Involve plastic surgeons early in breast cancer treatment

Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue — a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer.

Each surgery has its own unique benefits and challenges, but there are variables to consider beyond what the procedure can offer for a patient’s immediate situation.

A study performed earlier in 2017 revealed that, for patients who underwent radiation therapy for breast cancer, breast reconstruction with implants failed in about 30 percent of the group. The 29.4 percent of these patients whose reconstruction was unsuccessful is compared to a failure rate of just 4.3 percent in the group who had autologous reconstruction.

While this highlights the fact that breast reconstruction patients whose journey involves both radiation and implants face potential reconstruction failure at a rate 11 times greater than their autologous counterparts, it also underscores the importance of looking at the entire breast cancer treatment and reconstruction process as a whole.

Plastic surgeons who know that their patients are likely to be undergoing radiation therapy as a part of their breast cancer treatment are better equipped to recommend an appropriate reconstruction strategy, such as a DIEP flap.

The deep inferior epigastric artery perforator flap (DIEP for short) takes skin and fat from the patient’s own abdominal area and uses it to create a new breast mound, either just after mastectomy surgery or later, if the patient chooses. While this procedure allows for the installation of implants, in some cases, the tissue harvested from the donor area is enough to allow for a new breast to be built with no need for an implant.

Involving the careful connection of blood vessels to nourish the transplanted tissue, DIEP flap surgery is a very technical endeavor—but one with a higher rate of long-term success in patients with irradiated breasts. That said, this surgical option is available only to candidates whose anatomy and other factors allow for it.

Other flap-based options include the muscle-sparing TRAM flap, which can allow for the construction of a larger breast; the superficial inferior epigastric artery (SIEA) flap, which avoids involving the abdominal muscles; the transverse upper gracilis flap, which takes tissue from the thigh instead of the abdomen; and the pedicled TRAM and latissimus flaps.

Again, it should be noted that flap surgeries are only available to patients who meet certain health and weight criteria. But for radiation patients for whom breast reconstruction is a priority, they should be explored with help from an experienced plastic surgeon before any decisions are made.

Removing any tumors and cancer cells is obviously of utmost importance for a breast cancer patient, and the decisions guiding this aspect of a patient’s journey should be given the most weight as the top priority. Thanks to modern technology and advances in medicine, as well as diagnostic techniques and well-educated patients who can benefit from an earlier diagnosis, aesthetics can be a part of the conversation—without sacrificing health considerations.

For some women, breast reconstruction is a vital part of their own journey, giving them emotional and mental healing as they continue to deal with life after mastectomy and cancer treatment. With that in mind, every precaution should be taken to allow the reconstructed breasts the best chance of survival.

Terry Myckatyn is a plastic surgeon, West County Plastic Surgeons of Washington University, St. Louis, MO.

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