In China, the health burden of cancer is growing every year, with more than 1.6 million cancer diagnoses and 1.2 million cancer-related deaths each year. As in most other countries, breast cancer is the most common cancer among Chinese women; it accounts for 12.2% of new cases and 9.6% of deaths worldwide each year. China’s increasing global “contribution” is largely attributed to its rising socioeconomic status and specific fertility patterns. Although the current incidence of breast cancer in China is low, the incidence of breast cancer in China has increased more than twice as fast as the global rate since the 1990s, particularly in urban areas. Currently, breast cancer is the most prevalent cancer among Chinese women and the sixth leading cause of cancer death. As of 2008, China had a total of 169,452 new cases of invasive breast cancer and 44,908 deaths from breast cancer, accounting for 12.2% and 9.6% of all deaths worldwide, respectively.
After the diagnosis of breast cancer, most Chinese women have to go on to undergo traditional mastectomy. However, after mastectomy, there is a lot of psychological trauma that follows; many patients are not even allowed to see their husbands’ breasts and their married and social lives are greatly affected. Many patients have the opportunity to preserve the appearance of their breasts, but they either did not accept their doctor’s advice because they were too afraid of cancer in the early stages of their disease, or they were denied the opportunity to preserve their breasts because the hospital they visited did not provide technical support. They now have two options: breast-conserving surgery or immediate breast reconstruction.
With advances in breast surgery technology and improved early diagnosis systems, more and more breast cancer patients, especially those with early stage breast cancer, have a new option: breast-conserving surgery, which essentially preserves the shape of the breast with complete removal of the cancerous tumor.
However, the current rate of breast-conserving surgery in China is much lower than that in western countries, mainly due to the following reasons.
1. relatively late stage of breast cancer when it is discovered, which is not suitable for breast-conserving surgery
2. doctors or patients cannot view cancer recurrence correctly
3. breast-conserving surgery is also followed by radiotherapy, which prolongs the treatment time and increases the cost
4. Oriental women have smaller breasts, and many patients do not achieve the ideal shape after breast-conserving surgery.
In view of the above reasons, more breast cancer patients in China are suitable for immediate breast reconstruction surgery.
1.Who are suitable for immediate breast reconstruction?
For stage I, II and III breast cancer, patients with good general condition and the requirement of breast reconstruction can undergo immediate breast reconstruction. For patients with benign breast tumors, partial or total breast reconstruction should be performed if breast surgery has resulted in breast loss.
2. Is there an age limit for breast reconstruction?
Generally speaking, there is no age limit for breast reconstruction, and breast reconstruction can be done as long as the health condition allows.
3.Which is better, immediate or second stage breast reconstruction?
Immediate breast reconstruction refers to the reconstruction and repair of the breast at the same time as the mastectomy. It has many advantages: 1) the excision and reconstruction are done at the same time, reducing hospitalization time and cost; 2) the patient does not have to go through the psychological pain of losing the breast; 3) the shape of the reconstructed breast will be better. It does not interfere with postoperative chemotherapy and does not increase local recurrence. Immediate breast reconstruction is indicated for stage I, II, and III patients, except for those with existing distant metastases, or those with contraindications to surgery. Delayed breast reconstruction can be performed 6 to 9 months after mastectomy because chemotherapy and radiation therapy can be completed during this time. Some patients with advanced disease requiring extensive radiotherapy and chemotherapy may be considered for delayed breast reconstruction after their disease has stabilized.
The aesthetic results of second-stage breast reconstruction are inferior to those of immediate reconstruction, and immediate breast reconstruction should be preferred for patients who are eligible. Some doctors think that the patient’s demand for breast reconstruction will be significantly reduced after experiencing the pain of breast loss, and suggest the patient to have delayed reconstruction, which is very irresponsible and inhumane.
4.What are the methods of breast reconstruction?
There are many methods of breast reconstruction, which are divided into three categories.
(1) Application of breast prosthesis.
(2) Application of autologous tissue.
(3) Breast implants combined with autologous tissues. Each patient’s condition is different, and the choice of breast reconstruction method should be discussed with a doctor who has extensive clinical experience. Generally speaking, it is difficult to achieve a good aesthetic effect by simply applying breast implants, and experienced doctors will mostly choose to apply autologous tissue or implants combined with autologous tissue for breast reconstruction.
5.What is autologous tissue breast reconstruction?
Autologous tissue breast reconstruction is a method of breast reconstruction using your own tissue as the donor area and tissue transplantation. The donor area can come from the abdomen, buttocks, back, etc., and can be transferred with the tip or transplanted free of charge.
The results of breast reconstruction with autologous tissue transplantation are long-lasting and realistic in appearance. It can tolerate postoperative radiation therapy and can be used for patients who have received radiation therapy and underwent extensive excision due to recurrence; autologous tissue with good blood flow can promote the healing of bad wounds and ulcers.
6.Can the reconstructed breast be symmetrical with the opposite breast?
Generally speaking, the reconstructed breast is shaped according to the standard of the opposite breast. However, because the contralateral breast is too large, too small or sagging, many surgical reconstructed breasts have a better shape than the contralateral breast, and if the patient requests, a breast reduction, augmentation or breast fixation can be performed on the contralateral breast.
7.When should I have nipple areola reconstruction?
Nipple areola reconstruction is an integral part of breast reconstruction. Nipple reconstruction can be done at the same time as breast reconstruction, but mostly after the final stabilization of the bilateral breast shape. The procedure is relatively simple, does not require hospitalization, and has good results.
8.Do I feel the reconstructed breast?
After flap grafting, the sensation will be dull in the short term, but it will gradually recover in about one year after surgery.
9.Is the hospitalization time for breast reconstruction long?
Breast reconstruction is performed at the same time as breast cancer treatment, and the whole operation takes about 5-6 hours.