Breast reconstruction is possible after breast amputation due to breast cancer. The aim of the operation is to replace the skin that was removed during the amputation and to reconstruct a new mammary gland volume. Also the nipple and areola can be reconstructed. Additional surgery is often needed to reshape the remaining breast to match the reconstructed breast.
Indications en contra-indications
Any patient can undergo a reconstruction, regardless of age or previous medical history. The essential question is which technique is preferable in a particular patient and when the operation has to be performed.
When can the reconstruction be performed?
Breast reconstruction can be done at the same time as the amputation. This is called an immediate reconstruction. Preferably no implants are inserted when the patient needs additional radiation or chemotherapy after surgery; the surgeon rather opts for using own body tissue (see below). The psychological advantage is obvious.
We talk about a delayed reconstruction when it takes place at the earliest 3 to 6 months after completing any additional treatments such as radiotherapy and/or chemotherapy. The advantage is that the result of the reconstruction is no longer compromised by any post-treatments and that the patient had plenty of time to consider the possible options.
Consequences for follow-up treatment, recurrence and follow-up
All scientific studies show that a reconstruction (both immediate and delayed) has no harmful effect on the course of the disease and does not impede the detection and treatment of recurrences.
Techniques for breast reconstruction
Firstly, a new breast can be created with own body tissue, which is called an autologous breast reconstruction. This type of reconstruction uses, for instance, mammary gland tissue, a skin and muscle flap from the upper back (latissimus dorsi flap) or skin and subcutaneous fat from the abdominal wall (a TRAM or DIEP flap).
A second possibility is to use a so-called expander. This balloon is placed beneath the skin during the first operation and is slowly inflated over a period of time (weeks or months). This way, the skin has stretched enough for the reconstruction. A second operation is needed to replace the expander by a definitive soft implant.
Many factors determine which technique is preferable for a particular patient: expectations and motivation of the patient, age, stage of disease and prognosis, previous operations, general health, quality of skin and blood vessels, profession, hobby,…
The contralateral breast
Breast reconstruction can only create a satisfactory result when there is symmetry between the healthy and reconstructed breast in both volume and shape. Therefore, the healthy breast is often reduced or lifted.
Nipple and areola reconstruction
Nipple and areola reconstructions are usually the final (third) phase of breast reconstruction, several months after the definitive reconstruction of the breast itself. The nipple reconstruction is done with a local skin flap. Often the nipple is too big immediately after reconstruction, but it will decrease in length. Final length is determined after 3 months. A tattoo or skin transplant can be used to reconstruct the areola.
A breast reconstruction is a procedure that does not have a harmful effect on the course of the disease. This type of reconstruction is an attempt to rebuild the breast, as much as possible, to its natural shape and volume. The patient must, however, be realistic: a reconstructed breast will never be a perfect match or substitute for a natural breast. A breast reconstruction can be an important step in the psychological healing process of the amputation and lead to a normalization of the self-image and the life after the amputation.