As Seen in The News Journal 10-13-16
“Yes, they’re fake, my real ones tried to kill me” – (Breast Reconstruction After Cancer)
I’m happy when I see breast cancer patients proudly sporting T-shirts which say “Yes, they’re fake – my real ones tried to kill me”.
October is National breast cancer awareness month. Look around you at (or think of) your eight closest female friends. Chances are, one in every eight will be diagnosed with breast cancer in her lifetime.
It is the second most commonly diagnosed cancer (after skin cancer) and the second most common cause of cancer death in women (after lung cancer).
Fortunately, diagnosis and treatment of breast cancer has been steadily improving over the years, resulting in longer survival and higher cure rates.
Depending upon the type and stage of breast cancer, surgery may be recommended to remove the cancerous cells. This may involve a lumpectomy (removing part of the breast) or a mastectomy (removing all the breast tissue).
If only a small amount of tissue is removed, simply transferring fat may be all that is needed to fill in the empty space.
If a moderate amount of tissue is removed and the opposite breast is large, reducing the opposite breast may achieve a pleasing appearance and symmetry. In the case of a mastectomy, however, various breast reconstruction techniques are available to recreate the form of the breast.
There are two main types of breast reconstruction: implant based and autologous tissue reconstruction.
Autologous tissue is tissue from the patient’s own body, taken from elsewhere and transferred to the chest. In plastic surgery, most autologous breast reconstruction techniques use a flap, which may consist of muscle, fat, and/or skin.
The most common flap for breast reconstruction is the TRAM flap which uses the Transverse Rectus Abdominis Muscle to move a block of fatty abdominal tissue up to the chest wall.
The TRAM flap can reconstruct one or both breasts by using the lower abdominal skin and fat, tunneled under the skin of the upper abdomen, to create a breast mound. The rectus muscle can be divided at either end because it has two separate blood supplies, either of which can independently supply the flap.
When divided at the lower end, the muscle is used to maintain the connection between the flap and the chest wall. The TRAM flap gives the added benefit of tightening the abdominal skin, similarly to a “tummy tuck”.
Another common flap is the “Lat flap”, short for Latissimus Dorsi muscle flap. This muscle, rotated from the back, can reconstruct a moderate sized breast when used along with overlying fat and skin, or can be used with an implant to reconstruct a larger breast.
Muscle flaps have the advantage of using healthy, living tissue which can make the reconstructed breast look and feel very natural. They help fight infection, which can be significant problem when an implant is present or the area has had radiation therapy.
There are also a variety of flaps that can be lifted and transferred using meticulous microvascular techniques to re-attach the tiny artery and vein to a donor source in the chest.
The diameter of the artery and vein to be reattached is measured in millimeters and the suture material used is thinner than human hair. They are called a “free” flaps because the flap is completely removed from the body and then reattached in a different location.
Free flap breast reconstruction is technically challenging and generally performed in teaching institutions, where an entire free flap team is assembled to oversee the surgery and the extensive post-operative monitoring and care necessary.
Implant based reconstruction uses silicone implants to recreate the appearance and feel of the missing breast tissue. The implants need to be placed underneath the Pectoralis Major muscle of the chest so that the implant itself is not felt/seen under the thin skin flaps left after the mastectomy.
Usually implant reconstruction is done in stages. First a tissue expander is placed, which is a specialized implant that can be gradually expanded with saline in the office. This allows the tissues to gradually stretch enough to accommodate the permanent implant. Later, the tissue expander is replaced with a permanent silicone implant.
Silicone implants have been studied for decades in millions of women and found to be safe. The silicone used nowadays is semi-solid, often described as “gummy bear” implants.
It is completely inert, not reacting to nearby tissues or causing any autoimmune or rheumatologic diseases. Modern implants are very strong and usually will last a lifetime without needing to be replaced.
“The choice of which type of breast reconstruction to have is complex and needs to be made in conjunction with your plastic surgeon.”, says Dr. Katheryn Warren, a plastic surgeon in Newark who also performs breast reconstruction. “Some patients are not good candidates for certain reconstructions due to factors like obesity, smoking, radiation therapy, or diabetes, all of which increase the risk of post-operative complications. More than 80% of my patients elect to have breast reconstruction with implants. This is frequently due to their desire to have the quickest recovery and to be able to get back to their normal daily activities as soon as possible.”
Hopefully Joe Biden’s “moonshot” goal to cure cancer will be realized as soon as possible. But until then, we are fortunate to have many different options for women who choose to have reconstruction after breast cancer.