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Breast reconstruction

Breast Reconstruction


Breast Reconstruction is an attempt by the surgeon to preserve the woman`s
Shape to how she was, or correctly, near enough to how she was before her
cancer treatment.
Could be carried out either Immediately, at time of Mastectomy or Delayed, at any time later in life.

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Immediate Breast Reconstruction is carried immediately at the time of Mastectomy, during same admission
:It has so many advantages, psychological and physical
,o Single operation
.o Same pain
.o Same admission
o Huge psychological advantages, walk in with a 2 breasts and walk .out with 2 breasts
o Economic advantages, only one period off work, costs of one
.operation instead of two
o Most of the original skin envelop is preserved, maintaining the best
.possible cosmetic, near normal look
.o More Reconstruction options
😮 But, also has some disadvantages
– Could delay the start of complementary treatment that may be
.needed should complication occurs
– Patients might feel rushed into decision making without sufficient
.counseling

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Delayed Breast reconstruction could be carried out at any time the patient
wishes after the initial surgery.
There is no time limit as to when the patient could have the reconstruction
as long as she maintains good health.
Advantages are: No delay to needed complimentary treatment.
Patients will have had better counseling .
Disadvantages are: a second operation.
A second period of hospitalization.
More costs on hospital and patients.
A touch inferior cosmetic results compared to immediate

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Combines the benefits of immediate (by preserving the skin envelope) with
the benefits of the delayed (by keeping all the options open).

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Any woman could have Breast Reconstruction regardless of age,
ethnicity, culture or education.
Few exceptions:
o Auto-immune disorders like, Systemic Lupus, Rheumatoid etc..
o Diabetes Mellitus, esp. type one.
o Smokers are better avoided.
o Heart dysfunction.
o Lung dysfunction.

o Some malignant tumors, like Inflammatory Cancer.

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To build a breast you simply need SKIN and a Filling

1. Implant only Reconstruction: Using either a Silicon or Saline filled
implant inserted under or more recently over the chest wall muscle.
Overall , satisfactory results.
Simple operation.
One incision.
Less pain.
Relatively quick recovery.
But has many Disadvantages:
-Sometimes, least satisfactory look or feel.
-Slightly higher rate of infection.
– Does not stand well the insult if Radiation therapy if needed.

4- Tissue Transfer – FLAP- Surgery: It involves moving tissue around (muscle –
fat and overlying skin) to be used to replace the removed breast.
– Conventionally, either the back muscle or the abdominal muscles are
used.
– Superior look and feel.

– Examples are: Latissimus Dorsi Flap (LD) and TRAM Flap, free flaps
But, bigger operation.
More risk of complications that might compromise complementary
treatment.

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o Breast Reconstruction stood the test of time.
o Has become an integral and essential part of breast cancer
management.
o It proved to be fairly safe.
o Does not increase or interfere with diagnosing disease recurrence.
o In reality, it reduces disease recurrence by allowing the surgeon to be
more aggressive with the disease at the first operation.
o A woman chooses to undergo Breast Reconstruction only to fulfill her
wishes, not anyone else.
o Women have to be realistic in their expectation.
o The results are very satisfactory in at over 80% of patients.

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