The Choice of Breast Reconstruction After Breast Cancer | ExpatWoman.com
 

The Choice of Breast Reconstruction After Breast Cancer

What are the available options for breast reconstruction?

Posted on

15 October 2014

Last updated on 1 February 2018
The Choice of Breast Reconstruction After Breast Cancer

October is the month of “breast cancer awareness” which takes place internationally, including the Emirates. It is therefore an appropriate time to take a more detailed look at what happens when breast cancer has been diagnosed: the treatment options and particularly the possibility for breast reconstruction following surgery, which provides many women of today with the opportunity to regain their femininity and return to a full, productive life following treatment for this most distressing disease.

In this article by Dr Allen Rezai, Consultant Plastic & Reconstructive Surgeon, the key aspects of breast reconstruction are discussed in the context of modern medical diagnosis and treatment methods so as to broaden awareness of available options and give hope both to the many women already suffering from breast cancer and also to those who are concerned about it, perhaps due to an inherited family predisposition to contracting the illness.

Breast cancer awareness
 
Firstly, states Dr Rezai, it should be known that most women with breast cancer will have some type of surgery as part of their treatment. And depending on their circumstances, surgery may be undertaken for different reasons. For example, to remove as much of the cancer as possible (which is done through procedures known as breast-conserving surgery or mastectomy); to relieve the symptoms of advanced cancer, or to restore the breast's shape after the cancer has been removed (which is known as breast reconstruction).
 
Although each case is different, most mastectomy patients will be suitable candidates for reconstructive surgery, of which there are several types. The available options will depend on the exact medical situation and personal preferences. There may also be the choice between having breast reconstruction at the same time as the mastectomy - immediate reconstruction - or at a later time, weeks, months, or sometimes even several years later. This is known as delayed reconstruction.
 
Breast reonstruction

Immediate vs delayed reconstruction

Breast reconstruction makes many patients feel better about their appearance, however, it is important to be realistic about the expected outcome. A reconstructed breast may not look 100% like the original breast nor will the sensation be the same. Thus, the decision to have a breast reconstructed is a very personal one and patients should fully explore the various options so as to make the best choice for their body and lifestyle.
Factors determining the suitability of the important choice between immediate and delayed reconstruction include: 
  • Stage of breast cancer
  • Patient’s medical condition
  • Patient’s preference and lifestyle
  • Whether or not additional therapies, such as radiation is needed to treat breast cancer
The shape and size of the mastectomy scars will vary between immediate and delayed reconstruction. For immediate reconstruction, it is often possible to perform what is known as a nipple- or skin-sparing mastectomy which will result in either a circular scar around the nipple and areola or a relatively small straight-line scar. However, for delayed reconstruction, more skin is removed at the time of mastectomy leaving a long scar across the chest wall. There are advantages and disadvantages associated with both options. These are summarised in the following table:
 
 
 

Immediate Reconstruction

Delayed Reconstruction

Advantages

·         Better aesthetic results
·         Smaller breast scars
·         Possibly fewer surgeries
·         One anaesthetic and recovery period
·         Decreased risk of emotional and social difficulties

Advantages

·         Staggered surgery resulting in easier and shorter recovery after each procedure
·         Patients have more time to consider breast reconstruction options
·         Additional cancer therapy after mastectomy (such as radiation) does not cause problems at the reconstruction site

Disadvantages

·         Longer anaesthetic and recovery time
·         Harder to detect mastectomy skin problems
·         Increased risk of infection
·         Distortion of reconstructed breast if radiotherapy is required

Disadvantages

·         Longer breast scars
·         Less optimal aesthetic results
·         Requires additional surgery and recovery time
·         Multiple hospitalisations
·         Sometimes difficult to reconstruct after scarring occurs

Regardless of whether an immediate or delayed approach is used, it is important to understand that it may take several procedures to achieve the final desired aesthetic outcome.


The Choice of Breast Reconstruction After Breast Cancer

Types of breast reconstruction

There are two main types of reconstruction: Implant Breast Reconstruction and Autologous Breast Reconstruction, sometimes known as “natural tissue” or flap breast reconstruction. Implant breast reconstruction involves the use of silicone or saline breast implant to recreate the breast mound, whereas flap breast reconstruction uses the patient's own tissue from another part of the body to recreate the breast.
 
There are pros and cons to all types of reconstruction. There may be good reasons why one type of reconstruction is much better for you than another. A thorough consultation with a plastic and reconstructive surgeon is required in order to discuss the types of treatments available to each patient, including the pros and cons of each, and allow the patient time to reflect on the information received in order to make an informed decision about the preferred option. Once the type of treatment has been established, a bespoke treatment plan will be drawn up and all aspects of the procedure will be discussed with the patient, at length. But to help you decide, we’ve listed some of the main points here.
 
Flap breast reconstruction will typically produce the most natural look and feel. And a breast reconstructed from natural tissue also has the advantage of belonging to the patient for the rest of their lives, whereas breast implants will typically require replacement.
Within the category of Autologous Reconstruction, there are two basic types of procedure, each with a number of variants. These are known as Perforator Flap procedures and Musculocutaneous Flap procedures, the former being the most advanced methods in autologous reconstruction and requiring microsurgical expertise. Where possible, these methods will be chosen in preference to the latter. 

