BREAST RECONSTRUCTION AFTER A MASTECTOMY
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.
Here Mr Mark Ho-Asjoe explains the various procedures available to you.
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.
"Dr Beechey-Newman, my cancer surgeon (a renowned breast surgeon in London) had recommended Dr Mark Ho-Asjoe to me for reconstructive surgery after a mastectomy. I saw Dr Beechey-Newman again yesterday and he was extremely happy with the results; he noted my breasts were very symmetrical. Needless to say, I am very happy too! Dr Mark is kind, caring and professional. He listens carefully to you and I feel very comfortable talking to him. He is realistic and will advise on what could or could not be achieved. He is very knowledgeable and has many years experience behind him. I highly recommend him to anyone. He genuinely cares for his patients. And the aftercare is amazing. I would just like to quickly add that Carol, his PA is lovely. She is most kind and caring. I really enjoyed talking to her." Doctify 05.01.2021
"Mark Ho-Asjoe performed my breast reconstruction when I had my mastectomy. He came highly recommended by my breast surgeon and I am very pleased with the treatment. Mark was always available and took time to listen and answer all my queries and concerns and put my mind at ease before and after. The surgery itself went very well and was a success.
Carol is fantastic and always available and she provides amazing support. She was always very accommodating and went out of her way to organise my consultations and surgery for a time when it suited my schedule.
Thank you Mark and Carol for all you have done." A Calleja