Breast Reconstruction for Breast Cancer Patients

Common treatment options for breast cancer include chemotherapy, radiation and hormone therapy, and breast removal surgery. Depending on the type and stage of cancer at the time of detection, most women with breast cancer undergo a combination of these treatments. Prescription drugs that attack specific abnormalities inside cancer cells are called targeted drugs. More advanced combinations of treatments are being discovered all the time through research and clinical trials.

Surgical options depend on the stage of the cancer and the size of the cancerous growth. Most breast cancer surgeries involve the removal of the affected breast tissue (lumpectomy) or the total removal of one or both breasts (single or double mastectomy).  Women who undergo breast removal face additional challenges. They may feel disfigured and demoralised and feel they have lost an important part of their identity. They may also find it difficult to re-establish intimacy with their partners. These issues can have far-reaching implications in their lives and sense of wellbeing. Wearing false breasts (prosthetics) and having breast reconstruction surgery are two options available to women after breast-removal surgery.

Prosthetics

External prosthetics fit inside a bra to give a natural look while wearing clothes. They are usually provided by a doctor and used until a permanent prosthesis can be fitted. Some women find that wearing prosthetics can be uncomfortable and inconvenient, prosthetics, for instance, cannot be worn under swimwear.

Breast reconstruction

Breast reconstruction involves a series of surgical procedures to rebuild the breast after breast-removal surgery. Breast reconstruction is also an option for those with breast abnormalities or for those who have suffered trauma to the breasts, causing them to be deformed in some way.

Breast reconstruction rebuilds the breasts using an implant or tissue taken from another area of the body, such as the stomach or buttocks. A reconstructed breast will have contours similar to a real breast. It also provides symmetry to the breasts, especially under clothing or in a bathing suit. Reconstructed breasts will not, however, look exactly like natural breasts or be as sensitive as a natural breast would be.

Reconstructive surgery can help women regain self-confidence and provide an improved body image that partially erases any physical reminders of breast cancer. Reconstruction does not impede the detection or treatment of new cancers in the future.

Your surgeon will help you choose the type of reconstruction, depending on your body type and age as well as the cancer treatments you need to undergo.

Immediate or delayed reconstruction?

A breast reconstruction can be performed immediately following a breast or cancer removal as one combined procedure or afterwards, as a separate procedure.

Reconstructions are mostly performed on women who have early stage breast cancers. Surgeons do not recommend immediate reconstruction for women who need to undergo other, more important treatments that should not be delayed.

A reconstruction completed at the same time as breast removal might cost less than a delayed procedure, allowing the patient to return to normal activities sooner. It may also result in less scarring compared to the two procedures, necessary in a delayed reconstruction.

The disadvantages of immediate reconstruction includes having to be under a general anaesthetic longer, a probable higher level of post-operative pain, and a longer recovery period. Statistics in the US show that only 24 percent of women who undergo a breast removal opt for immediate breast reconstruction.

Breast reconstruction with implants

In breast reconstruction with implants, an implant is surgically placed behind the pectoral muscle of the chest, similarly to the way a breast augmentation is performed.

Breast implants are filled with either a silicone gel or saline solution. Those who prefer immediate reconstruction can have the breast implant placed at the same time as the breast removal. Most women, however, go through a two-stage process involving a tissue expander before having breast implants.

Tissue expansion prepares the chest for a breast implant by using a balloon-like device placed under the pectoral muscle. This is usually done during the breast removal surgery itself. Injecting saline gradually into the expander over a few months helps the skin stretch to accommodate the breast implant. It is natural to experience some discomfort during this period. A doctor, or a nurse under medical supervision, administers the saline injections into the tissue expander.

Once the tissue expansion process is complete, further surgery will be performed to replace the expander with a permanent implant.

Breast reconstruction with body tissue

Breast reconstruction with body tissue involves transferring tissue from another part of the body in order to fill the breast area. The transfer is done using either pedicle flap or free flap surgery.

In the pedicle flap method, the surgeon severs some of the blood vessels feeding the tissue flap, leaving others intact. The tissue is then tunneled across the body from the original donor area to the chest.

Free flap surgery involves removing the tissue from its blood supply and reattaching the tissue flap in the breast, using microsurgery to reattach blood vessels.

The most common form of flap reconstruction is named after the muscle and its location in the body.

• Abdomen TRAM flap surgery involves the removal of tissue from the abdomen using a procedure called transverse rectus abdominal muscle (TRAM) flap. The TRAM flap can be transferred using either the pedicle or free flap method. The whole of the rectus muscle—one of the four main muscles in your abdomen—is used.
• A free TRAM flap or a muscle-sparing free TRAM helps you to retain abdominal strength after surgery.
• Abdomen DIEP flap uses the deep inferior epigastric perforator (DIEP) flap. The procedure is the same as a muscle-sparing TRAM flap, but only skin and fat tissue are removed, leaving the stomach muscle intact. DIEP flaps are transferred as free flaps.
• A superficial inferior epigastric artery (SIEA) flap is a variation of the DIEP flap, which enables a less invasive type of flap surgery. It is only possible on women who have sufficient levels of SIEA blood vessels.
• Latissimus dorsi flap is a surgical technique that uses skin, fat and muscle tissue from the upper back. The tissue gets tunneled beneath the skin to the chest area. Because only moderate amounts of tissue are transferred in this method, it is best for reconstructing small or medium sized breasts or for making up pockets for breast implants. Some women experience muscle weakness in the back, arms and shoulders after surgery.
• Gluteal flap is a free-flap procedure using tissue from the buttocks. It is used on women who lack sufficient levels of tissue in their abdomens and backs.