June 3, 2022
Dr. D G Vijay and Dr. Tanay Shah, Surgical Oncology
Breast reconstruction is one of the many aspects that can have a positive impact on the quality of life among cancer patients who have undergone mastectomy for breast cancers. However, some patients get intimidated by the idea of undergoing breast reconstruction, owing to some misconceptions and a lack of awareness.
Here are some of the important things that breast cancer patients should know about breast reconstruction surgery.
1. What is breast reconstruction surgery?
Breast reconstruction surgery, which is also known as oncoplastic surgery, is a surgical procedure that is available for women who have undergone lumpectomy or complete mastectomy.
Breast reconstruction surgeries are performed to restore the shape, appearance, size and symmetry of one or both breasts to a near-normal state.
Breast reconstruction surgery can either be performed right after the breast cancer surgery (immediate reconstruction) or some years after the surgery (delayed reconstruction).
2. How is breast reconstruction surgery performed?
Breast reconstruction surgeries are broadly classified into two types:
a. Autologous or Flap Reconstruction: Autologous breast reconstruction is a surgical procedure wherein the patient’s own body tissues (skin, blood vessels, fat and muscles) are used for breast reconstruction. Also known as flap surgery, this procedure is performed by oncoplastic breast surgeons. The tissue for reconstruction is usually taken from the belly; but it can also be taken from the thighs and back.(buttocks).
Occasionally, surgeons may move a flap from nearly bodily site. (pedicled flap). This flap retains its own blood supply. Surgeons can also remove the flap from its blood supply and link it to blood vessels in the chest (free flap).
Flaps can be used for both partial breast reconstruction and whole breast reconstruction.
Following are some of the commonly used flaps for breast reconstruction:
- Flap from Abdomen (Belly):
DIEP (deep inferior epigastric perforator artery) free flap: This flap contains the skin, fat and blood vessels from the lower belly. Also has the advantage of simultaneous abdominoplasty (tummy tuck).
TRAM (transverse rectus abdominis muscle) pedicled flap: This flap contains the skin, fat, blood vessels and the muscles from the lower belly. This flap also provides advantage of tummy tuck.
- Flap from Thighs:
PAP (profunda artery perforator) flap: PAP is a blood vessel that runs through the thigh. PAP flap contains this blood vessel along with the skin and fat from the thigh.
TUG (transverse upper gracilis) flap: The TUG flap contains skin, blood vessels, fat and muscles from the thigh.
- Flap from the Back:
LD (Latissimus dorsi) flap: LD flap is taken from the region right below the shoulder blade and behind the armpit in the back. This flap comprises the skin, blood vessels, fat and muscles. The LD flap is transpositioned to the breast area from the back while it is still connected to its own blood supply.
- Flap from the Bottom:
SGAP (superior gluteal artery perforator) flap/hip flap: Gluteal artery perforator is a blood vessel that crosses the buttocks. This flap comprises the blood vessel, skin and fat from the hip region or upper buttocks.
IGAP (inferior gluteal artery perforator) flap: This flap contains the tissues that come from the lower part of the buttocks.
Autologous whole breast reconstruction comes with an unintended collateral advantage of fat loss in the belly region.
b. Implant Reconstruction: Implant reconstruction is a surgical procedure where the breast is reconstructed using saline or silicone implants. In some cases, the implants may be combined with the patient’s own body tissues. Implants are largely considered for whole breast reconstruction.
Following a mastectomy, implants are put beneath the skin or behind the chest wall muscle. Implant reconstruction is a two-stage surgical procedure. The surgeon first inserts a tissue expander under the skin that remains after the mastectomy or under the chest muscle in the first stage. This expander is filled with saline at regular intervals after surgery. In the second stage, the expander is replaced with an implant after the chest scar has healed.
Our centre houses some of the best breast cancer specialists in Ahmedabad, who can devise breast reconstruction plans based on the individual needs of the patients.
3. What are the selection criteria for breast reconstruction surgery?
Before recommending breast reconstruction surgery, we consider various factors like the stage of the disease, size of the tumour and the overall condition of the patient.
Tumour to breast ratio is an important criterion that we consider. For those candidates, who have a tumour to breast ratio of less than 20%, i.e., the tumour comprises less than 20% of the breast volume, breast conservation surgery is considered. In this case, a reconstruction procedure may not be required.
However, if the tumour is more than 20% of the entire breast volume, then reconstruction surgery is performed after the removal of the tumour. This reconstruction surgery helps in maintaining the symmetry between both breasts.
4. Are there any side effects associated with breast reconstruction surgery?
In most cases, the specialists aim to perform reconstruction surgeries with superior precision. Therefore, there are very few chances of the patients experiencing any serious side effects. However, on rare occasions, there are chances where the patients may experience the following side effects.
- Wound healing problems
- Changes in sensation
- Partial or complete loss of flaps (due to impaired blood supply)
- Implant disposition or extrusion
In the case of whole breast reconstruction, there are chances of herniation at donor sites, i.e., the regions from where the tissue is extracted for breast reconstruction. This is a rare long term side effect.
5. How Does Breast Reconstruction Surgery Impact Breast Cancer Recurrence?
It has been found that cancer can recur after breast cancer surgery whether or not the patient has undergone breast reconstruction surgery. It is important to note that breast reconstruction surgery does not increase or decrease the risk of cancer recurrence. It is basically disease and stage which are responsible for recurrence rather than whether patient has undergone reconstruction or not.
Also, breast cancers do not recur at the same site in most cases – they tend to recur in distant organs, namely the lungs, liver, bones or the brain.
Hence, cancer patients need to keep up the follow-up appointments after their treatment. During follow-up visits, the specialists look for symptoms of cancer recurrence, check if the patient is experiencing any side effects and if they are doing okay.
Breast Cancer Treatment at HCG Cancer Centre, Ahmedabad
At HCG Cancer Centre, Ahmedabad, we have a large and robust team of surgeons who extensively specialise in the surgical management of breast cancers. We perform a broad spectrum of breast cancer surgical procedures ranging from lumpectomy (breast conservation surgery) and modified radical/radical mastectomy to breast reconstruction surgery and oncoplastic breast surgeries.
In the last one year, we have performed 591 breast surgeries. We have performed 242 mastectomies, 145 breast conservation surgeries, 112 reconstructive surgeries, 145 chemo port insertions and 240 sentinel lymph node biopsies.
Our team focuses on devising personalised and patient-centric treatment plans, which help us in achieving positive clinical outcomes whilst ensuring a better quality of life.
Regular screening plays a pivotal role in the early detection and timely treatment of breast cancer. Apart from early detection, getting in touch with the right specialist also becomes equally important. At HCG, we have some of the best breast cancer specialists in Ahmedabad, who have vast experience in the diagnosis and treatment of breast cancer, breast conservation and breast reconstruction and can help patients win over breast cancer – the right way, the first time.
– By Dr. D G Vijay, Senior Consultant – Surgical Oncology, Director – HCG Cancer Centre, Ahmedabad and Dr. Tanay Shah, Consultant – Surgical Oncology