Breast reconstruction following breast Cancer
Breast reconstruction following breast Cancer
Breast reconstruction following breast Cancer
Objectives
Patients diagnosed with breast cancer are usually going through a very particular and challenging time in their lives.
Breast reconstruction is now considered an integral part of breast cancer treatment. There is abundant literature indicating the positive impact that breast reconstruction has on the quality of life of patients in numerous aspects (psychological well-being, self-esteem, interpersonal relationships, social well-being, sexual relations, etc.).
Our main objective as plastic surgeons is to accompany the patient and their family during this process and advise them on the best reconstructive surgery option for their specific case.
There are numerous techniques for breast reconstruction, and the technique selected for each patient will depend on various factors and must be discussed between the patient and plastic surgeon to make a joint decision based on:
-Type of surgical procedure to be performed: lumpectomy, quadrantectomy, mastectomy with or without preservation of the nipple-areola complex.
-Type and duration of associated treatments: chemotherapy, radiotherapy, hormone therapy, etc.
-Patient’s physical characteristics: breast size and position, chest characteristics.
-Patient’s desires: the most important factor that will lead to the choice of the indicated technique being made jointly between patient and surgeon.
Indications
Breast reconstruction is indicated in:
- Partial breast tissue resections: lumpectomy, quadrantectomy.
- Total resections of unilateral or bilateral breast tissue: mastectomy with or without preservation of the nipple-areola complex.
- Patients with BRCA mutation candidates for bilateral prophylactic mastectomy.
General information
- All women are candidates for breast reconstruction following breast cancer surgery.
- The goal of breast reconstruction is to restore a woman’s body integrity by recreating the breast so that the woman feels and looks complete and without permanent loss of part of her body that may harm her daily life. Women with breast reconstructions can wear clothing without any restrictions, problems, or the need for an external prosthesis, engage in physical activity without issues and lead a normal life.
- You should discuss all breast reconstruction techniques with your reconstructive surgeon. Remember that not all surgeons are familiar with all surgical techniques and therefore will not offer them as an option. Especially those in which the reconstruction is performed with tissue brought from another body area (free flap reconstruction), which is currently considered the gold-standard technique (best available technique) and is not performed by all plastic surgeons.
The breast reconstruction techniques are as follows:
- Reconstruction with tissue from another part of the body (flap) brought from a distant area or microsurgical-free flap. It is currently considered the best reconstructive technique and the most natural.
- Reconstruction with tissue from another part of the body (flap) brought from a nearby region or pedicled flap.
- Hybrid reconstruction with tissue from another part of the body (flap), fat (lipotransfer), and breast implants.
- Reconstruction with tissue expander and implants or two-stage reconstruction.
- Direct or definitive implant-based reconstruction or one-stage reconstruction.
- Oncoplastic reconstruction with the patient’s breast tissue in lumpectomies or quadrantectomies.
Breast reconstruction can be performed at different times:
- Immediate breast reconstruction: performed at the same time as the mastectomy. The result is usually more natural, and fewer surgeries are typically required to complete the reconstruction.
- Delayed breast reconstruction: performed in a separate procedure after the mastectomy. This may be by the patient’s choice who does not want to undergo reconstruction at the same time as breast cancer treatment because breast reconstruction was not offered at the time of mastectomy, or because the patient was not in physical or psychological condition at the time of mastectomy to undergo such an extensive surgery.
- Other adjunctive procedures serve to complete breast reconstruction in some cases, such as nipple reconstruction with flap or areola tattooing.
