Interview With Leading Plastic Surgeon; Prof. Lior Heller
Reconstructive breast surgery after breast cancer treatment
When a malignant breast tumor is identified in the early stages of the disease, the patient will, most probably, undergo surgery to remove the tumor, or the entire breast.
In the case of a mastectomy, which is the complete removal of the breast, the patient also undergoes reconstructive plastic surgery.
Professor Lior Heller, one of the leading plastic surgeons at Herzliya Medical Center, answers questions in relation to this operation, to help you make the right decision.
Who is a suitable candidate for reconstructive breast surgery?
In principle, any female patient who underwent a partial or a total removal of the breast, is a candidate for reconstructive breast surgery. The final decision whether to conduct the operation or not, is entirely up the patient herself.
Reconstructive breast surgery is not recommended in cases where the procedure threatens the health of the patient or significantly delays further cancer treatment.
As a rule, this applies to patients suffering from ischemic heart disease, lung disease or those with additional tumors.
Such patients will seek advice of an anesthesiologist, who will assess the general state of their health and if reconstructive surgery is feasible in their case.
Is breast reconstruction carried out as one operation?
Breast reconstruction consists of two or three procedures, the process depends on the reconstruction method. Typically, the first step is the hardest, with the longest recovery period. Despite this, it is important to understand that even without reconstruction mastectomy requires a long recovery period, and breast reconstruction only slightly increases it.
How many methods of breast reconstruction exist today?
There are several methods of breast reconstruction. The most common method is to introduce the implant in the chest during a mastectomy. The application of this method is possible only if the remainder of the skin is enough to cover the implant. If the skin is limited due to extensive excision, the surgeon can use the so-called "stretching". We are talking about a small empty implant, which is implemented in the area of the breast during the mastectomy, and over the next two to three months is inflated to the corresponding breast size. When the desired size is reached, the "stretcher" is changed to a permanent implant (usually silicon).
The second method involves the use of skin and fat layer harvested from the abdomen wall which, together with a small piece of muscle is transplanted to the chest. This fat layer, together with the skin of the abdomen recreates the breast. This method is more difficult than the previous one, because it requires delicate work with small vessels, but the result looks more natural than silicone implants.
The third method of breast reconstruction is based on the transplantation of skin and muscle tissue from the back to the chest. Under this flap the implant is introduced.
Are all methods suitable for all patients?
The choice of breast reconstruction method is decided by the plastic surgeon in conjunction with the patient. The choice of method is determined by multiple factors, including the patient's wish, her body, and general health, the size and shape of the breast. Given these factors, there are patients who are suitable for all three methods of reconstruction, while others can only be offered one or two of the options.
Do patients prefer to choose a method of autologous reconstruction (from the wall of the abdomen), to get the effect of a tummy tuck?
The view that in autologous reconstruction the patient gets a tummy tuck, sounds appealing. It is important to understand that choosing autologous reconstruction for that reason alone is incorrect. Firstly, it is a complex operation, and a tummy tuck can be done with much more simple methods. Secondly, it is important that the priority of the patient is breast reconstruction, in the first place and the cure of the disease, and the symmetry of the breasts after surgery.
When is it best to do breast reconstruction: in conjunction with mastectomy or after cancer therapy?
Reconstructive breast surgery can be carried out in conjunction with a mastectomy, and after cancer treatment. Reconstruction after mastectomy provides a more aesthetically pleasing result, because it uses the original skin of the breast, rather than the flap. If the operation is postponed, the skin becomes unusable and it will have to re-stretch.
Will the reconstructed breast look like the real one?
Reconstructive breast surgery is designed to allow the patient to feel comfortable in clothes and in a bathing suit. When in nude, scars, no doubt, will be noticeable, but over time they heal very well. To create an absolute symmetry between the breasts is not an easy task, so when the breast is exposed, there may be a slight difference. The surgeon aims to create the maximum impact of symmetry when the patient wears a bra or a blouse.
Is a partial removal of the breast preferable from an aesthetic point of view?
In some cases, effective treatment of breast cancer can be achieved by a partial removal of the breast rather than mastectomy followed by irradiation. Of course, in most cases, women prefer a partial removal, but sometimes with a small breast tumor or a centrally positioned, this may result in significant deformation. In such cases it is necessary to weigh the mastectomy with reconstruction, which will give the best result from a cosmetic point of view. In any case, the final decision depends on many factors and is always in the hands of the patient.
Can breast reconstruction affect the detection of tumor recurrence in the future?
Breast reconstruction does not affect the process of observation in cases of fear of recurrence of the tumor. Implants are generally located below the muscle layer, the tissue of the breast skin and remain on the surface. That is, in case of relapse, the tumor is formed over the implant and it will be easy to identify. If the patient underwent autologous reconstruction, it is recommended to go to the attending physician and have periodic breast ultrasound done.
What innovations and developments in the field of breast reconstruction have occurred in recent years?
In the past few years, the bio-based grid is widely used, like alloderm allowing a more thorough design for the shape of the breast reconstruction with an implant. Also, plastic surgeons began using autologous fat in those areas of the chest, where it is necessary to add a little volume.
What are the chances of complications in the course of the reconstruction after a mastectomy, does it increase the risk of postoperative complications?
The more surgical procedures are performed in a single session of anesthesia, the higher the risk of postoperative complications is. Despite this, the benefits of improving the self-esteem of the patient as a result of reconstruction outweigh the possible risks of complications. Multiple studies have shown that patients who have undergone breast reconstruction, returned to normal family and social functions faster than those that have suffered a mere tumor removal from the chest.
Surgery at Herzliya Medical Center is carried out as an individual approach to achieve the most effective treatment plan for the patient. In our hospital we use the most advanced methods of breast cancer treatment .