Reconstruction of the breasts done at the same time as surgery to remove the cancer. The patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. The process is done in the shortest time possible and is not a series of complex surgeries over a length of time.
This reconstruction involves placing a temporary tissue expander either under or over the muscle at the time of your mastectomy. The expander gradually stretches the muscle and skin in preparation for either an implant or flap reconstruction. The overall result is more symmetric, natural and aesthetically pleasing. It allows a woman to complete radiation treatment while having a “placeholder” implanted. It allows enough time to make sure all the cancer has been treated.
This reconstruction happens after all treatment to treat the cancer has been completed. Whether it’s been 20 days or 20 years since a woman’s lumpectomy or mastectomy, she is likely a candidate for delayed breast reconstruction.
A breast implant is a silicone shell filled with either silicone gel or a salt water solution known as saline. The recovery from the initial expander placement surgery and from the permanent implant placement surgery is usually quicker than flap surgery. It may be easier to control the final size of the reconstructed breast with implant reconstruction. There are no additional scars on the patient’s body other than those on the breasts. For patients without excess fatty tissue and who do not require radiation treatment, implants are a good choice and yield good final results. With implants most patients require placement of an expander first, followed by replacement of the expander with an implant. This type of reconstruction almost always requires at least two surgical stages and multiple visits to the plastic surgeon’s office between these stages for tissue expansion. it is important to realize that for patients who are having a unilateral (one-sided) mastectomy, matching the other natural breast with an implant can be difficult. The shape and “feel” of an implant is not exactly like that of a natural breast.
DIEP, SIEA, SGAP Flaps The DIEP flap is the technique where skin and tissue (no muscle) is taken from the abdomen in order to recreate the breast. Other flap techniques, called the SIEA flap, the LSGAP flap and the SGAP flap, take tissue from the lower abdomen or lateral buttock regions. Since the reconstruction involves using the patient’s own tissues, the risks of implant reconstruction are avoided, particularly in the case of radiation.
What is neoadjuvant chemotherapy? Neoadjuvant chemotherapy refers to medicines that are administered before surgery for the treatment of breast cancer. Your doctors may recommend neoadjuvant chemotherapy due to the size of the tumor, since the drugs may shrink the tumor and give you more surgical options.In some cases, a woman who would have needed a mastectomy due to the large size of her tumor can become a candidate for lumpectomy by shrinking the invasive tumor prior to surgery. Neoadjuvant chemotherapy is also performed for certain types of breast cancer, such as inflammatory breast cancer. What is adjuvant chemotherapy? Adjuvant (meaning “in addition to”) chemotherapy refers to medicines administered after surgery for the treatment of breast cancer. Adjuvant chemotherapy is designed to prevent recurrence of the disease, particularly distant recurrence. Your doctors may recommend chemotherapy if your breast cancer is invasive, has unfavorable prognostic factors, is a certain size, or has spread to nearby lymph nodes. It also may be recommended if you are relatively young at the time of diagnosis.
Hormonal therapy (not to be confused with hormone replacement therapy that some women take to ease menopausal symptoms) is classified as selective estrogen receptor modulator (SERM) or an aromatase inhibitor (AI). Both of these types of treatments help block estrogen’s ability to reach a breast cancer cell. If your hormone receptor (HR) test was positive, that tells the doctors that estrogen and/or progesterone may promote the growth of breast cancer cells in your body. By taking a drug that works on breast cancer cells, like an estrogen blocker, the risk of breast cancer recurring or possibly continuing to grow is reduced.
In recent years clinical trials have been conducted to evaluate the effectiveness of new drugs that alter the behavior of the breast cancer cell. These drugs are referred to as targeted therapy or biologic targeted therapy. During the clinical trial, the pathologist performs a special prognostic factor called HER2neu receptor on the invasive breast cancer cells. This receptor stands for human epidermal growth receptor 2. It is a gene that helps control how cells grow, divide and repair themselves. The HER2 gene (not to be confused with BRCA 1 or 2 genes) directs the production of a special protein. This gene is designed to help the breast cell grow normally. However, if there are too many copies of the gene within the cell, the breast cells then have the ability to turn into a breast cancer cell. Those breast cancers that are HER2neu positive are considered more aggressive. Special tests referred to as immunohistochemistry (IHC) or FISH (Fluorescence in situ Hybridization) are used by the pathologist to determine if the breast cancer cells are HER2/neu positive or negative. If positive, a patient may be advised to take targeted biologic therapy.
If breast cancer locally recurs in the breast after lumpectomy surgery, it typically recurs in the same place it originally grew. Partial breast irradiation (PBI) involves treating only a portion of the breast; the site of the lumpectomy plus the surrounding tissue. Since a smaller volume of breast tissue is irradiated, the number of times a patient must have radiation is reduced, making it easier on patients and their families.
A higher dose of radiation is delivered in a shorter number of weeks.