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Breast reconstruction surgery

Breast Reconstruction Surgery

Breast reconstruction surgery, post a breast cancer surgery helps in restoring confidence, amongst most patients.

Breast reconstructive surgery
Breast cancer

 

Breast Cancer is the most common cancer affecting Indian women. It is estimated that more than 1.5 lakh women get affected by Breast Cancer in India every year

More than 50% of the patients, who are being treated for Breast cancers survive or get cured of the disease.This number is improving by the time with the development of newer drugs, targeted agents and radiation techniques.

Still, only around 10% of women have their Breast when the treatment is completed.

Surviving Breast Cancer without Breast is actually battle half won.

Breast is an integral component of women’s feminity, in fact, the expression of feminism is through Breast.

Losing their Breast has a great effect on a woman. There is a definite loss of confidence and affects the psyche. Personal life is also impacted.

Every morning she is reminded of being affected by Breast cancer.

Restoring of Feminity is very well possible; the advances in reconstructive surgery have made the process simple and safe. In Medical terminology, the procedure is known as secondary reconstruction or Neo Breast Formation

Planning for Procedure:

  1. A disease-free interval of a minimum of six months, if the patient has received radiation then a time interval of 1 year is preferred for radiation effects to be minimized.
  2. A follow-up PET or MRI scan is done to make sure there is no disease; also the scan helps us to know the approximate volume of the contralateral breast. Accordingly, we plan the volume to be achieved in the reconstructed breast.
  3. Factors taken into account are the age of the patient, size, shape, and ptosis of the contralateral breast, body habitus, availability of tissue in the abdomen, lateral chest, and back, laxity of the abdomen, presence of comorbid conditions like diabetes, history of smoking, etc.

Type of procedures:

  1. Implant Based
  2. Autologous tissue
  3. Implant augmented by autologous tissue

Description of the procedures:

Implant-based breast reconstruction

The follow-up imaging is processed by 3d volume assessment software which lets us know the approximate volume of the contralateral breast.

The implant is normally placed beneath the chest wall muscle (pectorals muscle and serratus anterior). Normally anatomical rather than just spherical implant is used for post-mastectomy reconstruction. Anatomical implants are shaped like breasts.

Also, the Silicon gel moves in the implant with a change in position, like normal breasts.

The maximum volume of implant that can be safely put is around 450 ml, more than can lead to problems of extrusion, discomfort in the future. The original Breast skin sometimes is limited in Post Mastectomy situations, we generally use expandable implants which can be filled slowly by saline to get the desired volume and also the skin is slowly expanded. It is the original Breast skin which, retains or brings back the sensation of the breast.

Implant augmented by autologous tissue

The main issue of Post Mastectomy reconstruction is the Skin loss which occurs during a mastectomy. Sometimes, especially post-radiation it is very difficult to expand the chest skin. In such a case, we bring tissue from other parts of the body. The most commonly used is Latissimus dorsi myocutaneous flap (LD) through which skin from the back can be harvested and brought to augment the skin of the Neo Breast, also muscle component provides cover to the implant.

If the large volume breast reconstruction is planned. Then volume enhancement along with implant is provided by majority times by LD flap. If still more volume is required then abdominal tissue in form of pedicles TRAM or Microvascular DIEP flap is used instead of LD

Autologous tissue

Autologous tissue transfer is a very safe procedure for the formation of a Neo breast. The abdomen is the most commonly preferred site especially in females with a lax abdomen. The abdominal tissue is harvested by performing a tummy tuck(abdominoplasty), the excess lower abdominal skin and fat is brought to form the Neo Breast. The blood supply is established by microsurgery in form of DIEP flap or by a pedicled flap in the form of TRAM flap. The morbidity to the donor site is minimized, with limited muscle and abdominal wall loss. The women get a new breast with a tummy tuck i.e. complete restoration of feminity. The volume of Neo Breast is determined by the tissue harvested in abdominoplasty. If a large volume is required then an implant is used to augment the volume, if tissue harvest is limited.

The first step is to create a Breast mound, then if required contralateral breast may be given better aesthetics with a breast lift or reduction. Breast reduction in certain situations prevents Breast cancer.

The nipple reconstruction using silicone prosthesis, autologous tissue or nipple grafting is done according to contralateral nipple position.

Secondary Breast Reconstruction is a very safe procedure with excellent results. Age is actually no bar; every woman should consider this option, as restoration of feminity is complete cancer cure in real essence.

If you know a breast cancer survivor, who may benefit from a neo breast formation, please write to us on care@cancerx.co.in.

Speak to us on care@cancerx.co.in for a 2nd opinion on your breast cancer diagnosis from the best cancer doctors in India

 

Article authored by Dr. Mandeep Singh Malhotra, Breast Reconstruction Specialist, surgical oncologist

 

 

 

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