Breast Reconstruction
Cancer of the breast is treated by partial excision (lumpectomy) and radiation or by mastectomy. During all methods of treatment, the excision of the significant amounts of skin and breast tissue may be required to remove the cancer, depending on the size and type of tumor and the treatment approach applied. Significant loss of breast size or shape can occur after lumpectomy and radiation or after surgical mastectomy. Breast reconstruction is performed to restore a normal breast appearance.
A breast reconstruction can be performed at the time of surgical mastectomy (primary reconstruction), at some time after mastectomy (delayed reconstruction), or to repair the deformity which follows lumpectomy and radiation. The reconstruction can be achieved with a breast implant, temporary expander, or flap from the abdomen or breast. Missing breast skin may be expanded (stretched, much as the skin of the abdomen is stretched during pregnancy) or replaced with skin from the abdomen or back . The breast mound (volume and shape) is restored with an implant or tissue from another part of the body. The nipple and areola are also reconstructed.
Breast Reconstruction Surgery
Your Choices:
There is no one way or a perfect way to rebuild the breast. Different options and techniques are available for postmastectomy reconstruction or for a defect which follows lumpectomy and radiation. All have advantages and disadvantages.
1. Once the diagnosis of breast cancer is made, the patient must first consider the most appropriate cancer treatment for them. Although a lumpectomy and radiation does not increase cancer cure, it can effectively, in many patients, control the cancer, while preserving most of the breast – thus avoiding a mastectomy . However, a lumpectomy does not produce good results in all patients. In some circumstances, the breast appearance is significantly distorted by the partial excision (lumpectomy) of the breast which is required to remove the tumor. This deformity occurs most often when the tumor is large or located in an area of the breast which is more easily deformed after limited excision( tumor under the nipple). Occasionally, radiation produces excessive scarring and further distorts the remaining breast. Some patients decide to have a mastectomy, rather than lumpectomy, because of possible side effects of radiation. Because the risk of local recurrence is higher after lumpectomy and radiation, than after a total mastectomy, more frequent followup exams are required after lumpectomy and radiation. This may make total mastectomy with reconstruction preferable to partial excision and radiation.
2. Some patients may wish to postpone breast reconstruction to the future or indefinitely.
3. A breast reconstruction is performed to repair the breast after lumpectomy and radiation when a significant breast distortion has been created by the partial tumor excision (lumpectomy) or the effects of radiation.
Breast reconstruction is most commonly performed to rebuild the absent breast after a mastectomy.
4. A breast reconstruction can be performed at the time of mastectomy or postponed to a later date.
5. The timing and method of reconstruction will depend on the patient’s preference, size and type of tumor, need for radiation and chemotherapy, quality and quantity of the tissues available after mastectomy, personal preferences, smoking history, past breast scars and other factors.
6. After breast injury, varying amounts of tissue require replacement – the nipple and areola, breast skin, or breast gland mound.
Common methods breast reconstruction include:
- Placement of an Implant
- Tissue Expansion
- A Latissimus Dorsi Flap
- A Tram Flap