Breast
reconstruction has changed in the last 10 years, with the reconstruction
rate of patients with early breast cancers being 30-50% in many areas.
As well as the increase in reconstruction there have been 2 other changes:
1) Skin-sparing mastectomy is being performed with earlier cancers/DCIS.
This type of mastectomy removes less skin with the breast tissue, and
combined with immediate reconstruction with a flap gives the best possible
cosmetic result. It may also reduce the need for surgery on the other
breast to achieve a symmetrical result. There have been 2 large studies
(now with 10 year follow-up following surgery) which have shown that
skin-sparing mastectomy does not affect the treatment of early breast
cancer. This technique, however, is only suitable for patients with
very early breast cancer.
2)
Immediate reconstruction (at the time of mastectomy) is being used more
because it has better results (and because of the increasing number
of patients with earlier cancers). Immediate reconstruction may decrease
the number of operations involved, but depending on the type of reconstruction
often increases the recovery time after the operation. Again immediate
reconstruction has been shown not to affect treatment of early breast
cancer. Immediate reconstruction can also decrease some of the psychological
impact of mastectomy, allows a quicker emotional adjustment to the diagnosis
of breast cancer and a quicker return to normal life - it avoids wearing
external prostheses, and allows a quick return to wearing normal clothes,
normal activities eg swimming.
There have
been a number of studies looking at the benefits of breast reconstruction,
which have shown that these patients have significant increases in emotional
well-being, vitality, general mental health, functional well-being,
and body image compared to those patients without reconstruction.
1) What
type of mastectomy is needed? - this depends on the individual patient's
situation. However, these days many mastectomies are performed for very
early cancers or precancerous changes (eg DCIS), and in this situation
a "skin-sparing mastectomy" can sometimes be performed, which
minimises the scar and often allows a better reconstruction to be achieved.
If used with an immediate flap reconstruction (see below) nearly all
plastic surgeons would consider this the gold-standard technique for
treating early disease - the patient wakes up after the operation with
a breast almost exactly the same as the one they went into the operation
with.
2) When can the reconstruction be done? - it used to be said that
a women should live without a breast for at least 1 year before a reconstruction
was done, because of worries of reconstruction delaying detection of
local cancer recurrence. There are now studies in large numbers of patients
with early breast cancer showing no increase in local recurrence with
skin-sparing mastectomy and immediate reconstruction. In general immediate
reconstructions have better results compared to delayed reconstructions.
Delayed reconstruction can be performed any time after mastectomy, and
reconstruction should be delayed it is known that radiotherapy will
be given after the mastectomy, or if the patient needs more time to
make a decision about the options.
3)What technique would be used for the reconstruction? - here there
are 3 main choices, which all have advantages and disadvantages. Most
types of reconstruction usually take at least 2 operations to complete.
These decisions
are made on an individual basis, depending on many factors, including
the position and particular type of cancer, the patient's general medical
health, the size and shape of the patient's breasts, and the patient's
lifestyle and wishes.
breast reconstruction
