The present review discusses the principles, methods and complications of breast reconstruction surgery for breast cancer patients who need mastectomy (surgical removal of the entire breast).
Women with breast cancer often need extensive surgeries to eliminate the cancer, along with healthy breast tissue, skin or the nipple and areola (the darker area around the nipple) to ensure complete cancer removal. This leads to breast asymmetry as well as physical and emotional trauma for the patient. Breast reconstruction is a type of surgery that aims to restore the volume, shape and contour of the breast for women who have had a mastectomy. It is performed by plastic surgeons, usually in concert with breast surgeons. Unless bilateral mastectomy (removal of both breasts) precedes reconstruction, the opposite breast serves as reference.
Breast reconstruction is an option for most women who have had breast cancer surgery, particularly for those with considerable breast asymmetry. This procedure is suitable even for patients with advanced disease. However, it is not indicated for patients with metastatic (spread) cancer and those who have a higher risk of problems with general anesthesia.
Breast reconstructive surgery can be done at the time of mastectomy, or it can be delayed. This means more surgeries but allows the remaining breast tissue to heal. Sometimes reconstruction is delayed in order to complete radiation therapy. The patient may also need time to make an informed decision about the procedure.
Breast reconstruction techniques include breast implants, tissue flaps or a combination of the two. Breast implants can be silicone or saline (salt solution) filled and can have a fixed or an adjustable volume (breast expanders). Expanders are more suitable for patients who have had more skin removed during mastectomy. Breast implants have the advantage of shorter general anesthesia and hospital stay, but can cause complications such as infection or rupture and often need replacing. Tissue flap procedures (also known as autologous reconstruction) use tissue from the abdomen, back, thighs, or buttocks to rebuild the breast. The most common is the TRAM flap, which uses skin, fat and muscle from the lower tummy area of the patient. Unlike implants, tissue flaps are permanent and feel more natural. However, the surgery is longer and leaves two scars instead of one. There can also be some differences in size and shape of the breast. Patients may wish to operate on the opposite breast in order to achieve symmetry, for example via breast reduction or breast lift.
In summary, breast reconstruction is an important part of breast cancer management. Patients should be well informed of all aspects involved. These include timing of surgery; the various techniques, their advantages, risks and drawbacks; and the most suitable treatment choice, based on the patients’ general well-being and individual cancer-related traits.
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