What Does It Involve?
Breast reconstruction is a surgical procedure restoring the size and shape of breasts after mastectomy or wide local excision.
Women who have been stricken with breast cancer turn to reconstructive surgery to restore their body image which can be accomplished in several ways.
Flap surgery is far more complex than other methods of breast reconstruction. During the procedure, Mr Ho-Asjoe partially detaches a flap of skin, muscle, and fat from the patient’s abdomen or back, and then rotates it, tunneling it underneath the skin to the mastectomy site – making sure that enough of the arteries and veins that channel blood through the flap continue to do so. The surgeon then forms the flap into a mound that matches the healthy breast as closely as possible and sutures it into position. If both breasts have been removed, a bilateral procedure using two flaps can be carried out.
Latissimus Dorsi is the largest muscle on the back and can be used for breast reconstruction. It can be lifted from the back with a skin paddle via a transverse scar (bra strap scar) or an oblique scar. It can then be tunneled to the front to replace the skin loss from the breast and part of the volume lost. In general, an implant is required for the volume replacement and the muscle is mainly used for padding and skin replacement. There are pros and cons when comparing the Latissimus Dorsi flap with implant reconstruction versus purely autologus tissue (own tissue with no implant). Mr. Ho-Asjoe will explain the options available depending on your suitability.
In the most common type of autologus flap reconstruction, the TRAM (Transverse Rectus Abdominus Myocutaneous) flap procedure, a piece of skin, fat and/or muscle is moved from the abdomen and used to rebuild a breast. On most occasions, the abdominal muscle can be spared leaving the abdominal wall structure intact. In order to achieve this, single blood vessel is dissected out carefully from the muscle and this is known as Deep Inferior Epigastric Perforator flap (DIEP flap). Both TRAM and DIEP eliminate the need for an artificial implant and, since the ‘donor’ tissue comes from the abdomen, women undergoing a TRAM/DIEP flap procedure effectively have their waistlines reduced at the same time.
If the abdomen is not suitable due to scarring, lack of tissue or for other reasons, autologus tissue can be used from the buttock (S-GAP) or possible the inner thigh (TMG flap). They are alternative but patient may not be suitable for the above. Consultation with Mr Ho-Asjoe will clarify the suitability and the pros and cons associated with the different options. Subsequent to the initial reconstruction, the scars surrounding the reconstructed breast heal in about two months. At this point the surgeon may go on to create a nipple and an areola using the flap skin, and later he may tattoo the areola to give an even more natural appearance.
IMPLANTS AND ‘TISSUE EXPANSION’
A simpler and more common way to reconstruct breasts following mastectomy involves the insertion of breast implants filled with saline or silicone gel, often in conjunction with a procedure called tissue expansion. Tissue expansion produces improved results for many women, particularly those who, after mastectomy, are left with chest skin that is too tight and taut to accommodate an implant of sufficient size to restore body symmetry. This procedure is now being used more widely since general surgeons are performing less radical mastectomies these days and are also recommending less radiation treatment.
Women who have tissue expansion as part of breast reconstruction undergo several procedures. First, a tissue expander is placed beneath the skin, usually at the time of mastectomy. This has three parts: a saline bag, a self-sealing valve, and a tube that connects the two parts. For a period of weeks or months your surgeon will use the self-sealing valve to fill the tissue expander gradually with saline solution until a sufficient amount of extra tissue has been created. The expander is then normally removed and a permanent saline or silicone gel implant is inserted, although in some cases the expander can be left in place as the permanent implant. At the same time of the exchange, some patients may benefit from an uplift, reduction or enlargement of the opposite breast to achieve symmetry. This would have been discussed before in the initial consultation as the new breast from reconstruction is determined by the shape of the implant.
The initial surgery to implant the expander causes most people only temporary discomfort, which can be controlled with medication. When tissue is expanded gradually, there may be slight discomfort each time the saline solution is injected.