The Star : Sunday July 8, 2007
Breast reconstructive surgery after a mastectomy can often help a patient on the road to full recovery, enabling her to be able to look and feel just like before.
ONE in 19 Malaysian women are at risk of having breast cancer. Early detection might increase the chance of survival, but for many women afflicted with this debilitating disease, they are often faced with the likelihood of undergoing lengthy treatments or worse, losing the part of their body that represents the femininity.
In breast cancer, the cells in the lobules or the ducts of the affected breast become abnormal and divide uncontrollably. These abnormal cells begin to invade the surrounding breast tissue and may eventually spread via blood vessels and lymphatic channels to infect the lymph nodes, lungs, bones, brain and liver.
Your only option in overcoming this disease is to undergo radiotherapy and/or chemotherapy or a more invasive treatment called mastectomy (removal of a breast).
What exactly goes on in the treatment? Mastectomy actually involves losing parts of or even a whole breast. To survive the curative surgery is one thing, to face stigma attached to it is a totally different ball game.
Most women who lose their breasts to cancer or have intensive scarring in the chest area will often feel stigmatised, socially and personally, making them feel less than a woman.
The number of breast cancer patients has been increasing for the past five years and some end up emotionally scarred because of their mastectomy surgery.
Their perception of a full recovery is often to be able to look and feel just like before. Thankfully, this can be made possible with breast reconstructive surgery. Many hospitals are offering reconstructive procedures once the patients are found to be in a stable health condition.
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In breast reconstruction surgery, the reconstruction can be done either with an artificial breast or by transfering tissue from other parts of the woman’s body. – AFP
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According to Wikipedia.com and Hopkinsbayview.org, there are two main methods of reconstructive surgery, which are prosthetic and autogenously regenerative. Simply put, the reconstruction can be done either with an artificial breast or by transferring tissue from other parts of the woman’s body.
Prosthetic reconstruction
Prosthetic reconstruction is a two-stage process that could be done during the mastectomy itself or after, depending on the patient’s health and willingness.
First, a tissue expander is placed under the muscles of a patient’s chest wall. In the following several weeks, the expander is slowly inflated by injecting saline into the expander. The implant will then expand, just like a water balloon, and will cause the skin to stretch. This process takes two to four months according to the size requested and how much saline is injected each time.
When it has reached the desired size, the expander will be replaced with a permanent implant, filled with silicone or saline. The nipple is also reconstructed at this point.
Some people might be wary of silicone implants. In the past, they have been rumoured to cause a high risk of breast cancer, but after a report released this year by the Institute of Medicine (IOM) of the National Academy of Sciences, it was found to be untrue. Rumours regarding implants passing silicone on to babies during breast-feeding have also been disputed.
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Artificial breast implants are filled with either silicone (left) or saline (right). – AFP
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Nevertheless silicone implants are not trouble-free as they come with some baggage in the form of implant ruptures, deflations and capsular contracture.
It is still the more popular option as it can give a natural feel and look to its receivers. It is also used in autogenous tissue reconstruction because the reconstructed breast may not reach a proper size without some boost from implants.
Autogenous tissue reconstruction
For women who prefer the advantages of all-natural tissue, this procedure is a logical alternative, although a little complex. Surgeons will need to take tissue from other areas of the patient’s body to reconstruct her breast.
The main advantage of this form of reconstruction is the creation of a more pendulous, soft breast, while its incidental benefit is that one can also get rid of some “unwanted” areas of one’s body.
The reconstruction is done in two stages. The first stage involves the surgeon creating a breast mound while the second stage is about refining the shape and look. The refining process is done via liposuction and surgical revisions, at the end of which a nipple is created.
The tissues are normally taken from the latissimus flap from the back, and the Transverse Rectus Abdominis Muscle (TRAM) flap from the lower abdomen. The latter will not only give you a reconstructed breast that looks and feel like a normal breast but, on top of that, you also get a tummy tuck. Indeed, killing two birds with one stone!
