Dr John Newton, Specialist Plastic Surgeon and Australasian Society of Aesthetic Plastic Surgeons (ASAPS) Secretary, explains some of the options for women who are looking to restore their breasts following a diagnosis of breast cancer.
When you are first diagnosed with breast cancer, let’s face it, your world has just been turned upside down. You will be overloaded with information very anxious and confused about what can be done and what should be done. I would caution you from turning to Dr Google. It can be a minefield of worst-case-scenarios or pseudo-science based programs. The best information you will be given will come from the surgeons intimately involved in your situation.
Try to think of the pathway forward as a flowchart of treatment. It starts at the top left with your diagnosis and hopefully finishes at the bottom right with you being disease-free and reconstructed. Your individual needs regarding cancer treatment and how these treatments fit with your suitability to reconstruction will all be a part of that flowchart.
Thinking this way will allow decisions to be made about your suitability for an immediate reconstruction or whether a delayed reconstruction is the better option for you. It will also determine what type of reconstruction is most suited to your circumstance. Talk with your Specialist Plastic Surgeon. Tell him or her your concerns and preferences. Importantly, be guided by your Specialist Plastic Surgeon, who has the knowledge and experience to obtain the best outcome for you as an individual.
When should I consider Breast Reconstruction Surgery?
Let’s get one thing straight. Treating and hopefully curing your breast cancer must be your number one priority. Be sure to get that part of your treatment arranged fully and optimally. Breast reconstruction must be a secondary consideration. That does not mean you can’t have breast reconstruction immediately or at a later date, but reconstruction must be seen in the full context of your breast cancer.
What is Oncoplastic Breast Surgery?
For over 40 years, Specialist Plastic Surgeons have been developing a variety of techniques of reconstruction to best suit individual patient needs after mastectomy. These techniques are generally able to be thought of in two major groups, reconstruction using a breast implant and reconstruction using your tissues.
Recently the term “Oncoplastic Breast Surgery” has become associated with breast cancer treatment.
Oncoplastic Breast Surgery is Surgery involving the removal of breast cancer and reconstruction of the breast in patients who have breast cancer. The aim is to provide the most normal and acceptable replacement of your removed breast tissue with minimal complication and maximal satisfaction. Treatment of your cancer, timing of your operation and technique suited to your situation are paramount to achieving this. It is important to be aware that not all surgeons performing Oncoplastic Breast Surgery are Specialist Plastic Surgeons.
Given the incidence of breast cancer, breast reconstruction has an ongoing and increasing place in the management of breast cancer in the hope of optimising the patients’ well-being. Specialist Plastic Surgeons are continually exploring and developing Oncoplastic Breast Reconstruction techniques. Your Specialist Plastic Surgeon will be thinking about all the options which may apply to you from the day they first meet you and every time they see you after your surgery.
Implant Reconstruction techniques include:
- One-stage Permanent Non-expanding Implants
- One-stage Permanent Expending Implants
- Two-stage Reconstruction using a Tissue-expanding Implant which is later removed and replaced with a Non-expanding Implant
Tissue Reconstruction techniques include:
- Pedicled TRAM flap which uses skin, fat and muscle from your tummy.
- Free DIEP Flaps (DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen) which are like TRAM flaps but involve Microsurgery.
- Latissimus Dorsi flap, which uses skin, fat and muscle from your back
- Combinations of a prosthesis with a flap are also used when extra bulk or better tissue is needed.
Additional Oncoplastic Breast Reconstruction techniques include:
- Nipple and/or Areola Reconstruction
- Liposuction
- Fat Transfer
Final thoughts
Try to stay calm when you are given a diagnosis of Breast Cancer. Discuss your disease and your treatment with your surgeons. Allow them and the other Oncologists to guide you through your “flow-chart” of management. Aim for the bottom right-hand corner of the page and get there via the optimal route, no matter what that route involves.
