Breast Reconstruction after Mastectomy
Mohammad Tarek El-Naggar;
Abstract
The breast is an important symbol of femininity. It plays an important role in woman's life functionally, psychologically and emotionally.
As the incidence of breast cancer continues to rise among women of all ages, the need for early detection becomes more pressing. A key to reducing the mortality from this disease is educating women that cure without permanent breast loss is possible if their cancer is diagnosed early. Mammography and breast examination are the main of breast cancer screening and early detection.
The surgical treatment of breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women, achieved by creating a breast mound that is similar in size, shape, contour, and position to the opposite breast. Women thus gain the freedom to wear a variety of clothing, without needing external breast prostheses, and have been shown to improve the psychosocial well-being and quality of life in comparison with those who have mastectomy without reconstruction.
Breast reconstruction can be performed immediatly after mastectomy or can be delayed several months. The optimal time for reconstructiondepends on the stage of breast cancer, the need for adjuvant therapy and the method of reconstruction.
There are three major classes of postmastectomy reconstruction: implant based reconstruction and autologous tissue based reconstruction or combination of both. Key to achieving the optimal aesthetic outcome is patient procedure selection. There are number of factors that can affect this decision. These include location of cancer and extent of resection, medical and surgical risk factors of the patient, need for adjuvant radiotherapy, availability of local and distant donor tissue, desired size and shape of the reconstructed breast, and most importantly patient preference. Individualized selection of a reconstructive technique for each patient is a predominant factor in achieving successful reconstruction.
Recent advancement in autologous breast reconstruction is the microsurgical free flap technique in which only skin and fat are harvested to recreate a natural-looking breast without disrupting the underlying muscle. Studies have shown that microsurgical breast reconstructions offer a more natural and durable reconstruction and minimize morbidity.
Types of free flaps commonly used in breast reconstruction:
1. Deep Inferior Epigastric Artery Perforator (DIEP) flap.
2. Free TRAM frap
3. Gluteal Artery Perforator (GAP) flap.
• Superior Gluteal Artery Perforator (SGAP) flap.
• Inferior Gluteal Artery Perforator (IGAP) flap.
DIEP flap reconstruction is a variation of the free TRAM flap reconstruction in which the same paddle of lower abdominal skin and fat is transferred for breast reconstruction with preservation of rectus abdominis muscle and fascia.
The DIEP flap combines all the advantages of the TRAM flap without most of its disadvantages. It provides generous amounts of well perfused soft tissue and its complication rate is similar to other free tissue transfers. The first and foremost advantage of the DIEP over the TRAM is its markedly decreased donor site morbidity. Furthermore, Postoperative pain is minimal, hospitalization time is reduced and patients can return more quickly to work and physical activities.
For patients who have insufficient tissue on the abdomen or have had previous abdominal surgery that compromises perfusion to the abdominal tissue, other options are available. The gluteal tissue can be used, based on its superior or inferior blood supply, known as the SGAP flap or the IGAP flap; these flaps allow the reliable transfer of skin and soft tissue from the Gluteal region without associated donor site morbidity.
The concept of free flaps has significantly refined the practice in breast reconstructive surgery. Harvesting the skin and fat which is considered the ideal tissue for breast reconstruction without sacrificing the underlying muscle or the functional motor nerves characterizes this technique. Despite the technical complexity & consequent prolonged operating time, free flaps are considered the most reliable method for reconstructing an aesthetically pleasing breast with numerous advantages and low complica
As the incidence of breast cancer continues to rise among women of all ages, the need for early detection becomes more pressing. A key to reducing the mortality from this disease is educating women that cure without permanent breast loss is possible if their cancer is diagnosed early. Mammography and breast examination are the main of breast cancer screening and early detection.
The surgical treatment of breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women, achieved by creating a breast mound that is similar in size, shape, contour, and position to the opposite breast. Women thus gain the freedom to wear a variety of clothing, without needing external breast prostheses, and have been shown to improve the psychosocial well-being and quality of life in comparison with those who have mastectomy without reconstruction.
Breast reconstruction can be performed immediatly after mastectomy or can be delayed several months. The optimal time for reconstructiondepends on the stage of breast cancer, the need for adjuvant therapy and the method of reconstruction.
There are three major classes of postmastectomy reconstruction: implant based reconstruction and autologous tissue based reconstruction or combination of both. Key to achieving the optimal aesthetic outcome is patient procedure selection. There are number of factors that can affect this decision. These include location of cancer and extent of resection, medical and surgical risk factors of the patient, need for adjuvant radiotherapy, availability of local and distant donor tissue, desired size and shape of the reconstructed breast, and most importantly patient preference. Individualized selection of a reconstructive technique for each patient is a predominant factor in achieving successful reconstruction.
Recent advancement in autologous breast reconstruction is the microsurgical free flap technique in which only skin and fat are harvested to recreate a natural-looking breast without disrupting the underlying muscle. Studies have shown that microsurgical breast reconstructions offer a more natural and durable reconstruction and minimize morbidity.
Types of free flaps commonly used in breast reconstruction:
1. Deep Inferior Epigastric Artery Perforator (DIEP) flap.
2. Free TRAM frap
3. Gluteal Artery Perforator (GAP) flap.
• Superior Gluteal Artery Perforator (SGAP) flap.
• Inferior Gluteal Artery Perforator (IGAP) flap.
DIEP flap reconstruction is a variation of the free TRAM flap reconstruction in which the same paddle of lower abdominal skin and fat is transferred for breast reconstruction with preservation of rectus abdominis muscle and fascia.
The DIEP flap combines all the advantages of the TRAM flap without most of its disadvantages. It provides generous amounts of well perfused soft tissue and its complication rate is similar to other free tissue transfers. The first and foremost advantage of the DIEP over the TRAM is its markedly decreased donor site morbidity. Furthermore, Postoperative pain is minimal, hospitalization time is reduced and patients can return more quickly to work and physical activities.
For patients who have insufficient tissue on the abdomen or have had previous abdominal surgery that compromises perfusion to the abdominal tissue, other options are available. The gluteal tissue can be used, based on its superior or inferior blood supply, known as the SGAP flap or the IGAP flap; these flaps allow the reliable transfer of skin and soft tissue from the Gluteal region without associated donor site morbidity.
The concept of free flaps has significantly refined the practice in breast reconstructive surgery. Harvesting the skin and fat which is considered the ideal tissue for breast reconstruction without sacrificing the underlying muscle or the functional motor nerves characterizes this technique. Despite the technical complexity & consequent prolonged operating time, free flaps are considered the most reliable method for reconstructing an aesthetically pleasing breast with numerous advantages and low complica
Other data
| Title | Breast Reconstruction after Mastectomy | Other Titles | إعــادة بنــاء الثــدى بعــد إستئـصــاله جـراحـياً | Authors | Mohammad Tarek El-Naggar | Issue Date | 2015 |
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