Breast cancer is the most common form of cancer contracted by women in Australia, with a one in nine risk factor.

The surgical removal of breasts is one of the treatment options for breast cancer. Those who undergo breast removal surgery have the option to wear breast prosthetics or have breast reconstruction surgery.

A woman’s risk of contracting breast cancer increases with age. About 75 percent of breast cancers are detected in women over the age of 50, particularly in those between the ages of 50 and 69. Current statistics show that fewer than 6 percent of women diagnosed with breast cancer are younger than 40 years of age. Estimates also show that by 2015, approximately 15,409 Australian women will be diagnosed with breast cancer.

Breast cancer rarely occurs in men. It accounts for only about one percent of cancers in men and one percent of breast cancer overall.

Women with a history of breast or ovarian cancer are at higher risk of developing breast cancer. Radiation exposure, obesity, excessive use of alcohol, and postmenopausal hormone therapy can also increase this risk.

Between 5 to 10 percent of cancers are caused by inherited genetic mutations and a history of breast cancer in the family. Mutations in two genes, referred to as BRCA1 and BRCA2, greatly increase the risk of developing cancer.

There are genetic tests to find out whether you have inherited defective BRCA genes from your parents. Having the mutations does also not necessarily guarantee that you will develop either type of cancer. It simply shows that you face a higher risk.

Because early detection can save lives, breast cancer awareness focuses on the need for regular breast self-examination, mammograms, and early diagnosis.

Risks can also be reduced through lifestyle modifications, including regular physical activity, restricted consumption of alcohol and animal fats, and avoiding hormone replacement therapy (HRT) and weight gain after menopause.

Treatment options

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.

Possible risks and complications

Reconstructions are mostly performed on women who have early stage breast cancers.

Whether a person is a suitable candidate for breast reconstruction depends on how healthy the patient is, her body type, previous surgeries, and continuing cancer treatment procedures such as radiation or chemotherapy. Non-smokers in good overall health are the best candidates. Those who smoke, are obese, are in poor health or suffer from chronic diseases such as high blood pressure or diabetes may face a higher level of risk and complications. They may face more difficult or prolonged recovery periods. Surgeons consider a woman’s ability to physically cope with major surgery in assessing suitability.

As with any surgical procedure, there are risks involved in breast reconstruction. You should be fully aware of these before you consider reconstruction surgery.

The best way to reduce risk is to find a fully qualified surgeon with formal training in breast reconstruction who has performed the procedure many times.

Make sure you familiarise yourself with the list of complications that could arise as a result of any surgery.

Specific complications may depend on the type of reconstruction and may require additional surgery to correct.

For reconstructions with implants:

  • The implant may rupture or deflate.
  • You may experience a change in breast sensitivity.
  • Excessive scar tissue can lead to compression of the implant and force the breast tissue into hard and unnatural shapes. This is referred to as capsular contracture.

For breast reconstruction with skin flaps

  • You may experience a change in breast sensitivity.
  • You may lose sensation at the donor site from which the tissue flaps were taken.
  • Removing abdominal muscles may lead to abdominal wall weakness or hernia.
  • Radiation therapy after reconstruction surgery may lead to complications during the healing process. Sometimes doctors recommend finishing radiation therapy before proceeding with breast reconstruction.

Before and after surgery

Carefully follow your surgeon’s instructions on how to prepare for breast removal and reconstruction surgery.

You will be given detailed instructions regarding the postoperative healing period.

Rough costs involved

The cost of a breast removal and reconstruction will depend on the type of breast removal surgery and whether the reconstruction is immediate or delayed. The techniques used in reconstruction, the expected time taken for the procedure and the length of the hospital stay will also affect the costs.

All breast surgery associated with breast cancer is considered to be reconstructive surgery; not cosmetic surgery and therefore, covered by Medicare and health fund rebates.

This information is correct as of 2019.

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