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Q&A: Breast reconstruction after mastectomy

For the Monitor
Published: 5/7/2021 2:13:01 PM

A breast cancer diagnosis is becoming all too common among American women, with many requiring mastectomy, or removal of the breast(s). However, breast cancer surgery has improved greatly over time and women now have the opportunity to have their breasts reconstructed afterwards.

Dr. Emese Kalnoki-Kis of Concord Plastic Surgery discusses the history of breast cancer and treatments as well as recent improvements to procedures and the advancement of reconstruction.

How has surgical breast cancer treatment improved over time?

The earliest mention of breast cancer was discovered in an ancient Egyptian text known as the Edwin Smith papyrus, which is dated from around 2600 BCE. After a medical description of the case, it solemnly mentions that there is no treatment. Thousands of years later, radical mastectomy appeared. Though life-saving, it could be gruesome, leaving patients both disfigured and debilitated.

Ultimately, in modern times, two things came about that repaved the way toward conquering breast cancer and led to the development of reconstruction; anesthesia and questioning the need for “radical” mastectomy.

Anesthesia allowed for longer surgical procedures without patients feeling pain. Questioning led to the discovery that the breast is actually comprised of different organs and if you separate out the different organs, such as the skin and the actual breast material, and you remove only the diseased organs, the procedure is less disfiguring and debilitating. It also leaves enough material to have a chance at reconstruction.

How has breast reconstruction evolved?

Vincent Czerny performed the very first autogenous (using tissue from the patient’s own body) breast reconstruction on an opera singer in 1895. Techniques have since progressed dramatically as surgeons continuously searched for new and better ways to reconstruct the breast after mastectomy.

In the 1970s, Stephen Mathes and Foad Nahai published the Clinical Atlas of Muscle and Musculocutaneous Flaps. Their discovery that we have basically five different types of muscle helped advance understanding of where surgeons could borrow tissue for these reconstructions. New and better procedures emerged, such as the DIEP (deep inferior epigastric perforator artery), the GAP (gluteal artery perforator), the PAP (profunda artery perforator), and the TUG (transverse upper gracilis) flaps. These surgeries, however, had shortcomings including the possibility of failure if the transplanted tissue did not fully profuse, or fat necrosis occurred; long surgical times; and extensive recovery periods.

Currently, patients have a variety of options, including flap procedures, but also breast implants using sixth generation of breast implants that are now made of a silicone polymer that feels like a liquid but is actually considered a solid, as well as fat grafting (injecting a patient’s own fat to smooth out irregularities), and nipple tattoos.

What benefits does breast reconstruction provide?

Reconstruction after mastectomy is really medicine and surgery coming together to first stave off mortality, but then to stave off despair. There is a loss of a sense of wholeness when patients undergo breast cancer surgery and breast reconstruction is there to repair that. We oftentimes try to do the reconstruction during the same surgical time as the breast cancer procedure so patients do not have to wake up to a shockingly radical change in the way they look. Ultimately, we want our patients to look like they have had a breast augmentation or that they have had nothing done at all.

What does recovery look like after breast reconstruction?

Reconstruction is a process though, which can take several months and as many as two to three surgeries. However, patients usually go home and recover relatively quickly. They initially only stay overnight because of the mastectomy, not the reconstructive procedures themselves. We want them up and walking around, but no heavy lifting, pushing or pulling for four weeks after the surgery, though most are back to work in one to two weeks.

What does the future look like for breast reconstructive surgery?

The future is pretty bright. We are seeing more and more techniques for breast surgery that are less invasive, more skin-sparing and more nipple sparing. Radiation is also much less devastating to tissue. All this results in more to work with in terms of a reconstruction after mastectomy and breast cancer treatment. We have better implants offering a more natural feel and a longer lifespan. Additionally, synthetic fat is also another exciting future possibility for the reconstructive arsenal.

Dr. Emese Kalnoki-Kis of Concord Plastic Surgery is a board-certified physician in plastic surgery. Dr. Emese Kalnoki-Kis presented on breast reconstruction after mastectomy at the March Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Kalnoki-Kis’ presentation on Concord Hospital’s YouTube channel at youtube.com/concordhospital.

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