Breast Reconstructive Surgery as an aid to tackle the effects of breast cancer – The Financial Express
By Dr Chirag Bhansali
Cancer is one of the most dreaded diseases with detrimental effects not only on an individual’s physical health but also mental health. Breast cancer is one of the commonest cancers affecting women. Every 4 minutes a woman is diagnosed with breast cancer in India. Incidence of breast cancer has increased over the years especially in young women aged 30-40 years.
The social and mental effects of having gone through the diagnosis and treatment of cancer may lead to long term emotional turmoil and lack of self-confidence, in cancer survivors. A significant number of women suffering from breast cancer have to undergo mastectomy – surgical removal of one or both breasts or lumpectomy – surgical removal of a discrete portion or a lump in the breast to get rid of the cancer cells. These procedures lead to the loss of the normal breast structure and this change in physical appearance can cause depression, frustration, low self-esteem and significant change in the social life of many women.
A breast reconstruction surgery is a procedure to recreate the breast structure in order to restore the physical appearance of the woman so that she can feel good about herself and lead a normal social life with self-esteem.
Breast reconstruction surgery: Its uses
A breast reconstruction surgery can be done following a procedure to remove breast cancer in order to restore breast shape, size, symmetry and location of the breast. The aim is to reconstruct the breast such that it looks as close to the original breast as possible. Sometimes, a staged procedure or a second surgery (breast augmentation or reduction) may be required to achieve the same
Reconstruction can be done at the time of the breast cancer resection (Primary reconstruction) or on a later date after the complete breast cancer treatment (adjuvant chemo-radiotherapy) (Secondary reconstruction)
Partial Breast reconstruction after breast conservation surgery – Breast oncoplasty
Removal of a portion of the breast can lead to significant disfigurement of the breast. Oncoplastic techniques help reconstruct these breast deformities while maintaining the oncologic outcomes. These techniques include loco-regional flap transfer, fat grafting and reduction mammoplasty. These help in filling the defect caused due to lumpectomy and helps in improving the shape of the breasts. Depending on the amount of gland removed, different techniques can be applied.
Whole breast reconstruction after mastectomy
Breast reconstruction surgery can be of two kinds: Implant based reconstruction and flap based (using patient’s own body tissues) reconstruction.
Implant-based reconstruction is an option when using tissues from other parts of body is not desired or not available for various reasons. Saline or silicone implants are used to recreate the breast. Sometimes a combination of implants and tissues from the patient’s body are used for reconstructing the breast.
In flap based reconstruction, the tissues (skin,fat,muscle,blood vessels) can be taken from a nearby bodily site (pedicled flap) which essentially retains its own blood supply or from a distant site (free flaps) wherein the blood vessels are disconnected from one site and then reconnected with the blood vessels of the chest . Free flaps are performed using an operating room microscope and is termed “microsurgery.” Lax lower abdominal tissues are most commonly used. This flap is called the DIEP flap and is considered the GOLD standard for breast reconstruction. This surgery comes with an unintended collateral advantage of fat loss from the lower abdomen (Tummy Tuck).
Tissues can also be taken from the back (LD Flap), thighs (PAP And TUG flap), buttocks (SGAP,IGAP)
Nipple and Areola Reconstruction
The nipple is reconstructed with a variety of techniques using the tissues of breast reconstruction. Example- C-V flap, Skate flap, Star flap, Arrow flap etc.
The areola viz the dark skin around the nipple is recreated with a medical grade tattoo. There are a variety of colours available to choose from to create a natural-appearing areola. Areolar tattooing is usually painless and can be performed on outpatient basis.
Breast reconstruction surgery can significantly boost self-esteem and have a positive effect on the mental health and social life of a woman after going through the trials and tribulations of breast cancer treatment. It helps the patients feel better about the clothes they wear and how they look. Undergoing breast reconstruction surgery is a personal choice and one may or may not opt for it depending on their preferences. In our experience, very few women undergoing surgical removal of breast cancer are offered the option for breast reconstruction in India. This is not usually the case in western countries where breast reconstruction is the norm rather than an exception. Consult a plastic and reconstructive surgeon for more information about breast reconstruction surgeries.
Our motto is to restore what the cancer has taken away and to reconstruct more than just the breast.
(The author is a Senior Plastic Surgeon, Consultant in the Department of Plastic and Reconstructive Surgery at HCG ICS Cancer Hospital, Mumbai. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)
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