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"When I meet a patient with breast cancer for the first time, two big priorities stand out when discussing treatment options:
First, what's the best way to safely and completely remove the cancer?
Second, how do we achieve the first objective while maintaining as much of the patient's natural appearance as possible?" - Dr Eva Nagy
After the diagnosis of breast cancer, many patients take a treatment path similar to the one described below. Treatment is dependent on many factors, and it is common for patients to undergo treatment plans that look different to this one.
Discovery of cancer
Surgery to remove breast cancer/s, lymph node assessment, and possibly reconstruction of affected breast/s
Chemotherapy (if required)
Radiation therapy (if required)
Hormone-modulating treatment (if required)
The recommended treatment plan for each patient is formulated by a team of specialists from the different fields involved in cancer treatment (Surgeons, Medical Oncologists, Radiation Oncologists, Pathologists, Radiologists, and Breast Care Nurses). The combined effort helps ensure that the patient's treatment is optimised to the specific circumstance of that patient.
Cancer Australia provides more information on breast cancer that readers may find helpful.
Breast cancer surgery broadly fall into two categories: cancer removal and breast reconstruction.
Breast cancers are removed from the body using one of two techniques: mastectomy, or breast conserving surgery.
A mastectomy is the surgical removal of the entire breast. This can be performed on one or both breasts, depending on what the patient requires. A detailed discussion on mastectomies can be found here.
Breast conserving surgery (also known as wide local excision, lumpectomy, or partial mastectomy) is the removal of the breast cancer, along with a margin of breast tissue surrounding the cancer; the remaining breast tissue is unaffected. A detailed discussion on breast-conserving surgery can be found here.
Sometimes after cancer is removed, the way the body looks is not the same as before. If uncorrected, this can negatively affect patients physically, emotionally, and psychologically. Breast reconstruction may help to restore the appearance of the breasts. While a 100% restoration of the appearance of the breasts is not assured, it is encouraging to note that the range of simple and advanced reconstructive techniques available today enables high satisfaction levels in the majority of patients. The specific reconstruction technique most appropriate for a patient will depend on several factors including the characteristics of the cancer, the type of cancer removal performed, the patient's body type, and the patient's personal preferences. The surgeon will discuss these factors with each patient to ensure that the appropriate treatment is considered.
Breast Reconstruction is typically performed using one of five categories of techniques:
1. Implant-based reconstruction (for mastectomy patients)
2. Reconstruction employing free flaps (for mastectomy patients)
3. Reconstruction employing regional flaps (for mastectomy and breast-conserving surgery patients)
4. Mammoplasty (for breast-conserving surgery patients)
5. Internal tissue flap reconstruction (for breast-conserving surgery patients)
In the context of breast cancer surgery, this form of reconstruction uses the implant to replace the volume of the breast after a mastectomy. Implants come in numerous shapes and sizes, and the surgeon will select the implant that best restores symmetry between the breasts. In most cases of implant-based reconstruction, a patient may achieve a superior cosmetic outcome by having fat transferred from one part of her body (e.g. tummy area or thighs) into the affected breast. This helps to achieve a more natural look and feel for that breast, and is known as fat grafting. For more details on implant-based reconstruction, click here.
After a mastectomy, a patient may prefer or may be more suited to undergo reconstruction without the use of an implant. Or, the skin around the area of the affected breast may be insufficient to accommodate an implant. In such cases reconstructing the breast from tissue taken from another part of the patient's body (known as a "flap") may be considered. While a flap may be taken from different areas of the body, a common part of the body that may be used is the skin and fat around the abdomen area. A section of fat and skin is taken from the lower abdomen, and transferred to the breast area. The blood vessels and skin are carefully reconnected to ensure both healthy blood supply and a good cosmetic result. For more details on reconstructions employing free flaps, click here.
3. Reconstruction employing regional flaps
In the case where breast-conserving surgery is performed on a patient with small-to-moderate sized breasts, and where the removed cancer leaves behind a significant cavity, tissue from or around the breast (e.g. below the armpit) may be reshaped and used to fill in the cavity. In such a situation, the breast-conserving surgery and flap-based reconstruction is an alternative treatment plan to a mastectomy followed by implant-based reconstruction. This form of reconstruction is known as a chest wall perforator flap and is discussed in detail here.
In certain situations, instead of using an implant, a larger regional flap may be used to reconstruct a breast after a mastectomy. This flap is taken from the upper back (latissimus dorsi) area. It is discussed in detail here.
Mammoplasty are a group of surgical procedures that aim to reshape and modify the appearance of the breast. In the context of breast cancer, mammoplasty is only performed on patients who undergo breast-conserving surgery and are typically suited for larger-breasted women. For more detail, click here.
5. Internal tissue flap reconstruction
This is a simple breast-conserving surgery reconstructive technique. It is reserved as a technique for smaller cancers. With the internal flap, unaffected breast tissue is reshaped or rotated to occupy the cavity that the removed cancer leaves behind. They are associated with low complication rates, and typically produce aesthetically pleasing outcomes.
All information on this page is provided only as a reference, and does not constitute medical advice. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
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