As many as 7% of women will develop breast cancer. Although often breast conserving treatments are possible, for many it means surgically losing one or both breasts. The impact to self image and esteem of mastectomy can be devastating and lead to ongoing distress. Following mastectomy, women often resort to wearing unnatural looking and feeling external prostheses. With modern advances in plastic and reconstructive surgery and microsurgery, women can now opt to have breast reconstruction that can be natural in appearance and feel. For women undergoing breast reconstruction, feeling "whole and normal" again is a great boost to their self image and esteem.
If you are contemplating breast reconstruction, it is best to be fully examined and assessed by your plastic surgeon. Your general surgeon (who performed the mastectomy) will often give you an initial idea of your suitability for reconstruction but the plastic surgical opinion will help you make you final choice of reconstructive method. Sometimes "immediate" reconstruction can be arranged at the time of your mastectomy and you can discuss this with your general surgeon prior to mastectomy.
There are various ways of achieving breast reconstruction. They vary in their complexity and their look and feel. There are three main ways Dr Drielsma performs breast reconstruction:
1. Tissue expansion and breast prosthesis
2. Latissimus Dorsi muscle flap and breast prostheis
3. TRAM Flap reconstruction.
Dr Drielsma will discuss at length these three options (which represent the world standard of breast reconstruction) and advise you on suitability and help you decide which is best for you. They differ by increasing complexity and degree of quality in terms of shape and feel.
This technique involves stretching the remaining chest wall skin at the mastectomy site so that a pocket is made to accommodate a breast prosthesis. A "tissue expander" (a plastic inflatable balloon) is surgically place under the pectoral muscle of the chest. The expander has a small plastic injection port which is placed just under the skin, allowing saline (salt water) to be injected from the outside into the balloon. Gradually over a period of about 6 to 8 weeks, the expander is gradually filled, stretching the muscle and the overlying skin and in so doing, recreating a breast mound.
At a second stage procedure, the expander is usually removed and a permanent breast implant placed in the pocket. Alternatively, with the use of a special type of expander called an expander-prosthesis, the expander stays in as the definitive prosthesis.
Tissue expansion is the simplest form of breast reconstruction in that the initial operation is relatively short. It is, however, the least natural looking and feeling form of reconstruction and involves the use of a breast implant. The resulting breast mound feels firm and of the three methods of breast reconstruction discussed is least likely to give a natural "ptotic" or drooped look. Late ongoing scar problems are common and usually result in complications requiring further surgeries and compromised shape of the reconstructed breast. Nipple reconstruction can be undertaken some 4-6 months later.
Latissimus Muscle Transfer and Implant
This technique involves using a muscle from the back (Latissimus Dorsi Muscle) with its overlying fat and skin and transferring this to the anterior chest to cover a breast implant and make a new breast. The procedure is more complex than tissue expansion, taking about 4 hours to do. It is however, less complex than TRAM flap reconstruction.
The Latissimus muscle technique, while still using a breast prosthesis, is more natural looking and feeling than tissue expansion. A generous layer of the body's own muscle and fat covers the implant allowing natural feel and "ptosis" or breast droop. Late ongoing scar problems related to the breast implant can also occur and require further surgeries and compromised shape of the reconstructed breast. Nipple reconstruction can be undertaken some 4-6 months later.
Disadvantages of this technique lie with the resulting back scar necessary to harvest the latissimus muscle and the fact that a breast implant is still used.
TRAM Flap Reconstruction
The TRAM Flap (Transverse Rectus Muscle Flap) is the most complex but most natural form of breast reconstruction. It is performed using only the body's own or autogenous tissue. Using a "tummy tuck" approach fat, skin and muscle of the lower abdomen is harvested and transferred to the chest wall to create a new breast. Because of the amount of tissue available for transfer using this method, there is no need for a breast implant. The transferred tissue is primarily fat removed from the abdomen and therefore the resulting reconstructed breast has a very natural look and feel with natural ptosis being achieved. No plastic is used and therefore there is no risk of late ongoing scar problems related to an implant.
The TRAM technique is the most complex form of breast reconstruction. It can be done as a "pedicle" technique, whereby the abdominal tissue is moved to the chest without actually being detatched from the body. Alternatively it can be done using the "Free Flap" technique, whereby the abdominal tissue is first completely detatched from the body and then later is rejoined to the body using microsurgery techniques. The free flap technique, while in general taking longer (about 6 to 8 hours), results in a more reliable blood supply to the flap giving a smoother post operative wound healing course. Dr Drielsma usually uses the free flap technique in preference for breast reconstruction.
The advantages of the Free TRAM Flap technique are that it results in the most natural look and feel of the commonly used techniques. It has an added bonus of giving the patient a "tummy tuck". It is a reliable technique when done using the free flap method and has a 97% success rate.
The free Flap TRAM technique involves an average hospital stay of one week and a 4 to 6 week recovery time. Nipple reconstruction can be undertaken some 4-6 months later.
The first step to your breast reconstruction is consultation with Dr Drielsma. A detailed discussion and examination will be undertaken and suitability for surgery is assessed. The best option that suits your particular needs and wishes will be defined.
