Breast Conservation Therapy via
Breast Reduction Reconstruction
Breast reduction reconstruction is a type of breast saving or breast conservation surgery available to some patients.
Your breast surgeon will inform you if you are a candidate for breast conservation surgery. Certain prerequisites need to be met in order to be a candidate for breast conservation surgery. Some of those are: the size of your breasts, the size and location of the tumour and ability to receive radiation. One of the reconstructive options available to a patient with an adequate tumour to breast ratio is wide local excisions of the cancerous area and reconstruction via a breast reduction technique.
During breast conservation surgery the breast cancer surgeon removes the tumour and a rim of surrounding normal tissue. Our unit pathologist assesses the excised breast tissue to make sure that the tumour has been completely excised. The remaining breast tissue is rearranged in such a way as to reconstruct the breast mound via breast reduction techniques.
Breast reduction surgery is done via incisions that surround the nipple and areola, a vertical component with or without a horizontal component, the so-called inverted T incision. The incisions facilitate the movement of the nipple and areola into a new position and removing breast tissue, fat and skin. Once the breast tissue has been excised the surrounding breast is arranged so as to give a cosmetically pleasing shape. Thus the breast size is reduced to accommodate the removal of the cancer tissue. Should you wish to have an even greater reduction your reconstructive surgeon may remove extra breast tissue. Thus the amount of breast tissue removed is determined by the oncological requirements firstly and secondly by patient preference.
The Reconstructive surgeon arranges the breast tissue and moves the nipple and areola into its new position. In most cases the nipple and areola remain attached to their blood vessels and nerves. However, if the breasts are very large and pendulous, the nipples and areolas may have to be removed completely and grafted into the correct position. The graft will result in complete loss of sensation in the nipple and areola. In cases where the tumour is situated in close proximity to the nipple and areola a clear disc of skin may be placed in the position of the nipple and areola allowing for nipple and areola reconstruction at a later stage. Once again all sensation will be lost as the nipple and areola are removed. There may be additional cuts on the cancer breast or some degree of asymmetry in order to accommodate complete cancer excision.
Post breast conservation surgery most of the patients will receive radiation therapy. Radiation therapy affects the breast in various ways and thus has to be compensated for if possible during the initial reconstruction. These changes caused by radiation include but are not limited to:
– Loss of volume: Thus initially the breast that will need radiation will be made slightly larger than the opposite breast.
– Fat Necrosis: Death of fatty tissue and formation of hard lumps. These may be managed conservatively and best not to interfere and cause further fat necrosis. The reconstructive surgeon may elect to excise the hard tissue or inject some fat to improve the condition.
– Skin changes
Breast reconstruction via reduction techniques is a safe procedure, nevertheless, as with any surgery, there is always a possibility of complications. These include bleeding, infections and anaesthetic related complications. The procedure leaves noticeable permanent scars and some patients have poor healing around the nipples and at the inverted T junctions, worsened by smoking.