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Undertaking breast reconstruction after a mastectomy or lumpectomy is not for every woman. But every woman should know all the available options before she makes any key decisions relating to breast reconstruction.
There are many options available for both oncoplastic and breast reconstructive surgery to help restore the shape, look and feel of the breast after surgery. Selecting the most suitable option is a personal decision that should be made in consultation with your doctor/ medical practitioner.
If you haven’t been offered breast reconstruction as part of your treatment, discuss your options with your doctor. Understand also that your medical insurance will cover the costs of reconstructive surgery.
A mastectomy is the removal of the entire breast including the nipple. The muscle that the breast lies on is usually not removed unless the surgeon suspects it has been affected by cancer. In selected cases, the patient’s skin and/or nipple need not be removed together with the breast and can be preserved for breast reconstruction.
You may prefer to go through (or are advised to go through) your full cancer treatment and mastectomy first to allow yourself time to heal and to adjust to the emotional and physical changes before making another big decision. Breast reconstruction can be done after completion of additional post-surgery therapy i.e. chemotherapy and radiotherapy.
Immediate reconstruction combines two major surgeries i.e. the mastectomy and reconstruction into one, reducing your overall time spent under general anaesthetic. This, in turn, means a shorter recovery period and lower hospital and medical costs. In addition, you avoid the anxiety of another operation and time away from your family and work commitments.
Implant breast reconstruction uses breast implants to restore the shape and volume of the breast. There are two main types of implants available: silicon and saline. Depending on the condition of the breast after mastectomy, implant breast reconstruction may be done in one or two stages.
Own tissue reconstruction involves the use of your body’s own tissues in the reconstruction of your breast. By using your own living tissue, your breast will not only look and feel more natural but will also change as your body changes, literally growing and ageing with you. There are four types of tissue that can be used: abdominal flap, thigh flap, buttock (gluteal) flap and back flap .
This implant can be a fixed volume or an adjustable implant (Becker implant). The implant acts like an inflatable balloon, allowing saline to be injected though a valve to increase its size. When the desired volume is achieved, the tubing and valve for injection are removed, leaving a tissue expander as the permanent implant. One advantage of the one-stage reconstruction is that it minimises the need for multiple surgeries with general anaesthesia.
The lower abdomen is the most common site for retrieving the tissue needed to reconstruct the breast. There are many names for the abdominal surgery used for reconstruction, including TRAM, DIEP and SIEA, depending on the source or pattern of blood supply to the abdominal skin and fat.
Some women may not have enough skin after a mastectomy to cover an implant. A two-stage procedure is used to overcome this, and involves inserting a tissue expander to create the breast mound. The tissue expander is then gradually filled with saline to enable the skin to stretch. The expansion procedure may be repeated over 12-24 weeks until the desired breast volume and amount of skin stretching is achieved. The tissue expander will then be replaced with a permanent implant.
The back flap or latissimus dorsi (LD) is a broad muscle in your back. In this procedure, the LD muscle, along with its overlying skin and fat, is transferred to the front of the chest for breast reconstruction.
In gluteal flap breast reconstruction, the gluteal flap, which consists of skin and fat from the buttock, is transferred to the breast. There are two types of gluteal flaps: the SGAP flap, in which the upper buttock skin and fat is used, and the IGAP flap, where the skin and fat of the lower buttock is used. Once the tissue has been transferred, microsurgical techniques are used to re-establish the blood flow into the flap.
Wide excision (commonly known as lumpectomy) involves removing the cancer by excising a cuff of normal breast tissue followed by radiation therapy to the breast. This method of surgery is aimed at conserving as much of the breast as possible while ensuring the safe and effective total removal of the cancer from the breast.
Oncoplastic surgery involves the use of plastic surgery techniques to reshape the remaining breast or reconstruct the breast after breast cancer surgery. It corrects the imbalance between the unaffected and affected breast after removal of the tumour and prevents undue scarring and deformation of the breast for an aesthetically pleasing outcome.
In this procedure, tissue flaps are imported either locally (local flap) or from other areas of the body. These flaps might contain muscle, fat and skin in various combinations depending on the defect that needs to be corrected.
This is a breast reduction technique suitable for patients with larger breasts. It is performed as part of the tumour removal process, and the breast is reshaped at the same time. This results in a smaller but more aesthetically shaped breast. Surgery to the opposite breast may be required to achieve symmetry.