Breast cancer is one of the most alarming diseases affecting a majority of women across the globe. The standard modality of treatment of breast cancer is surgical resection of the partial or the complete breast tissue along with the skin. The procedure is also referred to as partial or complete mastectomy (mastectomy=surgical removal of breast/breast tissue). If you are a breast cancer survivor or have a lump of tissue removed from your breast, if you have undergone a mastectomy or a lumpectomy procedure or your breasts are prophylactically removed because of increased risk of cancer, breast reconstruction could help you to rebuild your breasts. Ideally breast reconstruction is done immediately after a mastectomy for better results, but could even be done during your radiotherapy and chemotherapy sessions after partial or total breast tissue removal.
When should you consider a breast reconstruction with flap surgery ?
Getting your breasts reconstructed is completely your decision and is based on many factors such as the need for a reconstruction and how will a breast reconstruction affect your day today life. You can always ask your consultant specialist when you are undergoing breast cancer treatment planning. If you have already undergone a mastectomy procedure and you feel that reconstruction of breasts will improve your physical appearance and boost your self-confidence, ask your consultant surgeon if breast reconstruction could be the choice of treatment for you.
When is a breast reconstruction with flap surgery not indicated ?
Breast reconstruction surgery is a primarily a cosmetic enhancement procedure which falls in the category of major surgical procedures that require skilled expertise of a team of doctors viz. your general physician, oncologist, surgeon and plastic surgeon. If you are affected with diseases like diabetes, blood related disorders, uncontrolled blood pressure or are overweight/obese, have a habit of smoking and do not maintain a healthy lifestyle, breast reconstruction is not indicated for you. Ask your operating surgeon about the risks, benefits and suitability of a breast reconstruction surgery for you.
Is breast reconstruction with flap surgery performed immediately after a mastectomy procedure?
In most of the patients the breast reconstruction could be performed immediately after the mastectomy procedure as the outcome of the breast reconstruction is greatly improved. But, there are many factors which decide when a reconstruction procedure needs to be done for example, if you are affected with Stage I cancer of the breast, the reconstruction procedure can be performed immediately after the mastectomy surgery. Whereas, if you are affected with a Stage III cancer of the breast, you will be requiring radiotherapy or chemotherapy sessions followed by the mastectomy procedure, hence the breast reconstruction is usually delayed till your cancer is completely removed/cured.
What are the types of breast reconstruction procedures ?
Depending upon when the breast reconstruction procedure is performed, breast reconstruction can be of three types.
- Immediate breast reconstruction: As the name suggests this type of breast reconstruction procedure is performed immediately after the mastectomy procedure is performed. The treatment planning is done before the patient is posted for a mastectomy procedure. The surgical team consists of plastic surgeon along with your consultant surgeons who are specially train for breast reconstruction surgeries. In case if you are undergoing a prophylactic mastectomy as you are at an increased risk of cancer, breast construction is done immediately.
- Delayed breast reconstruction: As the name suggests the delayed breast reconstruction is performed in patients who are affected with advanced stages of cancer and require treatments like radiotherapy, chemotherapy and targeted therapy and a reconstruction is not advised until the complete cancerous tissue is removed. This delayed construction can be done after months or a year of the mastectomy procedure. Delayed breast reconstruction is also done in women who are not able to decide for a reconstruction surgery at the time of cancer treatment.
- Delayed-immediate breast reconstruction: This is a rather new approach for breast reconstruction wherein a tissue expander (a balloon type of device which helps in maintaining the shape of the breast tissue) is placed under the preserved skin of the breast which is removed. This tissue expander helps in preserving the shape of the breast and treatments like radiotherapy, targeted therapy could easily be administered. Once the adjuvant cancer treatments are over, this tissue expander and the reconstruction of the breast can be performed.
Depending upon the type of material used breast reconstruction can be classified as ;
- Reconstruction with implants: Breast reconstruction can be done with the help of implants which are either filled with saline, silicone gel or a combination of both. Ask your plastic surgeon about the type of implant which can be suitable for you.
- Reconstruction with flaps/ autologous reconstruction: This type of breast reconstruction primarily involves the use of your own skin, either from your back, abdomen, thigh and buttocks, which is then used to reconstruct the shape of your breast. Reconstruction with flaps can also include artificial implants. The types of flaps are discussed further in this article.
How do you prepare for a breast reconstruction with flap surgery ?
Like any other surgical procedure your consultant surgeon will do a thorough physical and clinical examination along with a detailed history taking. If you have a history of mastectomy or lumpectomy, your surgeon might have recommended a breast reconstruction for you. If you are a cancer survivor, the doctor also might do some scans such as a CT scan or an MRI to determine if your cancer is completely removed before deciding on a breast construction surgery. The doctor might also ask you to get a mammogram done to rule out any traces of cancerous tissue in the breast that requires reconstruction and the adjacent breast. Other investigations may include routine blood examination and pre and post-operative photographs. Breast reconstruction is a major procedure and requires a lot of planning.
Does breast reconstruction with flap surgery require administration of anaesthesia ?
Yes, the breast reconstruction surgery is a major surgical procedure that requires administration of general anaesthesia/ sedation before the start of the procedure.
What happens during a breast reconstruction surgery with Flaps ?
Breast reconstruction with flap surgery is one of the most difficult procedures which requires skilled plastic surgeons who are thoroughly trained to perform such procedures. Breast reconstruction with flap surgery is one of the most tedious procedures and requires a lot of planning before the procedure is performed.
