Health Watch

Breast Reconstruction

Mr. Fortune C Iwuagwu. MBBS, MSc (Lon), FRCS (Glas), FRCS (Ed), FRCS (Plast. Surg.) on graduating from the University of Nsukka in Nigeria moved to the UK for post graduate specialist training in all aspects of plastic and reconstructive surgery in very renowned units. He completed his training in the United States at the world famous Christine M Kleinert Institute for Hand and Microsurgery, Louisville , KY , USA . He is currently a Consultant Plastic, Reconstructive and Hand Surgeon at the St Andrew's Centre for Plastic Surgery and Burns in Broomfield Hospital , Chelmsford , Essex and Whipps Cross University Hospital in London . He also has practising privileges in various private hospitals in and around London .

In his free time Fortune enjoys playing his saxophone, listening to music and jogging.

He can be contacted via his secretaries on 01277-631395 and 01245 516126

This is part 1 of a 2 part series on Plastic Surgery and Breast Reconstruction

Breast reconstruction is the process of creating aesthetically pleasing and symmetrical breasts following a removal of all or part of the breast.

Some women require this procedure in order to rectify an anomaly that occurs during breast development, when one or both breasts may become deformed, develop to a different size, or may not develop at all.

However, the most common reason for the removal of a breast (“mastectomy”) is breast cancer.

And therefore for the purposes of this article, I am going to concentrate mainly on breast reconstruction following a mastectomy although the same principles and techniques apply for the other cases as well.

Breast cancer affects 1 in 8 women. Most of the people reading this article will probably know someone who has been affected by breast cancer, but only a few may be aware of the emotional and psychological trauma that losing a breast can cause. One of the most common treatments for breast cancer is a mastectomy.

Many years ago and even now in various parts of the developing world it is still common practice for women who have had a mastectomy to stuff their bras with cotton wool or various other materials. Some of the more enlightened ones may use different kinds of external prosthesis to mask the fact that they have had a mastectomy. This practice is equally common amongst uninformed patients in the western world. On the positive side however, patients awaiting surgical reconstruction may also use an external prosthesis.

Ignorance of what is available is prevalent. This even extends to the medical community. Fear of the process of breast reconstruction is another problem but this is also largely as a result of ignorance.

Consultation

A patient must have a consultation with a surgeon before reconstruction can take place. During the consultation, she will enquire about other treatments that the patient has had or is planned for the patient in the future such as radiotherapy (x-ray treatment), chemotherapy (anti-cancer drugs) or hormonal therapy. If any of these treatments are carried out after reconstruction, it may affect the final result. On the other hand, if the treatments are done before reconstruction they may affect the nature of the tissues and the blood vessels which can make the procedure more difficult. It is therefore important for the surgeon to have this information in advance of the procedure taking place.

The surgeon will also enquire about any medical problems such as diabetes mellitus or high blood pressure to try and ensure that a patient is in the best medical condition before surgery. Smoking history is essential as this adversely affects wound healing as well as the nature of the vessels. However smoking is not a contraindication to surgery but may affect the choice of method of reconstruction used.

It is also good to inform the surgeon of any medications including herbal remedies and allergies in this regard if applicable.

A surgeon will normally see a patient more than once before embarking on the process of breast reconstruction. This is because there is a great deal of information and it takes time for the patient to assimilate or digest this. It might be useful to see the surgeon with a close family relative such as patient's husband or sister because these are the people that form part of a patient's good support network. It is also usual practice for a patient to be given a reconstruction leaflet with diagrams to read. I usually advise patients to write down questions on a piece of paper before they come for the second consultation which enables them not to forget questions or issues that they are concerned about. By dealing with their concerns, patients are able to make an informed decision on what type of breast reconstruction they feel most appropriate for them.

Timing of Surgery

Breast reconstruction can be started at the time of the mastectomy or afterwards. This is a decision between the patient, breast (oncological) surgeon and the plastic surgeon. For patients who require a lot of adjuvant treatment, especially x-ray therapy, some surgeons do advise that the reconstruction is delayed because as mentioned above, x-ray therapy can alter the result of the reconstruction. Other patients want to get rid of the breast and decide later on if they want a reconstruction or not. However, those who postpone the reconstruction have to go through a period of emotional re-adjustment to an absent breast mound, which can be quite traumatic.

There are an increasing number of women who have complained that they would have had reconstruction at the time of the surgery had they been aware of the option. However, it should be born in mind that this is neither always possible nor advisable. Nevertheless, in appropriate circumstances it tends to give the best results because most of the breast skin is still available and what the plastic surgeon does basically is to fill the cavity with the patient's own tissue.

Why reconstruct the breast?

Following a mastectomy a woman may suffer from various emotional and psychological problems including:

• Depression and mood disturbances
• Loss of sexual interest
• Negative body image
• Loss of feminity
• Fear of recurrence
• Self consciousness in terms of clothing

Procedure

Breast reconstruction is a process and it therefore usually occurs in stages. For purposes of discussion I have described the reconstruction into three stages:

• Stage 1 creation of a breast mound.
• Stage 2 achievement of symmetry and creation of nipple and
• Stage 3 areola reconstruction (the areola is the brown or pigmented area around the nipple).

1st Stage – Creation of the Breast Mound

There are largely 3 ways of creating the breast mound.

1. using purely foreign tissue (non-autologous),

To be continued

According to Cancer Research UK , Breast cancer is the second most common cancer in the UK after non-melanoma skin cancer. Over 42,000 new cases are diagnosed every year of which 12,400 women die each year in the UK . Reduce your risk of breast cancer and be breast aware. For more information please visit the following websites:

www.breastcancercare.org.uk
http://www.bapras.org.uk/ - (British association of plastic, reconstructive and aesthetic surgeons)
www.plasticsurgery.org- (American society of plastic surgeons) www.cancerhelp.org.uk