Breast Reconstruction after Breast Cancer
In recent years, early detection of breast cancer due to advances in imaging techniques, as well as modern surgical and chemotherapeutic treatment, has made it possible for breast reconstruction to be an integral part of breast cancer treatment.
WHY IS BREAST RECONSTRUCTION NECESSARY?
The loss of one or sometimes both breasts due to breast cancer leaves deep marks in the life of a woman who has undergone a mastectomy. The psychological and physical trauma caused by cancer, as well as by the radical treatment – removal of the breast – can only be healed when the woman regains her breast.
I have happily observed that at the first postoperative check-up, three weeks after breast reconstruction, patients seem to bloom, their smiles return, they put on makeup and dress stylishly – a sign that the intervention has achieved its goal, namely the restoration of femininity.
The quality of life of a woman who has gone through the ordeal of breast cancer clearly improves when her body becomes whole again. I can say it is among the few surgeries that can heal depression, because often women come to the first consultation with tears in their eyes, and after surgery they see their positive and stable progress, regaining the joy of life.
WHEN CAN BREAST RECONSTRUCTION BE PERFORMED?
Breast reconstruction can be done simultaneously with mastectomy in early-stage disease – T1 or T2 – or in a second stage, one year after completing oncologic treatment. The decision must be made only after obtaining imaging and laboratory test results confirming the absence of any local tumor recurrence or the presence of metastatic foci.
Moreover, a positive recommendation from the oncologist must be the first step before scheduling an appointment with the plastic surgeon.
MAIN RECONSTRUCTIVE METHODS
The most common reconstructive method is using a breast implant, either directly or with a tissue expander followed by the implant.
- When there is enough tissue to cover the implant, it is placed under the pectoralis major muscle, and the skin is sutured directly.
- When there is sufficient tissue but a risk of implant exposure exists, a tissue expander is used, which is later replaced with a permanent implant.
- There is also a combined option: a silicone expander/implant placed in a specially created pocket under the pectoralis major muscle, gradually filled with saline to the desired volume.
Superior aesthetic results for the reconstructed breast are achieved with flaps – areas of the patient’s own tissue used to create a new breast. Radiation therapy, necessary as part of breast cancer treatment, besides its curative benefits, also irreversibly affects tissues, especially the skin, reducing elasticity, thinning it, and causing significant trophic changes.
Thus, the contribution of healthy, well-vascularized tissue ensures that the new breast has shape, volume, projection, and natural ptosis similar to a healthy breast.
The most commonly used pedicled flaps (with their own blood supply) are:
- latissimus dorsi, which uses a portion of skin, fat, and muscle from the back with the same name
- TRAM flap, which utilizes excess fat from the lower abdomen.
HOW DO WE CHOOSE THE BEST RECONSTRUCTIVE METHOD?
There is a wide range of reconstructive options from which we can choose the one suitable for each case. Depending on the type of mastectomy, the local tissue condition, the presence of radiotherapy, the resources required for flaps, lifestyle, and each patient’s preference, we select the best reconstructive method together. For each individual case, there is at least one therapeutic solution.
- BREAST IMPLANT RECONSTRUCTION
- AUTLOGOUS TISSUE AND IMPLANT RECONSTRUCTION
- AUTLOGOUS TISSUE RECONSTRUCTION
The main advantage of autologous tissue reconstruction is that over time, the appearance progressively improves.
There are also microsurgical methods for creating a new breast, where the vessels feeding the flap are connected to the internal mammary vessels under the surgical microscope. In this way, a breast can be created from multiple areas with excess skin and fat: lower abdomen, inner thighs, or lower buttocks.
The main disadvantage of this method is the significantly longer recovery time compared to other methods, with slower socio-professional reintegration.
