Breast Reconstruction After Cancer Treatment

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Breast cancer review

Breast cancer is the most common cancer type among women of all races (23% of all cancers). Most cases of breast cancer occur in women over 50 years old. According to the estimates of lifetime risk, 1 in 8 women will develop breast cancer.

Surgery is often the first method used to treat breast cancer. There are several surgery options which depend on the stage of the cancer and what is acceptable for the patient.

Lumpectomy – the procedure when a surgeon removes only the tumour and a small amount of breast tissue. This surgery is also known as breast-conserving. Radiation therapy is often necessary after this type of tumour removal.

Mastectomy – the removal of the whole breast.

Cryotherapy – currently used as an experimental method to treat breast cancer. This method is based on extreme cold which is targeted at the cancer cells in order to freeze and kill them.

Lymph node removal – additional procedure performed at the same time as lumpectomy or mastectomy. It is performed when the breast cancer has spread into the axillary lymph nodes.

Psychological aspects of breast surgery

The study on the psychological effects of mastectomy revealed that the loss of breasts decreases self-esteem and self-reliance of women. Breasts are more than just a part of the body. Healthy breasts are considered as the symbol of femininity and sexuality. Furthermore, it is an essential factor determining self-confidence and mental health of each woman.

Breast reconstruction

It is a surgery designed to restore breasts after the mastectomy or sometimes lumpectomy. The breast reconstruction can be performed either at the same time as the removal of the cancer or later. There are several methods of breast reconstruction, including breast implants, native tissue flap or combination of the two.

Breast reconstruction using implants – a surgeon places the implant either in the space created by removing breast tissue or underneath the chest muscle.

Breast reconstruction using tissue flap – flap reconstruction is a type of breast reconstruction based on using patient’s own tissues to restore the breast. A flap in this procedure can be a piece of skin, fat or muscle that necessarily has its own blood supply. This piece can be taken from the abdomen, back, buttocks or thighs. There are several types of the breast reconstruction using tissue flap:

TRAM (transverse rectus abdominis myocutaneous) flap – tissues for the new breast are taken from the lower abdominal area (Fig.1). The TRAM flap is composed of skin, fat, blood vessels and abdominal muscle. A term “myocutaneous“means that it is composed of skin and muscle. In addition, this procedure also  produces a tummy tuck effect.

Latissimus dorsi flap – tissues for the new breast are taken from the upper part of the back (Fig.2). This procedure usually involves usage of breast implants. The flap is threaded under the skin to the front of the chest. Then, the surgeon creates a pocket and places an implant in it.

These two above-mentioned types of the breast reconstruction are the most common. Other flap reconstructions require specific skills of microsurgery and are available only at specialized centres. These procedures include:

  • DIEP (deep inferior epigastric artery perforation) flap – the flap is taken from the same area as in the TRAM flap reconstruction. However, the abdominal muscle is not used in this procedure.
  • GAP (gluteal artery perforation) flap – skin, fat, blood vessels and muscle for the new breast are taken from the buttocks.
  • TUG (transverse upper gracilis) flap – the tissue flap is taken from the buttock and the inner part of the thigh. However, this type is not proper for women who have thin thighs.

Fig.1. TRAM flap breast reconstruction.

Fig.2. Latissimus dorsi flap

When breast reconstruction is performed?

Depending on the time when it is performed the breast reconstruction is classified into:

Simultaneous – when it is performed at the same time as tumour removal. This method is reasonable for patients who do not need radiotherapy.

Staged reconstruction – this type is recommended to patients who need radiotherapy after the surgical removal of the tumour. The breast reconstruction is divided into two stages in order to protect  newly reconstructed breast from the impact of radiation. Radiation can cause shrinkage of the fatty tissue used in formation of the new breast. Moreover, it can make breast implants painful and deformed. In the first stage of breast reconstruction a tissue expander is used (Fig.3). It is a temporal implant designed to keep the breast skin and space between the breast tissues until the second stage of reconstruction. The second stage is performed when the radiotherapy is completed. The surgeon removes the tissue expander and places the permanent implant.

Delayed reconstruction – this type is the most common in woman who did not have the opportunity of breast reconstruction at the time of mastectomy.

Fig.3. Tissue expander

Recovering after breast reconstruction

It is normal to feel fatigue, pain or discomfort for several weeks after the surgery. Usually, patients are recommended to stay in a hospital for 4-7 days or longer.

Further, a physiotherapist creates an individual exercises schedule.  Exercises depend on the type of surgery.

Moreover, it is very important to take care of the breast skin properly. Usually, the wound heals within six weeks after the surgery. Most surgeons recommend massaging the skin with creams or oils. The scar fades within 18 months.However, sometimes it can take about two years for the scars to shrink and fade.

Patients are able to return to most of everyday activities within six weeks after the breast reconstruction.

Breast cancer in men

We do not hear a lot about breast cancer in men because it is uncommon. Though breast cancer is the sword of Damocles hanging over the heads of women, it occurs in men too. Moreover, the frequency of the male breast cancer has increased in recent decades.

Moreover, the majority of breast cancers are diagnosed to 60-70 years old men. The statistics reveal that breast cancer occurs in 1% of men population.

Although men do not have breasts like women, their breasts compose of the same tissues. Consequently, the causes, symptoms, diagnosis and treatment of the breast cancer are the same in both genders.

Mastectomy is typically used  to treat breast cancer in men. Also, breast reconstruction surgeries after the mastectomies are performed.