Breast Reconstruction Awareness Day
BreastReconstruction Awareness Day has gone global and that’s great news for breast cancer patients! The focus of these events is to educate and raise awareness about options for breast reconstruction after mastectomy. Many of these events are held in the month of October in conjunction with Breast Cancer Awareness Month. The choice to have breast reconstruction is a very personal one. It involves a great deal of planning and requires a lot of information to make the best possible decision for each individual patient, both female and male. It is not for everyone but the key take away and message of the Breast Reconstruction Awareness Day campaign is that everyone has the right to be given the information and to be educated about this topic.
Breast Reconstruction after mastectomy is rarely a one-step surgical procedure. Most reconstruction options require more than one stage. What are those options?
Implant Reconstruction
A two-stage approach is commonly used for implant reconstruction. Think of preparing the breast area and skin envelope that remains after mastectomy for the implant. An expander is put in place under the chest muscle at the time the mastectomy. The skin remaining after a mastectomy must be stretched gradually overtime to receive the implant that will take the place of the original breast. This is done by gradual increase of the expander with a saline solution. The patient goes to the plastic surgeon’s office to have a needle inserted into the expander filing it with saline solution. This process occurs approximately six to eight times, depending on each individual patient’s skin envelope. The expander is removed and the implant is then surgical placed after a period of three to four months from the last expansion. Again, each case is unique to the individual patient.
The implants can be made of saline or silicone. It is important to ask your plastic surgeon to see these implants, discuss the pros and cons of each, risk involved in the surgery, and what your aesthetic expectations are after surgery. Let them know your lifestyle and activity level as well and how the implants may or may not affect this.
There are a few select patients who may be candidates for a one-step procedure using implants. The best candidates are those who are considering breast reconstruction after a nipple-sparring, prophylactic mastectomy. These are patients who carry the BRCA gene mutation. This is sometimes referred to as a DTI, direct to implant, procedure. It is important that you are carefully evaluated by your plastic surgeon for this choice as not all candidates qualify.
Autologous Reconstruction
Autologous breast reconstruction refers to using the patient’s own tissue to reconstruct the breast mound. This procedure has been done for many years using a method called the TRAM flap, transverse rectus abdominis muscle. There are plastic surgeons that perform this method today. The “gold standard” in breast reconstruction today, however, is considered to be the DIEP flap. Unlike the TRAM flap, the DIEP does not use the rectus abdominis muscle. There are other types of free flaps such as the Latissimus Dorsi flap, SIEA flap, GAP flap, TUG flap, and PAP flap. Each of these methods requires a highly skilled microsurgeon to perform any of these choices for breast reconstruction. The method you discuss to use with your plastic surgeon is dependent upon your individual circumstance but it is important to know all the options.
Combination Implant and Autologous Tissue
The third option in breast reconstruction involves using the patient’s own skin, autologous, in combination with an implant. The Latissimus dorsi method is one option that frequently uses this combination approach. These are all options that will be discussed when you find a plastic surgeon to perform your procedure.
Other Education and Information to Consider
Success in micro-surgical procedures is dependent upon the success rate of the microsurgeon you choose for your procedure. It doesn’t end there. There are other important questions to discuss with your plastic surgeon. Many patients don’t discuss the tools a surgeon uses for breast reconstruction but many don’t know about the various tools used. A plastic surgeon uses a number of devices to make your surgery safe and successful.
An example of just one used during surgery is SPY imaging. A machine is brought into the operating room for the surgeon to view the mapping of blood vessels. The patient has a dye placed into the IV. The blood vessels immediately fluoresce on a screen in real time for the surgeon doing the reconstruction. This is a valuable tool to show the surgeon where the blood perfusion is to attain optimal outcomes in breast reconstruction. I find this technology fascinating because my own plastic surgeon used it during my DIEP flap breast reconstruction. It is one of the many tools used and I encourage patients to ask their reconstructive surgeon if SPY imaging is used at the hospital facility where your breast reconstruction is performed.
Breast Reconstruction Awareness Day is to present the above information and so much more. I hope this has given you some insight into the purpose of this now International Day of education for breast cancer and BRCA positive patients. Ask your plastic surgeon if they know of breast reconstruction events in your area. They can be a first step in knowing your options for breast reconstruction after mastectomy.
