Where to Begin

Genetics, the type of cancer, stage of cancer and the course of treatment required will all influence and impact the Reconstructive Surgery options available in each instance. Gathering information and availing yourself of resources are the essential first steps to understanding what is possible.

You can click here for our article on Decoding your Options if you have just been diagnosed with Breast Cancer.

 

New Possibilities on the Horizon

Breast Reconstruction techniques and procedures have advanced considerably. They allow women far more choices and flexibility regarding how to approach reconstruction.

When a decision is reached to pursue Breast Reconstruction, your Cosmetic Surgeon becomes an integral part of the care team. The ultimate priority is to completely clear the cancer and regain health. Reconstructive Surgery can create aesthetic results with minimal risk, which can be instrumental when it comes to giving you back your sense of self.

Different treatment avenues will influence your reconstructive journey. Here are some of the factors to keep in mind as you approach the decision-making process and choose the best way forward to regaining your self-confidence and shape.

 

Type of Treatment Surgery

Personal anatomy, size of tumour and treatment recommendations will all determine what type of surgery is necessary.

Most women who undergo a Breast Conservation Surgery may find that full reconstruction is neither necessary nor appropriate. Other Reconstructive Surgery options may suit their needs better.

 

Lumpectomy or Partial Mastectomy

If treatment entails a Lumpectomy, a Cosmetic Surgeon can work alongside the Oncological Surgeon to reshape the breast tissue as part of the surgery. This helps to ensure that the removal of the tumour does not result in a concave shape or indentation in the affected breast. The use of a small implant or fat grafting may also prove to be a viable option.

 

Single vs Double Mastectomy

If a single Mastectomy is required, it is good to know that it is possible to surgically alter the non-affected Breast. This may include a lift, reduction, or re-shaping in order to create balance and symmetry.

 

Immediate Reconstruction vs. Delayed Reconstruction

As the name suggests – an Immediate Reconstruction takes place during the same time as the Mastectomy.

In the case of a Delayed Reconstruction, the Mastectomy is done first. After Mastectomy wound healing is complete and Cancer Therapies are finished the Reconstruction process is started.

It is important to keep in mind that Reconstruction is possible anywhere from months to years after a Mastectomy surgery.

 

Restoration via Implant vs. Autologous Tissue

When re-forming breasts after a Mastectomy, Surgeons can utilize:
Saline or silicone implantable devices
• Autologous Tissue (i.e. one’s own tissue)
• A combination of both

 

The Use of Implants

Implants generally require a two-stage surgery; one to prepare the chest muscles and skin to accommodate the implant by use of a tissue expander and a second surgery to place the implant. In some instances, it may be possible to place the implant during the initial Mastectomy surgery.

 

The Use of Autologous Tissue

using an individual’s own tissue from the Breast or elsewhere in the body; much will depend on the amount and extent of the tissue removed during the initial mastectomy. This will vary according to each individual situation.

 

Skin-Sparing Mastectomy

As often as possible when reconstruction is planned for – doctors employ what is referred to as a ‘Skin-Sparing Mastectomy”. In this procedure every effort is made to retain a large percentage of original Breast skin and tissue including the nipple for use in the reconstruction.

 

Tissue Flap Surgery

In instances where a ‘Skin-Sparing Mastectomy’ is not possible; a piece of tissue taken from elsewhere is used. This piece is referred to as a flap and the surgery during which it is used is known as a tissue-flap procedure. There are multiple types of flap-surgery. A flap for use in Breast Reconstruction could come from the abdomen, back, thigh or buttocks.

 

The Use of Both

It is possible, and might be necessary, to use both implants and body tissue together. An example of this would be using a flap to cover an implant.

 

Nipple-Sparing Mastectomy

When one’s own nipple can be used during reconstruction.

 

Reconstructing the Nipple & Areola

When a flap is used for reconstruction, the nipple and areola are created via the shaping of small skin grafts in a follow-up procedure. This may be combined with expert tattooing… If skin grafts are not used, then 3D tattoo artists can make impressively realistic images of the nipple and an areola – using only ink.

What determines whether an immediate or delayed reconstruction will be possible?

 

Use of Radiation Therapy

A major consideration affecting when breast reconstruction can start is the use of radiation therapy. Radiation Therapy may interfere with healing or tissue growth. Therefore, it may increase the chance of unwanted complications with the reconstruction process.

In most cases, reconstruction that is dependent on Autologous tissue is recommended to take place after radiation treatment is complete. Reconstruction with an implant is however sometimes possible – even when radiation therapy is required.

 

Type of Breast Cancer

Inflammatory Breast Cancer often requires a greater quantity of skin to be removed. This may then make immediate reconstruction more difficult. In these instances, it can be advisable to delay reconstruction until after all treatments are completed.

 

Personal Preference

Regardless of the type of cancer or treatment – some women may choose to wait for reconstruction or even forego reconstruction for a wide range of personal reasons. These may include age, health and previous surgeries – among others. All of these are valid and are to be respected. Protheses or breast forms can be used to create a familiar silhouette if desired.

 

On Your Team: Dr Potgieter

Dr Anton Potgieter is a board-certified Cosmetic Surgeon with experience and a passion for Reconstructive Surgery. Call today for a consultation. Let us know if you are investigating Reconstruction and we will give your appointment priority.
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References:
https://www.ncbi.nlm.nih.gov/pubmed/26835456
https://www.ncbi.nlm.nih.gov/pubmed/21735435
https://www.cancer.gov/types/breast/reconstruction-fact-sheet