Breast Reconstruction
Breast reconstruction is an option available to all women following mastectomy. It may provide improved self confidence and a return to normality after the emotional trauma associated with a diagnosis of breast cancer. Breast reconstruction may be immediate or delayed, depending on the individual situation.
Immediate breast reconstruction would be offered if the patient’s anticipated treatment is not complex, and if the patient is able to make an informed decision during the difficult emotional time preceding surgery. In certain circumstances, for example if post-mastectomy radiotherapy is anticipated, it may be better to delay reconstruction until after the other adjuvant therapies are completed. The options available for breast reconstruction fall into three categories:
1. Implant/tissue expander reconstruction,
2. Autologous tissue reconstruction including TRAM flap or latissimus dorsi flap reconstruction, or;
3. A combination of the first two.
Factors governing which style of reconstruction is chosen depends on the patient’s breast size and shape, the patient’s build, as well as the patient’s own wishes.
Implant reconstruction is ideal for smaller breasted women and in the setting of bilateral mastectomy. Advantages include a relatively short operating time and rapid recovery. Disadvantages include a greater need for procedures on the other breast for symmetry, long term life span of implants requiring replacement, and the rare risk of implant infection necessitating removal.
Flap reconstruction is well suited for larger breasted women, reconstruction after radiotherapy, and for filling defects in the breast followed breast conserving surgery (lumpectomy). Disadvantages of flap reconstruction include longer operating time, longer post-operative recovery, and donor site and flap complications.
The ultimate choice in reconstruction needs to be made by the patient after a detailed and informed consultation with their doctor.
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