PROCEDURES / BREAST RECONSTRUCTION
Breast Reconstruction is commonly performed on women who have had a mastectomy (removal of the breast due to cancer or precancerous condition) or who have post-radiation breast deformities after breast conservation surgery. The techniques of breast reconstruction have been refined over the past 4 decades so that the expectations for recreation of natural appearing and symmetric breasts can be achieved.
There are three broad categories of breast reconstruction:
1) At the time of breast conservation surgery—oncoplastic techniques that reposition or add volume to the breast to minimize the possible deformity from lumpectomy at the time of mastectomy
2) Implant-based reconstruction
3) Techniques that use only the patient’s own tissue (DIEP, TRAM, or latissimus flaps).
Which technique is best for a patient depends on many factors and variables; a customized treatment plan can be formulated to meet each patients’ goals and needs. A shared decision-making approach is used to facilitate the process.
Planning for breast reconstruction is a process that begins at the time of breast cancer diagnosis. Together with the multidisciplinary care team, decisions will be made regarding each patients’ suitability for primary surgery or, occasionally, primary treatment with chemotherapy before surgery. Decisions regarding nipple sparing or a skin sparing mastectomy are made prior to surgery based on the location and size of the cancer. In cases of prophylactic surgery for genetic predisposition to cancer (as in BRCA gene mutations), a nipple sparing mastectomy can often be planned.
After the mastectomy immediate reconstruction is preferred. Often the reconstruction will require several stages over 6–12 months to achieve the final result.