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Breast reconstructive surgery

Saturday, 30 October 2010

Breast cancer is a common cancer nowadays. Some of the patients will have to undergo a surgical operation as a part of the management plan. Mastectomy is a surgery that involves the removal of one or both breasts. This surgery can cause an emotional and a cosmetic problem in those women due to the loss of her breast.

However the solution is Breast reconstruction. As the name suggests, it is a surgery that rebuilds the breast after mastectomy so that the normal shape and size will be attained. There are many factors involved and will be explained in details in this article.

Timing of reconstruction:
Reconstruction can be done either immediately after mastectomy (in the same surgical setting) or delayed after months and years from the mastectomy surgery. 
Studies have showed a psychological effect, cost-effectiveness and better cosmetic appearance with the immediate reconstruction.

Surgical options:
Reconstructions can be done by the use of either autogenous (originating the patient's own body) or alloplastic (implantation of an inorganic material) or both

i. The most common method used is Tissue expander - Breast implant.

Indications of implants reconstruction:
1. Bilateral reconstruction
2. Patient requesting augmentation + reconstruction
3. Patient not fit for long surgery
4.  Patient not willing to have more scars on the back or abdomen

1. The need for adjuvant radiotherapy
2. Previously failed implants
3. Implant fear

ii. A common autogenous method is also used: 
Flap reconstruction. This method uses tissues from other parts of the patient's body such as the back (latissimus dorsi muscle flap) or the abdomen (TRAM flap).

Latissimus dorsi reconstruction:

1. Small breast
2. Mild breast ptosis
3. Abdominal donor site unavailable

1. Very large breast in a patient who does not desire reduction
2. Previous lateral thoracotomy

TRAM flap:

1. Breasts of all sizes 
2. Breast ptosis
1. Previous abdominoplasty
2. Patient unfit for long surgery
3. Patient unable to tolerate long recovery period
There are more surgical options in breast reconstruction but we mentioned the most common ones done. 
Besides surgical details were not explained for the sake of making the topic much easier and clearer. 

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