Banners_Breast-02

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.

You will receive a general anaesthetic. The reconstructive surgeon draws the appropriate access incisions on your breast either before or during the procedure.

Firstly, the oncological surgeon removes the breast tissue and necessary lymph nodes via the predetermined incisions. The pathologist determines adequate tumor removal intra-operatively and once the margins are clear the reconstructive surgeon proceeds.

The breast tissue is arranged in such a way as to accommodate for the excised tissue and to reduce the breast to the required size. The nipple and areola are positioned in the appropriate position, grafted or replaced by a clear disc depending on the oncological and size requirements. The opposite breast is reduced in a similar fashion.

Two drains are placed, one in each breast, draining to one drainage box. These drains will remain until the drainage is less than 30 ml in 2 consecutive days. The wound is closed in layers and appropriate dressings applied.

The patient is placed in a supportive bra in theatre. Thus it is important that the patient brings an appropriate sports bra to theatre. (without wire insertions, preferably black).

You would have to stay in hospital for a period of 2 to 5 days during the healing process. You will be taught how to empty the surgical drains and to keep record of the drainage. Antibiotics and pain tablets will be given to take home. The drains will be removed once they drain less than 30 ml in two consecutive days. Do not rush to get back to work. Allow yourself a period of 6 weeks for recovery. You will not be allowed to drive for 2 weeks following the procedure and will need to follow up with both the reconstructive as well as the oncological surgeon on the dates given at discharge.

 

Pain, bruising and swelling will gradually disappear over the next few weeks and slowly your breast will settle into the new shape. This process may take six months to a year. You will be required to wear supportive bras for up to four months.

Below follows a list of some of the more frequent complications associated with breast conservation surgery via breast reduction techniques.

Local complications i.e. around the breast……

Haematoma formation

Seroma formation

Delayed wound healing

Wound sepsis

Wound breakdown

Sensory changes in the breast

Pain

Systemic complications…. your body

Fluid and electrolyte abnormalities

Deep vein thrombosis

Lung complications

Long term and cosmetic complications… the way it looks

Asymmetries of the breast nipples (preexisting asymmetries will still be noticeable)

Poor scarring

Dog ears and irregularities of the wounds

Change in sensation of the nipple and surrounding breasts

Inability to breast feed post operatively

Complete nipple loss

Pain, from many causes including muscle spasms and nerve injury

There are secondary procedures to improve the appearance eg. fat fills

Thank you

We hope that we have explained the procedure in an understandable manner and have addressed some of your questions. Please feel free to ask any additional questions or discuss concerns.

I WOULD LIKE TO ENQUIRE

CONTACT US

Please don’t hesitate to contact us if you have any questions, comments or messages. We’ll try to respond to everything.

011 482 2196
dr.mventer@gmail.com