However, the suitability of each type of reconstruction will depend on the following criteria:
  • How much breast tissue has been removed during mastectomy
  • The health of the breast tissue and those of other areas of the body that may be used as donor sites
  • Whether the patient has had radiotherapy to the breast or chest wall
  • The shape and size of the breasts
  • Patient’s preference
  • Patient’s general health and body build

The table below shows the advantages and disadvantages associated with each of the two main methods employed in breast reconstruction:

Immediate Reconstruction

Delayed Reconstruction

Advantages

·         Better aesthetic results
·         Smaller breast scars
·         Possibly fewer surgeries
·         One anaesthetic and recovery period
·         Decreased risk of emotional and social difficulties

Advantages

·         Staggered surgery resulting in easier and shorter recovery after each procedure
·         Patients have more time to consider breast reconstruction options
·         Additional cancer therapy after mastectomy (such as radiation) does not cause problems at the reconstruction site

Disadvantages

·         Longer anaesthetic and recovery time
·         Harder to detect mastectomy skin problems
·         Increased risk of infection
·         Distortion of reconstructed breast if radiotherapy is required

Disadvantages

·         Longer breast scars
·         Less optimal aesthetic results
·         Requires additional surgery and recovery time
·         Multiple hospitalisations
·         Sometimes difficult to reconstruct after scarring occurs
 


The Choice of Breast Reconstruction After Breast Cancer

The other breast

The ultimate goal in breast reconstruction is to create a breast that is symmetrical with the remaining natural breast. Hence patients having breast reconstruction following a mastectomy at one side only may also require surgery on the opposite breast in order to make the breasts more symmetrical and to achieve optimal cosmetic results.
 
There are essentially five available options:  
  • Firstly, to have no surgery on the other breast. Many patients may feel having surgery on a healthy breast is unacceptable and would prefer a form of reconstruction that best matches the existing breast without any change.
  • Secondly, to enlarge the remaining breast. If the reconstructed breast is larger than the other breast and the larger breast is preferred, then the natural breast can be made bigger with an implant.
  • Thirdly, it is possible to lift the remaining breast. If the natural breast is more droopy than the reconstructed breast, it can be lifted and reshaped. A breast lift adjusts the shape and position of the breast and nipple without changing its size.
  • Then there is the option of reducing the remaining breast. If the natural breast is larger than the reconstructed breast, it can be reduced in size and altered in shape so that the final appearance is balanced.
  • And finally, there is the option to remove the other breast and reconstruct both of the breasts. In certain circumstances, such bilateral mastectomy may be recommended either due to there being cancer in both breasts, or as a prophylactic measure in high-risk patients.
 

Alternatives to Breast Reconstruction Surgery

Having their breasts reconstructed makes many cancer patients feel better about their appearance and benefits them emotionally and psychologically. However, some patients may not be good candidates for reconstruction, perhaps due to other health issues, or that they simply do not want to put themselves through further surgery after a mastectomy. This is entirely understandable.
 
In these cases, there is the option of wearing an external prosthesis. Such prostheses are usually made of a synthetic foam material that can be placed inside a custom bra to match the opposite breast. Or they can be made for both breasts. When normal fitting clothes are worn, most people are unable to tell the difference. However, the prosthesis can sometimes be uncomfortable to wear, particularly when hot outside or when certain types of clothes are worn.

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In conclusion

To examine the available options, initial discussion with cancer care professionals will frequently lead to a referral to a plastic surgeon specialised in breast reconstruction. He or she will be able to explain the available options and different types of reconstruction available based on individual anatomy, prior surgeries, current medical condition, cancer treatment needs and personal preferences. They will typically have a lot of experience in dealing with cancer sufferers and are usually very patient, understanding and caring. They will also be able to provide a completely personalised treatment plan.
 
In spite of the generally increasing level of breast cancer diagnosis, the outlook is still encouraging, both worldwide and in the Middle East, as an ever-growing number of people benefit from the more widespread availability of quality information and education now available, put their fears to one side and opt for early diagnosis and treatment. This helps in both prolonging lives and improving the quality of life for so many cancer survivors.
 
Furthermore, thanks to the ongoing advances in medical research and the development of new methods of diagnosis and treatment, including constant advancements in therapies and surgical techniques, the outlook for cancer sufferers has never been better and will continue to improve.

“I strongly believe that breast reconstruction plays an important factor in a woman’s psychological and physical recovery after having a mastectomy; however, it is the individuals’ choice to undergo a breast reconstruction post-mastectomy. But as a surgeon I have a responsibility to provide patients with ALL the treatment options available to them, explain the advantages and disadvantages of each option and leave it up to them to make an informed decision. After all, this is a life changing procedure for a patient and I believe that she should be involved in the decision-making process from start to finish.” Dr Allen Rezai
For further information about Breast Reconstruction or a Consultation with Dr Allen Rezai call +971 4 431 2396.
 

Elite Plastic & Cosmetic Surgery Group
Sponsored by
Elite Plastic & Cosmetic Surgery Group
Elite Plastic & Cosmetic Surgery Group is headed by Dr.Allen Rezai, a leading Consultant Plastic & Reconstructive Surgeon of international renown, who has for many years led a distinguished career both from his well-known clinic in Harley Street, London, UK and worldwide.

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