1.What is the purpose of breast reconstruction after breast cancer surgery?
Breast is the second sexual characteristic of women, an important part of the beautiful curves of women’s body and an important sexual organ of women. Breast cancer surgery not only causes great physical trauma to women, but also causes post-operative psychological problems such as frustration and depression, making it difficult to resume daily work and life and integrate into society again. Breast reconstruction can restore the patient’s appearance and avoid the above psychological problems, so that breast cancer patients can truly recover.
2.How far can breast reconstruction be done after breast cancer surgery?
After more than a century of development, breast reconstruction has become a mature surgery in plastic surgery. After surgery, patients can achieve symmetry on both sides after wearing underwear, without having to wear prosthesis, avoiding all the discomfort caused by wearing prosthesis and being able to move freely, avoiding embarrassment caused by prosthesis falling off when wearing prosthesis for movement.
3.What kind of patients cannot have breast reconstruction after breast cancer surgery?
There are three types of patients who cannot undergo breast reconstruction after breast cancer surgery: the first type is patients who do not want to undergo breast reconstruction; the second type is patients who are in poor general condition and can hardly afford another surgery; the third type is patients with poor prognosis of breast cancer, or patients with local recurrence or distant metastasis.
4.When can breast reconstruction be performed after breast cancer surgery?
There are two types of breast reconstruction after breast cancer surgery, one is immediate reconstruction, that is, breast reconstruction is performed at the same time of breast cancer surgery, the advantage of which is that only one anesthesia and surgery are needed, short hospital stay, less cost, short recovery time and less psychological trauma to the patient from mastectomy. The other case is postponed reconstruction, which is usually done six months after the patient’s breast cancer surgery and basically completed chemotherapy and radiotherapy.
5.Does breast reconstruction after breast cancer surgery have any effect on the monitoring of breast cancer recurrence after surgery?
According to a large sample survey of modern medicine, the local recurrence rate and long-term survival rate of patients who had breast reconstruction after breast cancer surgery and those who did not have breast reconstruction are the same, and breast reconstruction after breast cancer surgery does not affect the monitoring of postoperative breast cancer recurrence.
6.What is the procedure of breast reconstruction after breast cancer surgery?
Breast reconstruction after breast cancer requires multiple surgeries to reconstruct a perfect breast. The first surgery completes the reconstruction of the basic shape of the breast and usually requires hospitalization. The second surgery is performed three to six months after the first surgery, when the reconstructed breast is basically stable. The second surgery focuses on the reconstruction of the nipple areola and some local trimming and can usually be done on an outpatient basis. If necessary, multiple surgeries can be performed to perform some minor revision.
7.What are the methods of breast reconstruction after breast cancer surgery and what are the advantages and disadvantages of each?
Currently, there are two major types of breast reconstruction methods after breast cancer surgery, one is breast implant-based and the other is autologous tissue breast reconstruction.
Prosthesis-based breast reconstruction involves placing an implant under the skin or pectoralis major muscle to replace the excised breast. If the amount of skin or subcutaneous tissue is insufficient, a flap can be placed over the surface of the implant, usually the latissimus dorsi flap. Prosthesis-based breast reconstruction is a simple procedure, and patients recover faster than with autologous tissue breast reconstruction. However, the biggest disadvantage is that some patients may experience contracture of the implant capsule, causing deformation of the reconstructed breast and surgical failure, especially in patients who require radiation therapy. Other complications include breast pain, peri-implant infection, and implant leakage.
Autologous breast reconstruction involves reconstructing the breast with tissue from the rest of the patient’s body. The advantages include: the reconstructed breast feels the same as the contralateral breast, both are predominantly fatty tissue, and the tissue has the same mobility as the contralateral breast. Also, the reconstructed breast, like the contralateral breast, can blossom as the body gets fatter or sag with age. The disadvantage is that the surgery is more complicated and the recovery time is long.
8.What are the common methods of breast reconstruction with autologous tissue? What are the advantages and disadvantages of each?
The commonly used methods of autologous breast reconstruction include transverse rectus abdominis flap (TRAM), inferior abdominal wall artery perforator flap (DIEP), gluteal muscle flap, etc. depending on the donor area (the part of the body that provides the tissue for reconstruction).
Gluteus medius flaps are not suitable for breast reconstruction in the Eastern population because of the generally smaller buttocks.
Transverse rectus abdominis flap (TRAM) uses the flap of the patient’s lower abdomen to reconstruct the breast, which not only reconstructs the breast, but also reduces the fat in the lower abdomen, killing two birds with one stone. However, its biggest disadvantage is that it requires partial or even total excision of the rectus abdominis muscle and the anterior rectus abdominis sheath, which affects the function of the rectus abdominis muscle and makes it prone to postoperative abdominal wall hernias.
DIEP is the latest technique for breast reconstruction based on the transverse rectus abdominis flap (TRAM), which only removes the skin and subcutaneous fat tissue on the basis of preserving all the rectus abdominis muscle and the anterior rectus abdominis sheath, which protects the function of the rectus abdominis muscle and makes it less likely for postoperative abdominal wall hernias to occur. The disadvantage is that the operation is more complicated and requires doctors with rich clinical experience.
9.What do I need to do before breast reconstruction after breast cancer surgery?
For patients with immediate reconstruction, no special preparation is needed. For patients with delayed reconstruction, it is better to have breast reconstruction after completing chemotherapy and radiotherapy, after the general condition of the body is good, and after routine examination to confirm that there is no local recurrence or distant metastasis.