Via Christi Women's Connection: Breast Reconstruction
Dr. Vanessa VogeWichita Surgical Specialists
Briefoverview Types of breast reconstruction available after mastectomy Types of “reconstruction” that can be combined with lumpectomy
Each year more than 250,000 American women face breast cancer. Undergoing Mastectomy affects one in many dimensions--emotionally, physically, psychologically, etc… In the past, reconstructive options were not available or not widely offered.
New kinds of treatment as well as improved reconstructive surgery mean that women who have breast cancer today have better choices. Breast reconstruction is a type of surgery for women who have had a breast removed. The goal is to provide a treatment for breast cancer and still provide shape and symmetry to the breasts.
Often patients have many questions Forefront is the cancer itself What will I look like after mastectomy? What are reconstruction options? What will my breast(s) look like after reconstruction? How is reconstruction affected by additional cancer treatments such as chemo or radiation?
Treating the breast cancer first Very patient dependent Cancer treatment dependent Individualize treatment plans
Reconstruction or not Some patients are not candidates Severe obesity, systemic disease, psychological/emotional state Prosthesis Pros- decreased amount of surgery and surgery sequela, can vary size, effect of water Cons- Can shift, weight, not a part of body
Timing of Reconstruction Time of Mastectomy- “immediate breast reconstruction” After one has healed from mastectomy- “delayed reconstruction”
At the time of mastectomy Currently most common way Pros: Save skin, better aesthetic result, reconstruction started or possibly finished at time of mastectomy Cons: Post-operative radiation, possible increase in skin healing problems
Types of reconstruction- patient dependent Tissue Expander/Implant based Latissimus flap/implant TRAM flap Free Flap- DIEP, free tram, S-GAP, etc… Nipple and areolar reconstruction
Tissue Expander/Implant Makes up more than 75% of breast reconstructions in the United States Requires minimum of two surgeries At the time of mastectomy the tissue expander is placed--“first stage breast reconstruction”
Thereis more use of a biological support, such as alloderm.
Second surgery involves the exchange of the tissue expander for an implant- “second stage breast reconstruction” Approximately 4 months from first surgery, but varies greatly from patient to patient and surgeon to surgeon
Pros: Shorter surgery time, breasts remain same size and overall position, If bilateral symmetry possibly improved, less scarring, less operative sites, decreased “overall” complication rates
Cons:Foreign objects, not lifelong devices, capsular contracture, loss of implants, stay the same with time, asymmetry
Placing the breast implant at the time of mastectomy Not as common Only in certain patients with ideal anatomy and cancers Almost always with Alloderm or equivalent
Pros:Own tissue (replacing like with like), affected some by gravity, fluctuates with weight, possibly no additional surgery except nipple/areolar creation, matches other non reconstructed breast, remove excess abdominal tissue
Cons: Larger/longer surgery, longer recovery, not true abdominoplasty, risk hernia/abdominal bulge, bulge upper abdomen, weakness to abdomen, Full loss of flap, partial loss of flap, fat necrosis, specific candidates (previous surgeries, weight, smoking, etc…)
Latissimus dorsi muscle is on back Activities for “lat pulls”, cross country skiing, rock climbing, etc… can be affected.
Pros:Own tissue, non-radiated tissue, “covers” implant Cons:larger/longer surgery, muscle weakness, fluid collection, often needs implant or tissue expander/implant
Disconnecting the blood supply to an area of tissue and “reconnecting” the tissue’s blood supply at a distant site Often under a microscope Only at certain medical centers
Benefits over TRAM flap Rectus muscle remains in abdomen Debate on functionality of muscle as nerves may be injured, different techniques, etc… Decreased risk of hernia or abdominal bulge Potential decreased recovery time Can use is some people who smoke or are obese Less chance partial flap loss and fat necrosis
Downside to free flaps Higher risk complete flap loss Only available at certain centers Longer Surgery