Hello Everyone….
Back to the blogging board. This time I’m trying to write about something that every woman should know about and be aware about.
Yes, I’m talking about “Breast Cancer Awareness” and the “Pink Ribbon Run 2010” to be held this year.
Many of you must have also noticed the strange facebook satus messages which were again put out there to create awareness, regarding breast cancer.
But, what I’m going to be writing today here, is taking it a bit further. Yes, prevention is better than cure… and awareness to identify the problem early and deal with it is very important. But I deal with people who are already diagnosed and are operated on or have had their breasts removed in part or completely as a result of this disease.
I’m talking about “Rehabilitation awareness or Reconstructive awareness” as I would like to call it. Most if not all the women who have an established breast cancer are subjected to severe mental trauma for having to loose a breast – a sign of womanhood. That, many of them find more traumatic, than dealing with the actual disease - cancer.
The low awareness regarding the reconstructive options for such patients is appalling. We need to spread awareness to tell these women… this is not the end, they don’t need to feel inadequate or incomplete. There are options to reconstruct the lost part of your body and help them feel complete again.
As with anything in the world, the old adage holds true here too – “A stitch in time saves nine”. Early detection might help with getting away with only a lumpectomy rather than a full mastectomy.
So, yes early detection is the key, and for that awareness is a must. But, in cases with an established lesion, we have found that it is easier for patients’ to fight it knowing that they can be treated to get rid of the disease and it need not come at the cost of losing a part of their body leaving them “incomplete”. Of course many of them even if not reconstructed, over a period of time do reconcile to the situation, but the “quality of life” is not the same.
" Reconstruction is not an option….. in fact it must be the right of the patient. "
Every patient who undergoes a deforming surgery should be offered a reconstruction. It is her choice whether she goes ahead with it or not and this has to be discussed with them right at the outset when a treatment plan is made. Nowadays, every Oncology center has a good reconstructive team which is capable of planning and executing the same so that no patient has to go home feeling incomplete. With newer modalities of treatment and diagnosis, the reconstruction can be performed in the same sitting without the need for a secondary procedure later on.
There are many significant advantages of such an approach. The patient find it easier to deal with the trauma of deforming surgery, the quality of life is better and acceptance of curative resections will be more. There are some more advantages from the medical point of view with an immediate reconstruction which I will discuss during the course of this blog.
Now that we have established the need for reconstruction of the breast, let me just briefly highlight the various reconstructive options. For ease I will broadly classify the treatments into:
- Variations in treatment itself
- Reconstructive options
- Ancillary procedures.
Variations in Treatment:
Early detection helps giving us more options from the treatment point of view as in instead of doing a radical surgery to remove the full breast, variations such as Lumpectomies, Quadrantectomies, Partial mastectomies, Nipple sparing mastectomies or skin sparing mastectomies and the likes have come in. Of course as these fall into the purview of an Oncosurgeon and it would not be prudent on my part to be commenting on them.
But, it’s just to say that now, with early detection and by combining different modalities of treatment, the need for radical surgeries can be reduced.
Reconstructive Options:
But, when there is a situation wherein a part or the whole breast needs to be removed, we come into the picture to help with reconstruction of the breast.
Breast reconstruction involves using tissues from the body to reconstruct the breast either with or without an implant.
Implant Reconstruction:
In skin sparing mastectomies, partial removals or major lumpectomies, when the skin cover is more or less intact, then a reconstruction using a Silicon implant with or without a muscle flap is done. A muscle flap is combined along with the implant if only a think skin envelop remains to give better contour and also protection to the implant.
In cases where the skin envelop is more compromised and necessitates removal, then a combination procedure is done, where in a muscle flap is rotated from the back and then a tissue expander is inserted under this muscle to create a space for an implant. After 2 months or so, once the space is adequate, a silicone implant can be inserted or alternatively fat grafting to the breast can be done.
Breast reconstruction with Muscle & Skin Flaps:-
This kind of reconstruction is done using muscle and skin from other parts of the body to reconstruct the breast, when there is skin loss as well.
When a partial mastectomy is done or the native breasts are small, we could reconstruct using a Latissimus Dorsi Myocutaneous flap which is rotated from the back into the chest to reconstruct the breast. This can be combined with an implant as well. This muscle can be harvested to reconstruct the breast without too much of a deformity to the back and without significant loss of function. But this cannot be used when larger reconstructions are required.
For larger reconstructions the flap used is called the TRAM flap. This flap has been the workhorse for breast reconstructions for many years now. The main advantage of this flap is it provides good bulk for larger reconstructions and by removing it the patient gets an added advantage of having a flat tummy. This flap uses the fat and skin from the lower part of the tummy which is rotated into the chest to reconstruct the breast. This skin is normally discarded when we do a tummy tuck. So the patient get a tummy tuck as well as breast reconstruction in the same sitting.
Now there are more modifications to this flap allowing for more significant reconstruction with better aesthetic results.
Nipple reconstruction is usually done as a secondary procedure at a later date.
Ancillary procedures:
These are procedures done after the initial reconstruction to improve the result of the reconstruction and or the aesthesis.
- Nipple reconstruction: this is done as a secondary procedure. This is a minor procedure done to reconstruct the nipple using tissue from wither the opposite nipple or a skin graft of vulval skin.
- Reduction of the opposite breast.: Sometimes the native breast maybe too large, in such cases the reconstructed breast will be smaller than the native opposite breast. To help give a better balance a reduction mammoplasty of the unaffected opposite breast maybe required, but is not necessary. The choice is left to the patient.
- Scar revisions: sometimes rarely the scars can thicken or some scars may widen needing a scar revision later on.
So, from this brief write up, you can see that there are well established procedures for breast reconstruction after a mutilating procedure following cancer of the breast. But the awareness amongst patients is still low and hence patients need to understand and ask for reconstructions.
As I said before, in today’s day and age, no patient should go without a reconstruction. There are enough and more plastic surgeons in private and in government hospitals, capable of providing these reconstructions.
Hope we can spread the word around so no woman who has had to deal with a cancer of the breast be allowed to suffer the added pain of feeling incomplete after a mutilating procedure.
It is no longer a question of if one lives but also a question of how one lives – The quality of life….is point of emphasis here.
Dr.Surindher
