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Breast

Reconstruction:

Bringing back what nature gave but cancer took away

Facing cancer is an overwhelming and challenging journey. Whether you or a loved one are undergoing surgical intervention to cure cancer or to prevent cancer, the surgical options, adjuvant therapies and outcomes can be overwhelming. We understand that breast cancer is life changing; it is a journey you or a loved one did not choose, can plan for or anticipate. We have created this simple guide to help you understand breast cancer a little more and help better prepare for the journey ahead.

What is Breast Cancer?

Breast cancer is a development of abnormal cancerous cells that grow uncontrolled within the breast tissue and develop into a tumor. Although some tumors can be non-cancerous (benign), other tumors, known as malignant tumors, are cancerous. Breast cancer most commonly begins in the cells that line the milk ducts and lobules within the breast, however, in some cases, the cancer cells can invade healthy tissues and make their way into nearby lymph nodes and other parts of the body.

What is the surgical
treatment of breast cancer?

Lumpectomy

Removal of the tumour and a health margin of tissue around the tumour

Mastectomy

Removal of the full breast tissue

Chemotherapy

Uses drugs known as cytotoxic anti-cancer) drugs, which are given to kill the cancer cells and usually given once every 2-4 weeks following your surgery.

Hormone therapy

Hormone therapy: uses drugs, surgery or radiotherapy to reduce the production of hormones (estrogen and progesterone) which stimulates the growth of hormone receptor positive cancers.

Radiotherapy

Uses low doses of radiotherapy to kill the cancer cells. Radiation therapy is usually given over a period of around 3-5 weeks every 3-5 days and is usually given after surgery.

Targeted therapy

Uses drugs to change the cells production and growth, reducing the cancer from spreading.

Adjuvant treatment of breast cancer

Breast Reconstruction Overview

WHAT IS BREAST RECONSTRUCTION?

Breast reconstruction is a procedure to replace lost skin and breast volume which was removed during cancer treatment. Breast reconstruction can replace lost breast volume, reconstruct the nipple, and breast restore symmetry

Immediate Reconstruction

Reconstruction of the breast is performed at the same time as the mastectomy procedure.

Delayed Reconstruction

Reconstruction of the breast is performedas a separated procedure, not at the time of the mastectomy procedure.

Reconstruction

1 Latissimus dorsa flap: using a flap of tissue from your back muscle to reconstruct the breast

2 Superior gluteal artery perforator flap (SGAP) or inferior gluteal artery perforator flap (IGAP): takes skin and fat from the buttock to reconstruct the breast

3 Transverse myocutaneous gracilis flap (TMG)/Transverse upper gracilis flap (TUG): takes skin, fat and muscle from the thigh.

Flap Based

4 TRAM (Transverse Rectus Abdominis Myocutaneous) Flap: using skin, tissue and muscle from your abdomen to reconstruct the breast.

MSTRAM (Muscle Sparing Transverse Rectus Abdominis Myocutaneous) Flap: using just skin, tissue from your abdomen to reconstruct the breast.

DIEP: Deep inferior epigastric artery perforator (DIEP) flap: takes a portion of the lower abdomen including skin and fat (leaving behind the abdomen muscle) to reconstruct the breast

Breast Implant Based Reconstruction

One Stage

Breast Implant is placed immediately at the time of the mastectomy to reconstruct the breast. The use of an ADM or Dermal sling may be used in addition to provide coverage.

Two stage

The FLORA tissue expander is placed at the time of the mastectomy to expand the skin. Once expansion is complete the breast implant will be placed in a second procedure.

Other options available
Fat Grafting

Using liposuction fat is removed from parts of the body and reinjected into the breast.
Can be used to correct minor volume loss after lumpectomy or in addition to flap and breast implant options.

Reference List

  1. National Breast Cancer Fondation. Breast Cancer FAQ. National Breast Cancer Foundation. [Online] https://www.nationalbreastcancer.org/breast-cancer-faqs/can-a-healthy-diet-help-to-prevent-breast-cancer/..
  2. Cancer Research UK . Treatment options for breast cancer | Cancer Research UK. Cancer researchuk.org. [Online] 2017. Available at: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/treatment-decisions..
  3. American Cancer Society. . Treating Breast Cancer. American Cancer Society. . [Online] 2020. https://www.cancer.org/content/dam/CRC/PDF/Public/8581.00.pdf..
  4. org.uk. Nice.org.uk. . Overview | Advanced breast cancer: diagnosis and treatment | Guidance. [Online] 2009. https://www.nice.org.uk/guidance/CG81.
  5. McDonald JA, Goyal A, Terry MB. .Alcohol Intake and Breast Cancer Risk: Weighing the Overall Evidence. Current breast cancer reports. 3, 2013, Vol. 5.
  6. Body Mass Index and Breast Cancer Risk According to Postmenopausal Estrogen-Progestin Use and Hormone Receptor Status. Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. 1, 2014, Epidemiologic Reviews ., Vol. 36, pp. 114-136.
  7. National Cancer Society. Dense Breasts: Answers to Commonly Asked Questions. 7. National Cancer Society. [Online] https://www.cancer.gov/news-events/cancer-currents-blog/2015/dense-breasts-screening. .
  8. Institute, National Cancer. Dense Breast Screening. National cancer Institute. [Online] https://www.cancer.gov/news-events/cancer-currents-blog/2015/dense-breasts-screening..
  9. org. (2012). Treatment and Side Effects. [online] Available at: https://www.breastcancer.org/treatment.
  10. org. (2017). Treatment options for breast cancer | Cancer Research UK. [online] Available at: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/treatment-decisions.
  11. Farhadieh, R.D., Bulstrode, N. and Cugno, S. (2015). Plastic and reconstructive surgery: approach and techniques. Chichester, West Sussex ; Hoboken, Nj: John Wiley & Sons Inc.
  12. Henk Giele and Cassell, O. (2016). Plastic and reconstructive surgery. Oxford: Oxford University Press.
  13. Janis, J.E. (2018). Essentials of plastic surgery. Johanneshov: Mtm.
  14. org.uk. (2009). Overview | Advanced breast cancer: diagnosis and treatment | Guidance | NICE. [online] Available at: https://www.nice.org.uk/guidance/CG81.
  15. Roy, P.G. (2016). Modified Lower Pole Autologous Dermal Sling for Implant Reconstruction in Women Undergoing Immediate Breast Reconstruction after Mastectomy. International Journal of Breast Cancer, 2016, pp.1–7.