Breast Reconstruction Advances Repair Lumpectomy Distortions

A new report examines advances plastic surgeons have made in repairing the damage left when cancer is removed by performing lumpectomy (breast conservation surgery).

Researchers at Harvard Medical School (Boston, MA, USA) compiled a report that examines several techniques for breast reconstruction, suggested options for women who require a full mastectomy and for younger women who opt for preventative mastectomy due to a strong family history of breast cancer. The procedures including nipple-sparing mastectomy, deep inferior epigastric perforator (DIEP) flaps, and acellular dermis graft slings. In nipple-sparing surgery, cancerous tissue and the duct system of the breast are removed, but a pocket of skin, the nipple, and areola are saved. Plastic surgeons then insert either an implant or the patient's own tissue into the pocket to recreate the breast. The result looks very similar to the patient's original breast because the original nipple and areola are used. The procedure is somewhat controversial, but if the origin of the tumor is away from the nipple and areola, it is considered safe, according to the report.

DIEP flap surgery involves using skin and fat from the lower abdomen to recreate the breast. For patients undergoing a mastectomy, DIEP flap surgery may allow them to resume normal activities better, since they have not loss muscle function in their abdomen. Finally, the use of acellular dermis (connective tissue layer of the skin) derived from cadaver tissue allows plastic surgeons to create a new breast pocket, in patients undergoing a mastectomy, without using a tissue expander. An implant may then be inserted, creating an aesthetically pleasing breast. The report was published in the April 2008 issue of Plastic and Reconstructive Surgery.

"Although breast conversation therapies are a huge advance in the treatment of breast cancer, women are still concerned about how their breast will look after surgery,” said co-author of the report Sumner Slavin, M.D., of the division of plastic surgery. "Breast conservation surgery or lumpectomy can mean many things; a biopsy, partial mastectomy, wedge resection, or having a quarter of the breast taken. Women are often left with portions of their breasts removed and there are currently no implants that can address this unique cosmetic issue.”

"Many women don't know the full scope of their reconstructive options or are intimidated to ask,” added Dr. Slavin. "For breast cancer patients, even though they are living through the anguish of cancer, there are reconstructive procedures that will improve their quality of life and reduce the negative long-term impact of the disease and its treatment.”

Lumpectomy is the most common type of breast cancer surgery currently performed. A benefit of the surgery is that only part of the breast is removed, but a drawback can be the resulting physical appearance of the breast, which may be disfigured, dented, or uneven.


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