Breast Reconstruction
 | There have been considerable advances in the management of patients with breast cancer over the past decade. Two such advances have been the development of skin sparing techniques for mastectomy, and the acceptance of the oncologic safety of immediate reconstruction (i.e. at the same time as the mastectomy). |
Skin Sparing Mastectomy
A better understanding of the biology of breast cancer, has led to the development of this technique. Seminal work by the team at MD Anderson Cancer Center in the U.S., has shown quite conclusively, that in selected patients with early stage breast cancer, the breast can be removed through limited incisions, leaving most, if not all, of the breast skin for reconstructive purposes. In other words, the breast tissue can be "shelled out" of the skin envelope through small incisions.
The advantage of this, is that the reconstructive surgeon can fill this empty breast envelope at the same time as the mastectomy, with either a prosthesis, or the body's own tissue, typically the excess tummy fat. The cosmetic implications are obvious: retaining the breast skin, allows for a better match of the opposite breast, better positioning of the scars, better return of sensation, and better preservation of the breast crease. The nipple and areola, however, are routinely removed with the mastectomy specimen, but can be reconstructed - usually at a later date. What is important to note is that this procedure does not, in any way, negatively effect the prognosis. The former belief that radical procedures are neccessary to prevent recurrence has been shown to be untrue.
Immediate Reconstruction
Traditionally, patients with breast cancer have the mastectomy soon after diagnosis. When all has settled, those who want reconstruction are referred to a plastic surgeon - usually several months after the mastectomy. Whilst this is a perfectly acceptable way of doing things, it does mean another operation, with all the trauma this entails.
We can now offer patients the choice of breast reconstrcution at the same time as the mastectectomy. This too has been shown to be quite safe in patients with early stage breast cancer, and does not affect the prognosis either positively, or negatively. Immediate reconstruction is usually done in combination with a skin sparing mastectomy for the best results. The breast, along with the nipple and areola are removed, and the glands in the armpit are also resected as part of the cancer treatment. The breast envelope can now be filled with either a silicone prosthesis, or a TRAM flap - using the extra tummy fat to make a new breast.
So the patient is put under anaesthetic with two breasts, has one removed, and wakes with 2 breasts, and a flat, tight tummy! Psychologically, financially, and cosmetically superior to the conventional 2 stage approach.
Breast reconstruction is covered by most medical aids, although it may occassionally require motivation.
If you have any questions about this, feel free to email me
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