Breast Reconstruction: New hope for cancer survivors

Breast Reconstruction: New hope for cancer survivors

 

Mastectomy in cancer cases is psychologically and emotionally traumatic for a woman. It means a devastating feeling of loss of femininity and body identity. Here reconstruction gives the hope. It can be done alongside the surgery or even later. But an immediate reconstruction helps the patient cope with life ahead more easily. There is also less scarring and better utilization of original breast skin.

BY DR SANDEEP MEHTA

 

What can be more devastating than losing one’s body part? In a woman if it entails loss of a

breast which is the hallmark of her femininity, it would be even more mortifying. The diagnosis of breast cancer does not just bring in the fear of a dangerous disease but also the annihilation of so much of her body image.

What if all these women can believe that there is a way to get over this depredation by opting for immediate breast reconstruction after its removal (mastectomy) to treat cancer. This would not only give them the strength to bear the loss but would also make them feel “whole” again and realise that there is a normal life yet again.

Incidence of breast cancer in India is steadily increasing and according to the World Health Organisation (WHO) it has now become the most common form of cancer among urban women. The WHO had predicted approximately 1,55,000 new cases of breast cancer to be detected in the year 2015 with 50% of these in the age group of 25-45. There is a major lack of awareness about breast reconstruction option in India.  A  survey  done  in  Mumbai revealed  that  only  25%  had  any knowledge about it. This is the reason why  only  less  than  1-2%  go  for reconstruction.

Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. The surgery rebuilds the breast to match the size and shape of the other breast. The nipple and the darker area around it, the areola, can also be added at a later stage.

Some misconceptions

The common misconception that a patient of breast cancer has, is that reconstruction would interfere with her treatment or make her predisposed to have a cancer again? Unlike in the West where it is advised as an integral part of treatment, most of the women in India are wrongly advised by their family and spouses not to undergo breast reconstruction to avoid any extra burden on treatment. But almost all women who have to undergo removal of breast have an inherent desire to get the breast reconstructed.

Those who are not well informed about this also wonder about its possibility. The impression that these women are given by their near and dear ones is that the breasts are no longer required once the purpose of childbearing is over and it is alright to be living without them. But in their own minds they feel the calamitous loss of self-image. So, why do we as a society, family member or a treating physician not help her? Why do we deny a woman something which is possible today without any interference with her treatment or disease process? In the Western world it is taken for granted that every individual has a right to take autonomous decisions but in the context of India the decisions are generally taken by the spouse or the head of the family.

 

When to have surgery?

One can have reconstruction at the same time as breast cancer surgery or sometime later as delayed reconstruction.

An immediate reconstruction gives a new breast straight away. Women find that immediate reconstruction helps them cope more easily with their feelings about the loss of a breast. There is no need for another operation for reconstruction at a later stage. There is less scarring and better utilization of original breast skin.

Lumpectomy  (partial mastectomy)

Nowadays more and more of early breast cancers are treated by breast conservation in which only the part of the breast that is involved with the disease is removed (Lumpectomy) and the remaining breast is reconstructed by oncoplastic techniques (by modifying or adding to the normal breast) to bring it back to its normal shape, contour and aesthetics. This is a choice given to all patients diagnosed with early breast cancer.

 

Mastectomy and reconstruction

There are patients in whom the entire breast has to be removed to treat the cancer effectively. These patients can always undergo breast reconstruction at the same time when their breast is being removed.

The common methods of reconstructing

the breast are either by using implants made of silicone which are placed under the muscle while removing the breast or by bringing in new tissues from other parts of the body to fill the void created by the removal of the breast. These are in the form of flaps.

The most common method which gives the benefit of using one’s own body tissues to reconstruct the breast is by using the skin and fat from the lower belly. This may be done without harming the muscle of abdomen by doing the free DIEP flap as it is commonly referred to in medical terms. The skin and fat from the lower abdomen, where usually there is excess of both, are removed and used to make the breast by attaching its blood vessels in the chest area under magnification with the help of a microscope.

There are other methods of reconstruction whereby flaps from the back, buttocks or even thigh can be used to make a breast depending upon the size and volume required to match the remaining breast.

Some patients of breast cancer, with certain genetic defects, might have to undergo removal of both the breasts to prevent occurrence of cancer in other breast. It has become more common knowledge after Hollywood actress Angelina Jolie underwent it and made it public to promote awareness. In the West, more than 80% of these patients undergo immediate bilateral breast reconstruction as compared to only 39% who opt for reconstruction after removal of only one breast.

 

Conclusion

Studies have suggested that immediate breast reconstruction should be done in order to reduce psychological morbidity after mastectomy. It can be performed with acceptable rate of complications, high level of patient satisfaction and decreased distress about loss of breast.

Historically, reconstruction of breast was delayed and the patient was made to live with their deformity. It was thought there was a chance of recurrence of the disease. However, studies have now clearly indicated otherwise. The advantage of early breast reconstruction is that it is psychologically beneficial and significantly reduces postoperative emotional stress.

 

(The writer is Additional Director, Surgical Oncology, BLK Super Speciality Hospital, New Delhi)