The latissmus flap can be rotated to where your breast is but it is only sufficient to create a moderate sized breast. But to achieve a more noticeable size and symmetry with the other breast, implants are often added.
If the TRAM flap is used, skin and fatty tissues from the lower abdomen can either be rotated to one’s chest or reattached microscopically to blood vessels under the arm or in the chest. Again, size is a personal choice and one may typically need to have implants to reach the desired size.
After the breast is done, it will be followed by nipple reconstruction if it was removed during the mastectomy. This is usually delayed for a few months until the breast mound is completely healed and settled into its shape and position. This is to ensure that the nipple can be placed where it should be. There are several methods to achieve this i.e. via nipple-areola graft and local tissue flaps.
Nipple reconstruction
If one only loses a breast and the nipple and areola are big enough, doctors may take some sample tissues from the nipple and areola of the other breast to recreate those parts.
This technique is highly recommended because it eliminates the loss of sensation in the nipple and other donor-site (i.e patient) complications such as abdominal hernias and bulges if the tissues are taken from the abdominal area.
Another option would be by creating a small flap to produce a raised mound of skin. To recreate an areola, a circular incision might be made around the nipple and sutured back again. The region will then be tattooed to reproduce the colour of the real deal as well as to match one’s breasts.
Recovery
Usually, implant-based reconstruction has a faster recovery time than flap-based reconstructions. However, both take at least three to six weeks to recover and require follow-up surgeries in order to construct a new areola and nipple.
Survivors are advised against strenuous sports, overhead lifting and sexual activity during the recovery period. TRAM flap patients can show abdominal muscle weakness but most recipients return to normal activities after recovery.
Upper body exercise post-reconstruction surgery is quite limited. It is best to check with your surgeon on what works best for you.
Some surgeons recommend a visit to a physiotherapist who can determine suitable arm exercises. Cardiac exercises are also good for rehabilitation post-surgery and weight control.
Follow-ups to perform manual examinations on both the remaining natural breast and reconstructed breast post-surgery need to continue to prevent relapse.
What have we here?
Dr George Varughese, a plastic surgeon, suggests that newer techniques are constantly being developed and the Malaysian public are encouraged to contact members of the Malaysian Association of Plastic Aesthetic and Craniomaxillofacial Surgeons (MAPACS) via their website www.mapacs.com for further information.
These newer techniques include developments in completely natural breast reconstruction, including the use of near tissue or tissue transplant under local anaesthesia, similar to the tissue-transferring methods described earlier.
These techniques offer patients hope of achieving some normalcy in their life without undergoing long and complicated surgical procedures.
Overall Dr Varughese comments that breast reconstruction is a well established procedure with its own risks and benefits. He adds that the preceding information on breast reconstructive procedures is a general description that breast cancer patients would need before or after cancer surgery, and that continued future development of these reconstructive techniques will certainly enhance the options that plastic surgeons can offer to their patients, from those commonly available.
In terms of cost, it largely depends on a number of factors, such as the surgeon involved and the medical centre (private as opposed to public hospitals).
A general estimate for a reconstructive breast surgery is between RM20,000 to RM25,000, which does not include complex microsurgery such as for the TRAM flap method, in which case it could reach up to RM35,000.
In view of the high costs, it pays for women to be financially prepared and protected while they are still young and healthy.
There are insurance policies that are tailored to protect you from being crippled financially due to the disease. One such insurance would be the PRUlady plans available from Prudential. They are designed to help women battle with the financial implications of this often gut wrenching disease.
The plan provides protection against female cancers and other female-specific illnesses. For instance, not only will you receive 100% of your sum assured if you are diagnosed with breast cancer, but you will also receive an extra 30% sum assured to pay for breast reconstructive surgery.
Although there is no real prevention from breast cancer, there is no harm in being prepared – financially, at the very least.
Note: This article is courtesy of Prudential Assurance Malaysia Berhad. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Posted by drnaz 
Posted by drnaz 
Posted by drnaz 
