Breast reconstruction?

The latest techniques work microsurgically, with beautiful, natural results.

When you learn, as soon as you are diagnosed with breast cancer, that reconstruction is possible after invasive surgery, you regain some perspective on the future. Not only does reconstruction provide psychological and aesthetic relief - it helps you regain your femininity and self-confidence during what is surely a very trying time - it can also provide a certain physical comfort and avoid pains associated with treatment.

No additional risks

It is important to emphasize that breast reconstruction does not affect the further development of the cancer in any way. It in no way interferes with the chance of cure, does not interfere with subsequent monitoring or increase the risk of relapse. There are different reconstruction methods, depending on the experience of the surgeon and on the choice and situation of the woman concerned (a short or long operation, a short or long recovery,...). Despite the confusing emotions that you are undoubtedly confronted with upon hearing the diagnosis, it is still worth pausing to consider this possibility and compare some opinions side by side.

Immediate reconstruction

In breast cancer, part of the breast (tumorectomy) or the entire breast (mastectomy) is removed. If possible, the surgeon removes only the tumor and surrounding breast tissue: reconstruction then ensures that the operated breast does not dent and that both breasts remain symmetrical. If the breast is completely removed (the mammary gland, areola and the skin around it), the skin envelope is preserved as much as possible so that reconstruction is possible. Reconstruction, both of the breast curvature, and of the nipple and areola, is done in several steps, over several months. If radiotherapy or chemotherapy is not prescribed in addition to surgery, reconstruction can often be done during the same surgery as the tumor is removed. The surgery and recovery may take longer and be more strenuous, but it does have some undeniable advantages: you are only put under anesthesia once, you have less scarring and you do not face breast mutilation....

Different techniques

In terms of technique, there are several options: the internal prosthesis can be filled with silicone (which gives the most natural result, also in terms of feeling) or with physiological water. The prosthesis is inserted under the pectoral muscle. This is a short procedure from which you recover quickly. Still, the results are sometimes disappointing: the breast feels more static and does not always look symmetrical. After radiotherapy, you also run a greater risk of fibrosis or proliferation of connective tissue (a natural reaction of the body to a foreign substance). In itself harmless, but it can contribute to an unnatural shape and physical discomfort.

With your own tissue

You can also consider reconstruction with your own tissue (skin, muscle, fatty tissue,...), taken from elsewhere in your body (at the level of your back, your abdomen,...) and transplanted to your breast. Usually with very nice results, both in terms of mobility and flexibility of the breast. The surgery does take a long time (two to five hours) and requires a skilled surgeon. It is also more painful and recovery runs over several weeks. Another side effect is that the tissue is more difficult to bleed. You also have larger scars, although they do fade over the years. The latest techniques also work microsurgically, using skin flaps with their own blood supply, sparing the back muscles. Again, this is a long and delicate procedure, but with a beautiful, natural result.

A look at the latest surgery

An expert to speak: Dr. Pino Cusumano, gynecologist and oncoplastic surgeon.

"Doctors are now trained in a mix of oncology and plastic surgery, for even better results."

What does oncoplastic surgery involve?

"It's a new discipline that requires specific training, which you can currently only get in England and France. It is a fusion of oncology and plastic surgery: a form of surgery that meets all the oncological requirements (removing the entire tumor, preserving healthy skin margins, not delaying follow-up therapies such as chemo and radiotherapy,...), but which at the same time takes into account all the aesthetic standards during surgery."

Is the intention purely aesthetic?

"No. In this type of surgery, a surgeon who is inadequately trained risks creating grooves or asymmetries, sometimes with psychological, aesthetic or physical consequences. Inaccurate surgery can cause pain, reduced mobility or sensitivity of the breast... Noticing these aberrations, Dr. Clough instituted a series of oncoplastic techniques precisely to avoid these kinds of undesirable consequences. A significant advance, especially considering that in the past certain defects could only be corrected by mastectomy, whether or not accompanied by reconstruction."

For whom is oncoplastic surgery a solution?

"For all women suffering from breast cancer who have undergone breast-conserving surgery. Although oncoplastic techniques are also used in women with a larger tumor, up to 5 cm. In that case, you have to remodel the breast immediately to prevent dents in the tissue."

Who gets to do these interventions?

"There are different levels within oncoplastic surgery: the first level, which should be known to all surgeons and can normally be applied, and the second level, which is more technical and a lot more complicated. This requires training in both general surgery and plastic surgery. In certain delicate cases, we even collaborate with a plastic surgeon."

Do you succeed in preventing the effects of radiotherapy on an operated breast?

"Because of radiotherapy, which usually begins three to six weeks after breast surgery, the breast may increase or lose volume. We anticipate that to some extent but we also provide new symmetry about six to 12 months after the oncoplastic surgery and radiotherapy."

What would you recommend to women with breast cancer?

"If you have been diagnosed with breast cancer, you have six weeks to plan the procedure. So definitely take the time to think about it and educate yourself properly."

Source: Michèle Rager with Dr. Pinot Cusumano