In Spain between 10 and 20% of women who have suffered breast cancer decide to reconstruct their breasts. This low rate is due to different reasons, mainly due to the lack of information about the different reconstructive possibilities and the global approach offered by plastic surgery on breast pathology.
Doubts about breast reconstruction
When a woman is faced with the possibility of breast reconstruction, it is common for many doubts to arise. Even today there is a false belief that this process should be performed a few years after the mastectomy and after having finished the radiotherapy and/or chemotherapy. Other patients have doubts about whether the surgery could complicate or be harmful to the oncological treatment or make post-treatment follow-up difficult. Sometimes the conflict lies in the fact that some patients do not even consider the idea of breast reconstruction, others believe they are too old or even do not see this type of intervention as part of the comprehensive treatment of breast cancer. Therefore, it is important to contact a specialist in Plastic Surgery to resolve any doubts you may have in this regard.
Reconstruction techniques
Currently, there are two main groups of techniques: those that consist of the application of implants and/or expanders and those that use the body’s own tissues, the so-called “flaps”.
In the first option, the volume of the new breast and its shape are obtained thanks to the implantation of a breast prosthesis, of which, nowadays, there is a wide range. Often, after the mastectomy there is not enough skin left to give the necessary coverage to the implant, so it is necessary to “gain” skin in the area by means of a device similar to the prosthesis, but which is inflatable and expandable, the expander. This is applied in the area where the breast would be and is being inflated periodically in the weeks following the operation to achieve sufficient volume to have the necessary skin. In a second intervention, the provisional expander is replaced by a definitive breast prosthesis, generally made of silicone gel.
On the other hand, flaps are transfers of tissues with their own vascularization between a donor area of the body and another recipient, in this case the breast. Although it is possible to perform this exchange from different areas of the body, the most popular and effective are the back (latissimus dorsi flap) and the abdomen (TRAM or DIEP flaps, depending on whether they are pedicled or microsurgical). Other areas are the buttock or inner thigh. Although these methods provide a more natural final result, they are more complex, especially those that require microsurgery, and more aggressive, as they have to take tissue from a healthy donor area, with the consequent scarring, etc., but, in principle, they avoid the use of prostheses and, as they do not require expansion to gain the skin beforehand, they only require surgery.
Although expansion is a longer process in time (two surgeries and an extension period) conceptually they are simpler, less aggressive surgeries than flaps, so they are still the best option in many cases.
How to choose the best option
The recommendation of the most appropriate technique for each case is the responsibility of the Plastic Surgeon, since he is the specialist who has all the tools or reconstructive techniques (prostheses, expanders, flaps or even microsurgery). In addition, it is not only a matter of recreating a breast, but, fundamentally, of seeking an overall harmony in the body, in the thorax, so we often recommend complementary actions in the healthy breast, to reduce it, raise it if it is too low or even increase it if it is hypoplastic or “empty”. All this with the aim of obtaining symmetrical breasts. It is not so much a question of large or small breasts, reconstructed with one technique or another, but of two breasts as similar and symmetrical as possible.
Although the last decision in the choice of the ideal technique rests with the plastic surgeon, it must be supported by consensus and by the multidisciplinary team that is part of the treatment. In addition to applying it to the particularities of each case and adapting it to the concerns and reconstructive aspirations of each patient. Here again, the importance of prior information to patients about the different options to choose is highlighted.
Breast surgery in men
Breast cancer in men represents approximately 1% of the total, so it is not so frequent, but it does exist. The basic approach is similar: resection surgery and, depending on the case, the complementary treatment with radio and/or chemotherapy. The fundamental difference is that the breast does not have to be reconstructed: rather, what we have to do is to try to recreate the normality of a male thorax, despite the loss of soft tissues. It is more a reconstruction of the thoracic defect (skin, soft tissue) to compensate for asymmetries and restore a normal thoracic shape than to try to recreate such an anatomically and aesthetically complex structure as the female breast.