Although October is dedicated to breast cancer awareness, I believe we should be doing this all year round. After all breast cancer still remains the leading cause of cancer-related deaths among women. Moving on, following the diagnosis of breast cancer and successful treatment of any form of breast cancer, most women (and men) end up wanting to become ‘whole’ again, both physically and mentally. And the first step towards this is breast reconstruction surgery.
To get into the nitty-gritty of this reconstruction procedure, I had a chat with Dr Rory McGoldrick, consultant plastic and reconstructive surgeon, international key opinion leader, and trainer for non-surgical aesthetic treatments for Allergan PLC; and boy did he have a lot to tell. Keep reading below to know what he had to say, and the options after breast cancer treatment.
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Planned Cancer Treatment
One of the most important things when thinking about breast reconstruction surgery after you have a diagnosis of breast cancer is to ask the doctor who will be treating you what their planned treatment is, as well as your post-cancer options. The cancer treatment plan can involve surgically removing a lump or removing more than just a lump from your breast; whether it’s removing the skin, or nipple, or both, or the entire breast. Also, you should know whether there is any additional treatment other than surgery, to remove cancer such as chemotherapy or radiotherapy. Once you have these answers, it guides your decision-making with regards to the post-cancer journey, which is breast reconstruction.
Your Breast Reconstruction Surgery Options
Breast reconstruction surgery options depend on what is missing after breast cancer treatment. By that I mean if there is just a small part of your breast missing after a lumpectomy, then no reconstruction may be required. But when you’ve had a full mastectomy whereby you’ve had skin, all the breast tissue, and your nipple and areola removed, then reconstruction is needed.
1. Silicone Implants
The simplest form of breast reconstruction surgery is the use of silicone implants. Sometimes, if we are just replacing breast tissue, a silicone implant is enough but very often their needs to be other procedures done at the same time. For example, there might be a need to do a breast lift at the same time if there is excess skin. If there’s been the removal of skin, we might need to take a paddle of skin and muscle from your back and swing this around to give padding over the implant.
Why some patients might be against implants
Some patients never really want to have a breast implant during breast reconstruction surgery because a breast implant is a foreign object. With foreign objects, if there is, for example, an infection or a bleed around the implant that has been placed, it can cause some sort of complications. These complications are more likely in individuals that have undergone something like chemotherapy where the immune system has been compromised, or in radiotherapy when again the immune system and also blood supply to the area could be compromised.
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2. Fat Transfer
In addition to the implants, we can use your own body fat in a technique known as ‘Fat Transfer’ for your breast reconstruction surgery. With this option, patients have liposuction and then that fat is processed in a special way and injected in and around the breast tissue and/or the implant if it’s been used, in order to give more volume to the breast. Once we have the breast tissue in the shape of the breast achieved, we often leave the patient to heal. Then there’s a second operation where we would perform reconstruction of the nipple and areola.
3. Free Tissue Transfer
Another option for certain patients is by using breast reconstruction surgery methods that utilise their own body parts. It’s probably the gold standard or Rolls-Royce of breast reconstruction one can have in terms of reduced complications because you don’t need an implant. During this technique, we perform a tummy tuck, medically known as abdominoplasty, which involves transferring skin, fat and sometimes a degree of muscle from your abdomen to your breast area.
We disconnect on its blood supply, so it has an artery and vein. And then where you’ve had your mastectomy, and skin and nipple and areola have been removed, we remove a small piece of rib. Behind that rib, there is an artery and a vein, and we perform specialised a surgery called microsurgery which involves a microscope and sew together the artery to the artery, and the vein to the vein.
This type of breast reconstruction surgery is done in order to create a new blood supply to the tissue that we disconnected from your abdomen, and the technique is known as a flap or a free tissue transfer. The actual technical term is a DIEP flap (Deep Inferior Epigastric Artery Perforator Flap) which describes the blood vessel that supplies the tissue that we remove. Once that tissue has got its new blood supply it can be moulded onto the chest and actually tailored to look very much like your existing breast. It can also be used in situations where both breasts have been removed. In this situation, it’s called a bilateral or both-sided reconstruction.
Just like the reconstruction using an implant, DIEAP flap breast reconstruction surgery is normally done in stages. So, once you have the breast volume and the shape achieved, you then go on to do the secondary reconstruction elements such as the nipple and areola reconstruction. All of these reconstructions are very much dependent on your general health; what is missing and as to whether you can undergo such operations. This is because, for example, the DIEAP flap that I’m describing can take 6 to 8 hours to do. So, general health considerations do need to be considered and that’s why it’s very important when you first have your diagnosis of breast cancer that you consider your reconstructive options carefully.
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Breast Reconstruction Surgery timeline
In some countries, unlike in the UK and US, often breast reconstruction is not offered immediately. This means that we perform the reconstruction on the day that you have your breast cancer removed. This has advantages including less psychological upset because when you go to the operating theatre you have cancer dealt with, and you leave with your reconstruction on the same day.
Very often patients are not informed of the options for reconstruction, so they have to heal without having a breast and then have the reconstruction done on a different day in the future. Obviously the psychological and physical harm that this can do can be very damaging.
On the other hand, the evidence when it comes to breast reconstruction surgery is skewed towards having immediate reconstruction with something like a DIEAP flap. This technique works well if you’re young, fit, and healthy and you’ve got a diagnosis of breast cancer necessitating the removal of skin, breast tissue, and your nipples. This is the reconstructive option of choice. But as I say, you must consult a breast surgeon that has contact with plastic and reconstructive surgeons who are capable of doing such complex surgery.
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