Breast Reconstruction
Breast reconstruction is usually performed after a mastectomy or removal of the breast, usually for breast cancer. Breast reconstruction may be performed either immediately following the mastectomy or delayed for a certain period following the mastectomy.
Immediate breast reconstruction is done at the same time as the mastectomy while delayed breast reconstruction can be performed anytime after the mastectomy, upon completion of the treatment for the breast cancer with chemotherapy and / or radiotherapy.
Safety of Breast Reconstruction
It has been clearly documented that breast reconstruction do not
affect the long-term survival of breast cancer patients. In other
words, weather a breast reconstruction is done or not, this does not
affect the outcome of the breast cancer.
On the other hand, it has also been clearly demonstrated that breast reconstruction has a profound positive effect on the psychological well being of patients. Patients feel better and is less phychologically affected by the mastectomy because the breast has been reconstructed. Patients can also go about their daily activity with less restrictions, such as putting on their clothes and going swimming.
Immediate Breast Reconstruction
The breast may be reconstructed immediately following removal of
the breast cancer. With immediate breast reconstruction, the breast
surgeon would employ a slightly different approach with the
mastectomy, usually this would be what is called a SKIN SPARING
MASTECTOMY. With the skin sparing sparing mastectomy
technique, the skin of the breast (that is healthy and not affected
by the cancer) is preserved. Preservation of the skin is
advantageous because the natural breast skin gives a more natural
shape to the breast when filled with either your own tissue or an
implant.
Delayed Breast Reconstruction
This is when the mastectomy has been performed some time ago
and patients would like to have her breast reconstructed. As the
skin of the breast has been removed (usually leaving a straight
scar), both additional skin and the breast would need to be
reconstructed.
Techniques of Breast Reconstruction
The breast may be reconstructed with one of several methods. Your
own tissues or implants may be used.
Breast Implants
Implants may be used for breast reconstruction in immediate breast
reconstruction as the skin envelop of the breast is still available.
The benefit of breast implant based reconstruction if that no
additional cuts or incisions are needed and the procedure can be
completed in a relatively short period of time. There are limitations
of the procedure as the soft tissues covering the implant are quite
thin as the breast has been removed. The implant may be palpable
or visible because of the thinness of the tissues covering it. To
reduce the palpability of the implant, products (such as AlloDerm®
and DermaMatrix®) made of donated human skin to support implants
may be used. These are known as acellular dermal matrix because they
have had the human cells removed. They are used to support natural
tissues and to thicken the tissues covering the breast implant and has
been shown to be effective and safe for this purpose.
The limitations with the use of the implant may need to be changed
in future due to wear and tear of the implant as well as issues such
as excessive scarring of the tissues around the implant (Capsular
contracture).
Breast reconstruction using your own tissue (flap procedures)
A tissue flap procedure is one option to reconstruct the shape of your
breast after surgery to remove the cancer. The tissue used for a flap
procedure comes from somewhere else on your body, such as your
tummy or back.
In general, flaps require more surgery and a longer recovery than breast
implant procedures. But when they work well, they look more natural
and behave more like the rest of your body. For instance, they may
enlarge or shrink as you gain or lose weight.
The tissues available for breast reconstruction most commonly are from
the back or the lower abdomen.
Latissimus dorsi flap
The latissimus dorsi flap is a reliable and good flap for breast
reconstruction, usually used with a breast implant. For this procedure
the latissimus dorsi (a back muscle) with some overlying skin is brought
to the front of the chest for the breast reconstruction. This provides
added coverage over an implant and makes a more natural-looking
breast than just an implant alone. This type of reconstruction can
sometimes be used without an implant.
Abdominal flaps (TRAM and DIEP)
The TRAM (transverse rectus abdominis muscle) flap procedure
uses tissue and muscle from the tummy to reconstruct the breast. Most
women have enough tissue in this lower abdomen to shape the breast
so that an implant would not be needed. The skin, fat, blood vessels,
and the abdominal muscle are moved from the belly to the chest. The
TRAM flap also results in a tightening of the lower belly, or a “tummy
tuck”. A TRAM flap may not be possible in women are very thin or who
have had abdominal tissue removed in previous surgeries.
A pedicle TRAM flap leaves the flap attached to its original blood
supply and tunnels it under the skin to the chest. It usually requires
removing most if not all of the rectus abdominis muscle on that side.
There is a risk of bulging and/or hernia on one side of the abdomen.
A free TRAM flap moves tissue (and usually less muscle) from the
same part of the lower abdomen, but the flap is completely
disconnected and moved up to the chest. The blood vessels (arteries
and veins) must then be reattached. This requires the use of a
microsurgery to connect the tiny vessels and the surgery takes longer
than a pedicle TRAM flap. The main risk is that sometimes the blood
vessels get clogged and the flap doesn’t work.
For a detailed understanding of the procedure please visit us for a consultation.