As we wrap up women’s month we take a look at breast cancer, which is one of the most prevalent cancers among women in South Africa.
For anyone, being diagnosed with cancer is an emotional and traumatic experience which can be exacerbated when the treatment involves the removal of part of your body.
Today breast reconstruction surgery is often done at the same time as the removal procedure to rebuild the affected area.
With this in mind, Dr Frank Graewe, a renowned reconstructive and micro-surgeon has outlined the things you need to consider when undergoing breast reconstruction.
When to have breast reconstructive surgery
Having breast reconstruction done at the same time as the mastectomy has several advantages. It saves time, saves another procedure and reduces recovery time, but most importantly the patient does not have to face the physical loss and trauma of going without a breast. In most cases a better cosmetic result can also be achieved if some of the breast architecture can be preserved during the mastectomy.
While, in most cases, there is no medical reason to not perform a reconstruction immediately, some patients need time to reflect and are not comfortable weighing all the options while they still struggling to cope with the diagnosis of breast cancer. In these cases a delayed +reconstruction is necessary.
The types of breast reconstructive surgery
There are two main types of reconstructions available: Implant based reconstruction or own tissue based “flap” reconstruction. In the case of implants, a salt water or silicone implant is inserted. For “flap” reconstruction tissue from another part of the body, such as the stomach, thigh or back is transplanted to reconstruct the breast.
Both of these options have some advantages and disadvantages.
The biggest advantage of using a patient’s own tissue for reconstruction is the fact that it forms part of the body and is completely integrated into the area.
Own tissue is soft and feels natural. Own tissue reconstructions are also more resistant to radiotherapy than implant reconstructions.
Using your own tissue for reconstruction is technically more complex and contains two areas instead of one - the breast area that gets reconstructed as well as the area where the tissue is taken from. In addition, recovery and hospitalisation is usually longer than in implant reconstructions.
Implant based reconstructions, which are probably the best known type of procedure are simpler and have the benefit of a shorter recovery time. Implants are a good option in the absence of radiation treatment after mastectomy.
However, due to the fact that implants are foreign material in the human tissue there is the possibility of capsule formation. In addition the breast can get hard and contract, and there is a higher chance for infection. More importantly, there is an increased chance of complications and a statistically higher rate of secondary surgeries with implant reconstructions. Implant reconstructions are less resistant to radiotherapy.
The healing period
Patients who have immediate breast reconstruction with implants are usually booked off for two to four weeks. The healing period is longer when own tissue reconstruction is done. Generally patients are booked off for four to six weeks. If you are a very active person it is
important to consider how your mobility will be affected after surgery. While implant reconstruction has a shorter recovery time, studies have shown that patients who had own tissue reconstructions have a higher long term satisfaction rate.
Medical aids usually cover the surgery costs of both options, however, different medical aids have different sets of benefits for different procedures. Each case should be coded and motivated individually and handed in to the medical aids to apply for benefits.
The likely outcomes of breast reconstruction
It is important to note that the sensations in your breast will no longer be the same after reconstruction surgery. What will most likely not look or feel the same after breast reconstructive surgery mostly depends on the type and extent of breast cancer surgery and the oncology treatment. There are different types of mastectomies, treatment of lymph nodes and various reconstruction techniques. This can all affect the possible outcomes, such as the loss of feeling in the nipple. You need to make sure that you understand the various possibilities after having breast reconstruction, so that you are not caught by surprise and you can ensure that you can focus on recovering from the disease.
Pre and post reconstruction treatments and procedures
After the mastectomy and reconstruction we recommend physiotherapy to get back to normal daily activity levels. Some procedures which can be required after an immediate reconstruction are nipple areola reconstructions in cases where the nipple could not be spared, a breast lift or breast reductions of the unaffected side.
A frequent problem with implant reconstruction is rippling, meaning the folds in the implant surface are visible and palpable through the skin envelope that is usually thin.
This may require another procedure. More refining procedures are usually necessary in delayed cases than with immediate reconstructions.
Risks or potential complications
As with other procedures, having breast reconstruction comes with the risk of bleeding, hematoma (a swelling of clotted blood), seroma (fluid that builds up under the skin) or infection. There is also the risk of implant infection, cosmetic complications or the rupture of implants and contour defects. Your surgeon should discuss the risks or potential complications with you before any surgery.
Know your options
Breast reconstruction is a major surgical procedure and it is therefore important to know what the risks are and what the recovery will entail to help prepare yourself. Removing cancerous tissue from the breast is often part of the first steps in the fight against cancer.
I believe that breast reconstruction helps women to feel better about their bodies, which gives them the emotional strength for their ongoing fight against cancer.