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Breast Reconstruction After a Mastectomy to Treat Cancer

HIGHLIGHTS:

  • Surgical treatment of breast cancer can be undertaken using either breast-conserving surgery or a full mastectomy, depending on the type and stage of the cancer.
  • Breast reconstruction surgery could take place immediately after a mastectomy, or once any breast cancer treatment has been completed.

Breast Reconstruction After a Mastectomy to Treat Cancer

The term cancer strikes fear into those who hear it, regardless of the type of cancer. This is especially true for women upon hearing about breast cancer, with Thai women being particularly at risk of losing their life to this disease. Incidences have significantly increased over the past decade. Some breast cancer patients may undergo a mastectomy to treat their condition, with such procedures having the potential to severely affect their self-esteem.

Nowadays, early stages of breast cancer can be fully cured. There are two surgical techniques to cure breast cancer: either breast-conserving surgery or a mastectomy, depending on the type and stage of the cancer.

Breast Reconstruction Surgery

Mastectomies have been used to treat breast cancer patients for a long time, but lately there have been great strides made in terms of the innovative techniques available to surgeons carrying out these procedures. Breast reconstruction surgery can provide a boost to a woman’s self-esteem and confidence after a surgical procedure has been undertaken to remove her breast cancer. However, breast reconstruction surgery is not suitable for all those who have undergone a mastectomy. The surgical team will be the one to offer detailed advice and assistance regarding potential treatment plans to the patient and their family.

At which point can breast reconstruction surgery take place?

  • Immediate breast reconstruction: This form of surgery is suited to those for whom their cancer has not spread to other areas, and thus do not require radiation. The plastic surgeons will operate immediately after the breast cancer has been removed, meaning only a single surgery is required, thereby reducing any additional anxiety the patient may be feeling about mastectomy defect.
  • Delayed breast reconstruction: This method requires patients to wait until their cancer treatment has been completed in order to see whether or not the cancer recurs. The surgery also allows for the skin on the breast to recover, while patients are given time to ready themselves mentally and physically for another surgical procedure. Plastic surgery team will take the patient’s unique situation into consideration when making a treatment plan and deciding on the appropriate technique to be used.

Patients unsuitable for breast reconstruction surgery are as follows:

  • Breast cancer patients whose cancer has not been fully eradicated.
  • Patients with particularly thin skin around the chest area which makes them unsuitable for breast surgery, or patients whose skin has been severely damaged by repeated radiotherapy sessions. In any such cases, doctors will be the ones to make the final diagnosis and decision.
  • Patients who are yet to have their cancerous tissue removed, or those who have not yet had part of the breast removed, as these patients may still be at risk of the cancer recurrence.
  • Patients who have underlying health risks that may lead to serious complications occurring either pre or post-surgery.
  • Patients with a history of allergic reactions to foreign substances entering their body.

Breast reconstruction methods available:

  • Removal and transplant of tissue from another area of the body for use in breast reconstruction: The most commonly used muscle tissue is taken from the abdomen (TRAM flap) or back (LD flap) and transplanted onto the new breast. This procedure is quite complicated, so the surgeons involved must be fully trained and highly experienced.
  • Reconstruction of the breasts using implant: In cases where the breast tissue has not been significantly reduced through surgery, the surgeons will attempt to reconstruct the breast using implant. The implant will be placed underneath the muscle of the breast, which is less invasive compared to TRAM/LD flap. Also, recovery time is shorter.
  • Use of a tissue expander: This method sequentially stretches the skin of the breast before installation of the implant. It is usually performed in cases that have minimal breast skin after the mastectomy.
  • Fat grafting breast reconstruction surgery: A technique that utilizes the fat from the abdomen, hips or upper thighs to reconstruct the breasts. This method is considered to be highly effective. However, it is not yet a standardized method of surgery due to its limitations, such as the risk of the fat breaking down or the potential for the fat cells to perish in the long-term, meaning that patients may be required to keep coming in for repetitive injections. Additionally, there is a possibility that the fat cells may clump together and create an issue with regard to any future diagnosis of cancer. The treatment is also unsuitable for the reconstruction of large-sized breasts. All of these factors place huge responsibility on the skill and expertise of the surgeons involved.

No matter the method utilized for breast reconstruction surgery, the new breasts will still lack some of the qualities of the patient’s original breasts. For example, they will be unable to produce milk and their sensitivity to touch will be diminished. Hence, the current key objectives of breast reconstruction surgery are to return the woman’s self-esteem and confidence after having undergone a mastectomy.

It is important to know that breast enhancement through the use of implants does not increase the risk of breast cancer in any way. Therefore, those who have undergone breast reconstruction surgery do not differ from those who have not with regard to their risk of developing the disease. This risk is dependent on numerous factors, including the unique lifestyle traits and behaviors of each individual person.


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Oumyos Rattanamahattana, M.D. Summary: Plastic Surgery Plastic Surgery