Breast Reconstruction after Mastectomy

Breast Reconstruction after Mastectomy:
A Woman's Choice

By Norman G. Morrison, M.D.

"We restore , repair and make whole those parts ... which has been given but which fortune has taken away, not so much that they may delight the eye but that may bring up the spirit and help the mind of the afflicted."


-G. Tagliacozzi ( 16th Century Reconstructive Surgeon)

The current and comprehensive approach to the management of breast cancer , centers on the oncologic considerations while simultaneously incorporating the aesthetic and psycologic concerns of each patient. When a woman with breast cancer knows that breast reconstruction is possible, it may be easier for her to consider and accept the most established and effective method of local treatment for her disease. She may then make the decision for the type of treatment without fear of a permanent mastectomy deformity, which could influence her to seek a less effective and established method . The procedure is now considered the standard of care after mastectomy ,and has become a desirable procedure by an informed patient and oncologic surgeon. The patients recognize the beneficial effects of restoring self image and 'wholeness' to women who have lost a part of themselves to breast cancer.

Timing

The procedure may be done immediately following mastectomy as one operation , or it may be delayed wherein the procedure can be performed anytime after mastectomy.


Candidates

Any woman who has had a mastectomy , without evidence of distant metastases, is a candidate for reconstructive breast surgery.

Techniques

There are 2 techniques of Breast Reconstruction :

• Alloplastic Reconstruction ie. Reconstruction using synthetic ( man made) materials.
• Autogenous Reconstruction ie. Reconstruction using the patient's own tissues.

Breast Reconstruction after Mastectomy

The technique used depends on a combination of , patient choice and , particular patient characteristics.

Alloplastic Reconstruction

This is the simplest type of breast reconstruction ,and involves the placement of a tissue expander under the muscle , and over a period of weeks , expanding it to the desired size of the opposite breast. The expander is subsequently removed and the a more permanent saline filled implant is placed.

Autogenous Reconstruction

Autogenous Reconstruction, is the preferred method of reconstruction, and involves the transfer of one's own tissue from a distance to the chest to construct a breast mound. This can be achieved using tissues from the abdomen ( the TRAM flap ) , the back ( the Latissimus Dorsi flap), the thigh (Lateral Thigh flap) , or the buttock (Gluteal flap). The Latissimus Dorsi flap and the TRAM flap can be transferred to the chest without complex micro-surgical techniques, and are less complex and less time consuming. The TRAM flap whether performed by standard or micro-surgical techniques is the gold standard ,by which the other flaps are judged.

Risks

There risks associated to every surgical procedure , and these should be discussed with your surgeon , during consultation prior to surgery.

The New Breast

A breast can never be replaced once removed by surgery. The goal of breast reconstruction is to provide a reasonably close likeness to the removed breast. Breast reconstruction provide a pleasing breast mound which is of similar size , and shape and is reasonably soft. The new breast mound is therefore not an exact replica of the lost breast but is an acceptable and pleasing replacement. The newly reconstructed breast has no nipple or areola. If desired a nipple and areola is reconstructed in a second procedure 1-3 months later, this is a much simpler procedure and is performed under local anesthesia in an office setting.

Norman G. Morrison, M.D.

144 East 90 th. Street

New York , NY 10128

Related Posts