It is very essential to ask your treating surgeon, if flap surgery for breast reconstruction could be the choice for you. As mentioned earlier breast reconstruction with implants is a rather simple procedure where recovery is faster but the life of the implant is limited which makes the implant to be replaced over a period of time. Whereas the surgical operation to perform a breast reconstruction is more complex but has a better outcome and longevity.
Primarily two methods are used to perform flap surgery for breast reconstruction.
- Free flap surgery: This procedure follows the principle of removing the skin and tissue from a particular site, disconnecting its blood supply from the original site. The flap is then placed in the area of breast reconstruction and new blood vessels are re-attached to the tissue. This procedure is a comparatively lengthier procedure then other breast reconstruction options.
- Pedicle flap surgery: In this type of flap surgery, the tissue is from one site to the breast reconstruction site, while the blood vessels are still attached to the tissue. The flap tissue in this procedure is tunnelled to the site of breast reconstruction. This procedure takes comparatively shorter time when compared to a free flap surgical procedure.
Depending upon the site from where the skin flap is used for reconstruction, flaps can also be of the below mentioned types.
- Abdomen flap: This is commonly known as TRAM (transverse rectus abdominal muscle) flap. It is one of the most common flaps used for breast reconstruction. It can be used as a free flap or a pedicle flap. In simpler terms, the muscle from the abdomen is used for the reconstruction of breast. A variation in the TRAM flap could be muscle sparing flap which is indicated in individuals who have a weaker stomach.
- Deep abdomen flap: This is also known as DIEP (deep inferior epigastric perforator) flap but here also the skin and fat are removed and a major chunk of the abdominal muscle is spared. The benefit of this flap is that it preserves the strength of the abdominal muscle. A variation in this procedure could be a superior inferior epigastric artery flap (SIEA) which is a comparatively less invasive procedure.
- Back flap: Also known as Latissimus dorsi flap as it uses the same muscle for reconstruction of the breast tissue. This flap involves the skin, tissue, muscle and fat from the upper portion of your back. This approach is used in women who have rather small to medium sized breasts.
- Buttocks flap: This is also known as the gluteal flap as the gluteus maximus is used for the construction of breast. Primarily indicated in women who do not adequate tissue in their backs and abdomen for a reconstruction to be performed.
- Thigh flap: This type of flap is obtained from the inner thigh and is also called as the TUG (transverse upper gracilis) flap. This is a rather new procedure and is usually performed in women who have medium sized breasts and cannot undergo an abdomen, back or buttocks flap.
As complex these flap procedures may sound, they are more complex when performed, hence required skilled expertise of a plastic surgeon who is trained to be an expert in performing such procedures.
After the advent of anaesthesia, the operating surgeon (team of your cancer surgeon and plastic surgeons) will place an incision at the site where your breasts were primarily located to lift up the skin and tunnel in the flap which is being used for the reconstruction. The surgery may be done as an immediate reconstruction or a delayed procedure. Along with the flaps some surgeons also used implants to give breasts a fuller look. Breast which are reconstructed with flaps appear more natural as compared to the implanted breasts.
Occasionally, along with a breast reconstruction a nipple reconstruction might also be performed. The nipple and the areola region are reconstructed as your natural nipple colour and shape with the help of micro pigments which can give colour to your areola. In most of the patients who undergo a breast reconstruction surgery a nipple construction is performed after the surgical site is healed.
Also during a breast reconstruction with implants, you might require a reshaping of the other healthy breast to make the breast look symmetrical.
What happens after the breast reconstruction with flap surgery ?
After the successful completion of the breast reconstruction, the surgeon might cover your breasts with bandages and drainage tubes to prevent any infection at the site of the surgery. You will be advised to stay in the hospital from days to a week or ten days for close monitoring. Even when you are discharged from the hospital, the operating surgeon will advise you to follow strict instructions to avoid any complications. You will not be allowed to engage in strenuous activities, exercising, sexual activities, lifting of heavy weights till the doctor advises you to resume such activities. You can resume work when you are declared fit by your operating surgeon.
What are the risks and complications of a breast reconstruction with flap surgery ?
The complications can range from complications due to the anaesthesia administered such as nausea, vomiting, headache and gastric upset to procedure related complications such as bleeding, infection at the site of surgery, failure of reconstruction/ rejection of the flap, air entrapment in the tissues which can be fatal. If you are experiencing any of the above complications it is advised to seek immediate consultation with your doctor.
What is the outcome of a breast reconstruction with flap surgery ?
Breast reconstruction procedures are being performed across the world followed by a mastectomy or a lumpectomy procedure. A breast reconstruction procedure can help you regaining your confidence, help you in choosing the clothes that you want to wear. Breast reconstruction with flap surgery is one of the most elaborate procedures which is performed after a great deal of planning and requires skilled expertise of trained plastic surgeons. Though the procedure takes longer than other reconstruction options, the flaps used give the breast a more natural look when compared to implants. It is greatly advised to ask your surgical team to explain to you if breast reconstruction with flap surgery could be the choice of treatment for you.
How to find cosmetic surgeons for breast reconstruction with flap surgery ?
Now you can find cosmetic surgeons for breast reconstruction with flap surgery from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions from multiple cosmetic surgeons, cost estimates for breast reconstruction with flap surgery from different hospitals, compare things and then choose a cosmetic surgeon for breast reconstruction with flap surgery.
Find and choose a cosmetic surgeon for breast reconstruction with flap surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
