Hello. My name is Dr. Wandra Miles and I am a Plastic and Reconstructive Surgeon at the Swedish Cancer Institute.
I've been asked to talk with you about breast reconstruction
following a mastectomy and lumpectomy.
In this podcast we will cover the different options and methods of breast
reconstruction.
Let's begin.
There are three options for breast reconstruction: immediate,
delayed, or no reconstruction.
The option you choose may depend on many factors
an individual may decide upon immediate reconstruction if they would
like to avoid waiting to have an additional procedure done.
But that may not be the best option for everyone.
Delayed reconsstruction may be considered
if the pathology of your cancer is not clear and definitive treatment has not
yet been determined.
Delayed reconstruction may also take place
if someone is not sure if they're interested in reconstruction.
Delayed reconstruction can be done at anytime from two weeks after the initial
surgery to many years after.
If radiation therapy is planned
reconstructive surgery should be delayed
and not initiated until at least six months to one year after the completion of
radiation therapy.
Once you decide on having reconstructive surgery
then there are two types to choose from.
The first is commonly known as autologous tissue tissue
which means that you're using your own tissue.
When using your own tissue you generally only need to have one or two additional
surgeries.
There is no need for surgery in the future
once reconstruction
has been done.
The disadvantage is that there would be more scars.
a long recovery time, and potential risks of flap failure.
Flap is literally
using tissue consisting of skin, fat, and occasionally muscle.
There's also risk that the area you take the skin from
on the donor site site
could become infected.
Also due to the shape of your body, there could be obstacles when trying to use a
flap.
the other type of reconstruction involves using implants.
This type of reconstruction keeps the procedure as simple as possible with the
fastest recovery time.
With implants the surgery is usually a shorter duration
and you can return to work and your lifestyle much faster.
There are no additional scars with implant reconstruction, which is an
advantage, but the disadvantage is that additional surgery
will be needed in the future to replace the implant
due to its life span.
The placement of your implant is not the same
as with cosmetic breast enlargement.
When mastectomy is done
the skin is generally eased off the breast tissue
compromising its blood supply to the skin. To clarify,
if one puts a fully inflated implant deep to the tissue
as done with cosmetic breast augmentation,
there is significant risk that the tissue may die
due to increased pressure
since they're already is a compromised blood supply.
This occurs with a mastectomy because there is no longer any breast tissue
to protect the skin when the implant is placed.
Therefore, a temporary tissue expander is needed.
One should think of this as a deflated balloon
that is placed in a pocket deep into the skin and muscle.
Once the tissue is healed, the balloon is slowly inflated
to the correct volume
to create the size of mass that one wishes.
Then the temporary tissue expander is removed
and a permanent implant is placed.
The patient has the option of saline or silicone implants.
Slicone gel implants are now FDA approved.
The life span of the implant is approximately ten years
but can last for fifteen to twenty years.
Replacing the implant is a simple procedure and can be done as an outpatient surgery.
Moving along,
Lets talk specifically about the several types of autologous issue
which again means using your own tissue
that may be used for reconstruction.
The goal is to take the tissue from an area
that would not cause you any loss of function.
The type of flaps available to consider are pedicle, free or
a deep perforator flap.
As the type of flap used becomes more complex
the complications and the risks are greater.
Another option for autologous tissue
is the latisimus dorsi pedicle flap.
This means that the blood supply is never detached
and the flap always has blood supply
as it is being harvested.
The function of the latisimus dorsi
muscle is forearm extension,
but one has other functions that can maintain this function
once the flap is harvested.
This flap would not be the best option for individuals who are avid swimmers,
golfers,
tennis players.
or who would need to use crutches in the future.
The muscle tends to be small in most women.
Therefore they most often result in a small A cop and tissue expander or an
implant
would be needed to achieve volume
acceptable to most women.
The TRAM, otherwise referred to as a transverse rectus abdominis
myocutaneous taneous flap
can be easily a
pedical, free, or inferior epigastric perforated flap.
The DIEP perforated flap is a type of TRAM flap which consists only of skin and fat
and spares the core rectus muscle.
This flap cannot be used in individuals whose body habitus
is greater than twenty percent of their body fat.
It is also not appropriate for individuals who may be too thin and and do not have
enough tissue to create a breast.
When the flap is used as a pedicle flap
both the core rectus muscle
and the lower abdominal skin and fat is harvested to create a flap.
Again the blood supply is never detached
from this pedicle flap.
The biggest risk to this flap
is an increased risk of abdominal hernia or bulge due to the loss of the core
rectus muscle.
To try and minimize this complication the deep perforator flap was created
which uses only the skin and fact and the core rectus muscle is left intact in this
flap.
The blood supply is completely detached
and microsurgery i sneeded needed to restore blood supply to the tissue.
As a result
this is a more technically challenging flap to perform.
In either of these three flaps the surgery time is longer
as well as recovery time.
When a lumpectomy is performed
there can be asymmetry in breast volume between the breasts
as well as
a possible contour deformity from radiation therapy.
So if reconstruction after lumpectomies is desired the recommendations for
reconstruction would be to use either autologous tissue, your own tissue.
Finally,
you should know that there is risk when undergoing any surgery.
Studies have shown that the reconstruction is safe
when there's not a high risk for any potential recurrence of the cancer.
Also it should be assessed that when a patient is considering reconstruction
they need to be aware that it might not be completed in one procedure and
they must be willing to deal with the complications that may develop
throughout the course of reconstruction.
Thank you for listening to the Plugged in to Your Health
cancer podcast program on breast reconstruction.
For more information, please talk to your plastic surgeon.
Thank you.