Breast cancer is a serious diagnosis for any woman. The goal of the operation is to radically eliminate the cancer, which can generally be achieved by removing the tumour and applying post-operative irradiation. With certain variants of breast cancer and where there is a high genetic risk, however, it is still necessary to remove the entire mammary gland. Gynaecologists and plastic surgeons work hand-in-hand to reconstruct the breast at the same time as the operation to remove the tumour (immediate reconstruction).
In recent years, what is known as skin-sparing mastectomy has helped to achieve marked improvements in reconstruction outcomes. Despite a radical mastectomy, a large part of the breast skin can be retained. The missing volume is, where possible, replenished using the patient’s own tissue. The TRAM flap breast reconstruction has become established as one of the best methods. This involves moving the abdominal skin to the breast region complete with all the available abdominal fat. The rectus abdominis muscle is responsible for supplying blood to this skin and tissue flaps. Once this relocation has taken place, a slight weakness of the abdominal wall may remain. There is a positive side-effect, however, as the belly is tightened at the same time. The abdominal flap can also be ‘freely’ transposed to the position of the breast by connecting supplying vessels to receiving vessels in the breast region by means of microsurgery (free TRAM flap breast reconstruction or DIEP flap breast reconstruction).
An alternative option for breast reconstructions is to relocate the large back muscle (Latissimus dorsi). In most cases, this flap on the back needs to be augmented with a silicone implant. A further option is reconstruction with tissue distension (expander) and silicone implants. This method has the advantage that the operation is not so extensive; however, it does entail a greater risk of complications in the long run (capsule formation).
In cases where breast-preserving treatment cannot be carried out, the standard is for a skin-sparing mastectomy with the sentinel lymph node being removed in the armpit together with an immediate reconstruction.
Secondary bleeding 5%, infection 1%, poor scar healing. Specific risks, depending on the reconstruction form: partial flap necrosis through to complete loss of flaps, seroma formation (accumulation of tissue liquid), fatty tissue necrosis, weak abdominal wall. Capsule formation around implants.
An abdominal belt must be worn for four weeks.