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Types of Cancer > Breast Cancer > Invasive Breast Cancer
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| Reconstructive Breast Surgery and Reconstruction Followed by Radiation |
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Many women who undergo surgical breast cancer treatment will often opt to have reconstructive breast surgery done in order to retain their pre-surgery appearance. A woman can choose to have saline implants inserted into the affected breast or she can opt for an autogenous tissue reconstruction, which uses the patient’s own tissue to reconstruct the breast.
Implants are made with a silicone insert that is filled with silicon gel, saline solution, or a combination of both. The reconstructive procedure involves inserting this synthetic implant into the breast, thereby recreating its structure and appearance. Sometimes a doctor will choose to stretch the breast prior to inserting the implant. This procedure involves using a silicon balloon to stretch and expand the tissue. It can take from a few weeks to a few months to complete this procedure.
Autogenous tissue reconstructions can be grouped into a number of different categories including TRAM flaps, latissimus dorsi flaps and gluteal free flaps, with the TRAM flap being the most common. A TRAM flap reconstruction involves taking an oval-shaped section of skin, fat and muscle from the lower abdominal region and using the tissue to reconstruct the breast. This type of reconstructive surgery provides women with a very natural-looking breast.
A latissimus dorsi flap involves taking the latissimus dorsi muscle, skin and fat from the back and maneuvering it to the front to recreate the breast. This procedure is not as common as the TRAM flap as it cannot be used to reconstruct larger breasts and it causes some disfigurement of the back. If there is not enough tissue present in the abdomen or the back to perform a TRAM or latissimus dorsi flap, a gluteal free flap may be performed. This procedure takes skin, fat and muscle from the buttocks and uses it to reconstruct the breast.
After breast reconstruction surgery is performed, some women may choose to undergo a second operation to make both breasts match more closely in appearance. The procedure can involve making the other breast smaller or larger, lifting the breast, or tattooing and constructing a nipple onto the breast.
Often, women who are having breast cancer surgery will also undergo radiation therapy. Whether or not a woman undergoes radiation therapy can have an impact on when her reconstructive surgery should begin and what type of reconstructive surgery is going to be chosen. This is because radiation therapy can influence the cosmetic outcome of the reconstructive surgery.
If a woman is going to have breast reconstruction done immediately following her breast cancer surgery and radiation therapy is to be given after the reconstructive surgery, a TRAM flap reconstruction will often offer the best cosmetic results. It is important to note, however, that women who wait to have a TRAM flap performed until after radiation therapy will enjoy better cosmetic results in the long-term, although they may have to wait up to a year to receive the reconstructive surgery if they do not have the reconstructive surgery done at the time of the breast cancer surgery.
If a patient will be undergoing reconstructive therapy using an implant, it is usually thought that surgery should be performed before radiation therapy. This is due to the fact that patients who have undergone radiation therapy do not respond well to the tissue expansion treatments that are sometimes necessary for this type of surgery.
Which reconstructive surgery is best for a certain individual and when to have the surgery done is a very important and very personal decision. The type of surgery that is right for any given patient will depend on their medical situation and their personal feelings.
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| Author: | Robert Dale, Certified Medical Writer |
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| Reviewer: | Jiade Jay Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology) |
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| Publish Date: October 27, 2004 |
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