Early detection helps also in more efficient and faster reconstructive results, says the surgeon
The traumatizing experience of breast cancer, followed by a single or double mastectomy, is a stressful reality and it requires every supportive endeavour from doctors to help the woman make her journey onwards on this path.
When opting for breast reconstruction, as opposed to getting only an external prosthesis, there are many questions a woman may have, and it helps tremendously to restore her confidence if the plastic surgeon can address her concerns and allay her fears.
Dr Stefano Pompei, Head Consultant Plastic Surgeon, Aesthetica Clinic, explains the many aspects of breast reconstruction and the psycho-oncological aspects of this procedure.
The fundamental advantage of breast reconstruction following mastectomy, says Dr Pompei, is to restore the body’s sense of integrity. “Simultaneous or delayed (breast) reconstruction after mastectomy is a fundamental element to consider for the maintenance of body integrity and femininity of the patient. Even today where survival, especially in the non-advanced stages of the disease, exceeds 90 per cent of the cases, the maintenance or restoration of quality of life is an essential element.”
The woman who has suffered from breast cancer and undergone mastectomy may undergo a sense of loss of femininity too. Her mastectomy may affect the way she perceives her body. How can she be helped to integrate the newly reconstructed breast/breasts into her overall sense of completeness?
“Psycho-oncological studies over the last 20 years have demonstrated that simultaneous reconstruction with mastectomy minimizes the ‘sense of loss of femininity’ otherwise traumatically experienced by patients who do not benefit from this immediate multidisciplinary approach,” says Dr Pompei.
In this context, he says, the centres that deal with this condition must be equipped with a so-called Breast Unit, where all the aspects of the breast cancer treatment as well the emotional and psychological ones are attended to the fullest degree.
“A dedicated psychologist is of strategic importance to the patient both in the phase of emotional ‘trauma’ due to the diagnosis of breast cancer, and for the support in the subsequent phases connected to the surgical and reconstructive treatment, as well as the oncological treatments ,” he says.
Every age group can opt for breast reconstruction
Who is an ideal candidate for this procedure? Every age group can benefit from it, according to Dr Pompei. “The primary target of quality of life, in breast reconstruction extends to indication to every age group of patients.”
The procedure can be done with prosthetic material and/or “with the aid of transposition of the patient’s own tissue flaps taken from specific donor areas on the body,” he says.
Unlike in the past where there was a time lapse between the mastectomy and breast reconstruction, today’s advanced techniques mean that it is possible to conduct simultaneous reconstruction along with the removal of the breast tissue, says Dr Pompei.
“The reconstruction is generally a process in successive steps for the refinement of the result. Thanks to screening programs in many countries, it is now possible to detect breast cancers at an increasingly early stage. This is critical not only in order to further improve survival data/rate, but also allows for a Breast Conservative Treatment avoiding a complete mastectomy,” says Dr Pompei.
These interventions, he says, followed by radiotherapy, allow the tumour to be resected and immediately reconstruct the breast with the residual tissues without using breast implants.
Fat Grafting
For many decades after breast reconstruction techniques were pioneered, breast implants were the only material used. But as techniques improved and medical science expanded its boundaries, other methods came to the forefront. Today, fat grafting is a common approach.
“Fat removed from specific donor areas by liposuction is reinserted to create volume and thickness at the mastectomy site,” explains Dr Pompei. The stem cells contained in the adipose (fat) tissue possess an extraordinary regenerative power for tissues. “Even in patients for whom radiotherapy of the mammary region is necessary, Fat Grafting can significantly improve not only the appearance of the skin but also the elasticity and softness of the tissues (that have been subject to radiation therapy),” says Dr Pompei.
Allaying fears of recurrence
“In the most advanced stages of the disease, where distant metastases (growth of malignant cells) appear over time, breast reconstruction does not interfere with either diagnostic methods or reciprocally with any chemotherapy or radiotherapy treatments,” he says.
Even if there is an appearance of a localized malignancy recurrence in the tissues of a reconstructed breast, the reconstruction does not involve any delay in diagnosis nor does it interfere with any subsequent treatment, he says.
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3 KINDS OF PROCEDURES
There are three main breast reconstructive methods, says Dr Pompei.
Their indication depends on the local situation, the type of mastectomy and the patient’s preferences.
- Reconstruction with prosthetic implants.
- Reconstruction performed exclusively with autologous tissue (skin and fat of the patient) transferred from the abdomen or from other donor areas of the patient using microsurgical techniques.
- The so-called ‘hybrid’ methods in which both prosthetic implants and flaps of tissue taken from other anatomical areas of the patient’s body are combined to recreate the breast/breasts.
CONTRAINDICATIONS FOR BREAST RECONSTRUCTION
Chemo or radiotherapy treatments that are being administered to breast cancer patients do not represent an absolute contraindication to reconstruction, says Dr Pompei. “Depending on the case, a different timing for the reconstruction itself may be indicated, just as one method may be more advisable than another.”
From a statistical point of view, says Dr Pompei, “Evidence-based medicine shows us that there are conditions that pose a greater risk (for) potential complications such as cigarette smoking, obesity, diabetes, metabolic diseases as well as previous radiotherapy or chemotherapy .”