Breast cancer can be an extremely devastating disease. One in every seven women will develop breast cancer in her lifetime. There are many options that are available for treating breast cancer. The emphasis over the last decade has leaned toward breast conservation. However, there are times when a mastectomy is the only option. This leaves the woman with an asymmetry or deformity that she may find intolerable. The more conservative treatments may also leave a significant deformity.
Women now have options after mastectomy and/or lumpectomy. In the past decade, these options have been offered before the procedure is performed. Breast reconstruction is not for everyone. A diagnosis of breast cancer may be so overwhelming that a woman does not wish to think about this particular aspect prior to surgery or even ever. A thorough discussion between the patient and her doctor will help her decide what the best option is for her. She may also consider other options, such as radiation and/or chemotherapy.
The decision to have breast reconstruction may not stem from the fact that a woman is missing a breast. It is often more convenience-oriented than aesthetic. Women do not want to put a prosthesis into their bra everyday. They want to be able to wear a bathing suit, a low-cut dress, or an open blouse without having to worry about the prosthesis being seen. In addition, putting a prosthesis on everyday reminds them daily about their breast cancer.
The goal of breast reconstruction is to create a breast that looks and feels as natural as possible. However, it should be remembered that the reconstructed breast will never be the same as the natural one.
There is no evidence that reconstruction will increase the chance for recurrence nor hide recurrence.
Breast reconstruction requires a minimum of two procedures and may be performed either immediately at the time of mastectomy or at a later time. If delayed, it is often because the woman does not want to think about reconstruction. other health issues may also preclude her from undergoing breast reconstruction immediately. In the majority of cases, women elect to have immediate reconstruction.
Surgery for reconstruction can be accomplished using one’s own tissue (known as autologous) or using skin expansion. When a mastectomy is performed, there is a shortage of skin/tissue. If tissue expansion is used, a balloon expander is placed underneath the muscle of the chest wall. After healing, the tissue is gradually expanded in the office. When desired expansion is obtained, the second phase of the reconstruction is performed. The expander is removed, a permanent implant is placed, and a nipple is created (if desired). In addition, the opposite side may have to be adjusted for symmetry; for instance, if the opposite side is very large.
If autologous tissue is used, a skin flap from the back, abdomen, or buttocks is taken. This flap consists of skin, fat, and muscle with its own blood supply. In short, the tissue is elevated and transferred to the mastectomy site and a breast mound created. This is a more complicated procedure. It requires much more time, increases the possibility that blood transfusions will be needed, and necessitates a much longer hospital stay. However, the advantage is that there is no foreign body associated and there is usually less need for adjustment of the opposite side. The second stage entails nipple reconstruction and possible adjustment of the opposite side. one of the most popular flaps is called the “tummy tuck” or TRAM flap. This procedure entails taking skin, fat, and muscle from the bottom of the abdomen and transferring them up into the mastectomy site and creating a breast mound. The end result is the creation of a breast and the provision of a tummy tuck as the skin and so forth were removed from that site.
There are always risks and complications that can occur. These should be discussed in detail with the reconstructive surgeon. Any woman undergoing mastectomy should be told of all available options so that she and the team that is caring for her can make the best individual decision.