,
DIEP, SGAP, and Latissimus
on this website for more information
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