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.
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.