August 20, 2022
HCG Nasik Team,
August 20, 2022
HCG Nasik Team,
Breast reconstruction surgery is performed to reconstruct the breast after mastectomy or lumpectomy. The procedure may be during or after breast cancer treatment. It is important to understand the important aspects of breast reconstruction surgery.
The important thing that you need to consider is the requirement for breast reconstruction surgery. Before advising you on breast reconstruction surgery, the doctor comprehensively evaluates the cancer stage, size of the tumor, scope of cancer treatment, and overall health.
The parameter used to decide the type of breast surgery is a tumor-to-breast ratio. If the tumor size-to-breast ratio is less than 20%, the doctor may suggest you undergo breast preservation surgery. In such cases, breast reconstruction is not required. However, breast reconstruction surgery is recommended if the ratio is above 20%.
Breast reconstruction surgery is contraindicated in several instances. These cases include obesity, severe cardiac or lung disease, unstable emotional history, collagen vascular disease, advanced breast cancer, smoking, and the patient is not willing to quit smoking, age over 65 years, prior radiotherapy, and prior thoracic or abdominal surgery that prevent or reduces the blood flow to potential flaps.
Your doctor may advise you to undergo immediate or delayed breast reconstruction surgery. Both options have their advantages and disadvantages. The doctor will decide the timing of the surgery based on individual conditions.
In the immediate breast reconstruction surgery, the surgeon will reconstruct the breast during lumpectomy or mastectomy. The ideal candidate for immediate surgery should be healthy with low-grade cancer and have less chance of undergoing radiation therapy after the surgery.
The advantages of immediate surgery are improved psychological health, fewer procedures, and native skin and nipple preservation (possible). Disadvantages of immediate surgery are longer surgery and recovery and the risk of the requirement of post-surgical cancer treatment due to the unknown biology of the tumor.
Delayed breast reconstruction surgery is done months or years after the lumpectomy or mastectomy. The doctor advises delayed surgery in patients who cannot tolerate long procedures and long recovery time, have high chances of requiring post-surgical cancer treatment, and have multiple risk factors, such as diabetes, smoking, and vascular disease.
Advantages of delayed breast reconstruction include significant time to decide on the surgery, informed decision based on tumor characteristics, and less recovery period. Disadvantages include multiple surgeries, higher risk of nipples and missing skin envelope that complicates the surgery, and poor psychological health until breast reconstruction surgery is done.
Several options are available for breast reconstruction surgery. Your doctor will decide the best reconstruction procedure based on your overall health and preferences. Some of the breast reconstruction surgery options are:
Flap reconstruction: In flap reconstruction surgery, your skin is used for breast reconstruction. The surgeon generally takes the tissue from the abdominal region for this purpose. However, the tissue may also be obtained from the back, thigh, or bottom. The surgeon also obtains fat, muscles, and blood vessels along with the skin.
When the blood vessels are obtained along with the tissue, it is known as a pedicled flap. However, when the blood vessels from the chest are used to supply the new tissue, it is known as a free flap. There are several types of flap surgery. These are DIEP flap, TRAM flap, latissimus dorsi (LD) flap, PAP flap, IGAP flap, SGAP flap, SIEA flap, and TUG flap.
Implant reconstruction: The surgeon uses silicone or saline implants to reconstruct the breasts. Sometimes, a combination of implants and tissues is used for breast reconstruction. The implant reconstruction may be done either during mastectomy or sometime after mastectomy.
There are several types of implant reconstruction. In implants under the chest muscle, the surgeon lifts the muscle of the chest and places the implant under it. An implant chest muscle implant is placed over the chest muscle. This procedure requires relatively less recovery time as the chest muscles are intact. Another procedure is an implant with a tissue expander. In this procedure, an expander is placed under your skin. Your surgeon will fill this expander with saline approximately once every week. It will help the skin to stretch. Once the skin is adequately stretched, your surgeon will place the implant.
Irrespective of the type of procedure you have undergone for breast reconstruction surgery, there is evidence that it enhances the overall quality of life and emotional and psychological well-being. There is also an improvement in symmetry, body image, and balance.
Several studies have been carried out on the impact of breast reconstruction on women. When women who had undergone breast reconstruction surgery were questioned about their experiences, they stated that they would choose the same course of action again if necessary and recommend breast reconstruction to their friends who have survived breast cancer.
The complications of this surgery include hardening of the internal capsule of breasts, malposition, edge visibility or implant rippling, and an unnatural feel or look. Delay in wound healing, weakness in the donor site, and abdominal hernia or bulge are some complications with autologous reconstruction.
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