“Breast reconstruction should be considered as part of the breast cancer management process. The definition of health not only covers medical issues but also the psychosocial impact of disease. Breast reconstruction specifically targets the tremendous impact of breast cancer management, leading to restoration of self image.”
This what Dr Lyronne Olivier, oncoplastic and reconstructive breast surgeon and breast surgical oncologist, said when asked for advice or recommendations for breast cancer survivors who are considering breast reconstruction, but are concerned about the associated expenses.
A doctor for 17 years, Olivier fills many roles, including consultant breast surgical oncologist at St James Medical Complex, fellow of the Caribbean College Of Surgeons and the American College of Surgeons, member of the American Society of Breast Surgeons and the Prakash Fellowship Alumni University of Toronto, Canada, executive member of Society of Surgeons and an associate lecturer at the Department of Surgical Sciences, UWI.
Can you provide an overview of the types of reconstructive surgery options available for breast cancer survivors, and what factors determine the suitability of each option?
The reconstructive surgery options are:
1. Partial reconstruction: This approach is utilised in breast conservation surgery that involves a wide local removal of the breast cancer with clear surgical margins. Oncoplastic techniques, Volume displacement and volume replacement are the options for reconstruction to achieve oncological and good cosmetic outcomes.
The former involves partial breast removal (mastectomy) and utilising the residual breast tissue to fill the defect, while the latter involves partial mastectomy and simultaneous reconstruction of the breast, with a rotation of tissue flaps from another site.
Most patients are candidates for breast preservation and oncoplastic techniques. However, patients must be able to undergo adjuvant radiation therapy. Contraindications for radiation are generally a previous exposure to radiation at the foreseen site, active autoimmune connective tissue disease, pregnancy or pulmonary fibrosis.
2. Complete (mastectomy) reconstruction: Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are the breast-cancer-removal procedures prior to breast reconstruction. Nipple-sparing involves the preservation of one's nipple and skin envelope following removal of all the underlying breast tissue and cancer.
Patients without skin and nipple involvement as well as the absence of significant nipple downward descent (ptosis) and extensive skin may be candidates for this approach.
However, patients with cancer adherent to the skin and nipple may be a candidate for skin-sparing mastectomy.
Both of these options are contraindicated in inflammatory breast cancer.
NSM and SSM facilitate the opportunity for breast reconstruction via alloplastic or autologous techniques.
a. Alloplastic breast reconstruction: This approach utilises breast prosthesis/breast implants. Imp
