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Breast Conservation via “Spare Skin Surgery “

Breast reconstruction via spare part surgery is a procedure available to certain patients. Your breast surgeon will inform you if you are a candidate for this type of surgery.

Certain prerequisites need to be met in order to be a candidate for this procedure. Some of those are the size of your breasts, the size and location of the tumour and your ability to receive radiation should that be required.

During this procedure the breast cancer surgeon removes the tumour and breast 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. Some of the anterior and lateral abdominal wall skin may be mobilized and used in the reconstruction. It is important to realize that the entire inside of the breast tissue is removed and the remainder of the skin is arranged in such a way as to reconstruct a breast mound/round shape.

Breast 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 incisions. The incisions facilitates the movement of the nipple and areola into a new position and removing breast tissue. Once the breast tissue have been excised the surrounding breast skin flaps are arranged so as to give a cosmetically pleasing shape. Thus the breast size is reduced to accommodate the removal of the cancer and breast tissue.

It is important to realize that the entire inside of the breast is removed and it is merely the breast envelope that remains. It is impossible to predict the amount of tissue that will be available after the removal to reconstruct the breast. In addition there is a great possibility that some of the skin flaps and the nipples may not be able to stay alive once the inside of the breast tissue have been removed. This will require additional surgery to remove the necrotic or dead tissue.

The advantage of this procedure is:

1.) No additional cuts on the body besides the breast as no other donor tissue is used.

2.) Ability to receive radiation

3.) No need for prosthetic material

4.) Possibility to achieve breast reconstruction in a single stage although this may not always be possible.

5.) Reduction in the size of the breast

Disadvantages:

1.) Return to theatre

2.) Loss of skin and nipple

3.) Inability to predict the final size of the breast

Breast reconstruction via spare part surgery is a safe procedure, nevertheless as with any surgery there is always a possibility of complications. These include bleeding, infections and anesthetic 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.

The following pictures illustrate the reconstructive procedure

You will receive a general anesthetic. 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 is 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 theater thus it is important that the patient bring an appropriate sports bra to theater. (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 tables will be given to take home. The drains will be removed once it drains 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 compilations i.e. around the breast……

Loss of Nipple and skin

Haematoma formation

Seroma formation

Delayed wound healing

Wound sepsis

Wound breakdown

Sensory changes in the breast

Pain

Systemic complication…. 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 muscles spasms and nerve injury

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

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011 482 2196
dr.mventer@gmail.com