Breast cancer affects one out of eight women over their life time in the US. All current treatment strategies have a surgical component, which ranges from a lumpectomy to a modified radical mastectomy. As a consequence, different degrees of deformity arise, from mild asymmetry to complete absence of both breasts. The physical deformity has a psychosocial correlate. It may encompass the emotional trauma of mutilation, diminished self image of femininity, decreased self confidence, depression and fear of loss of sexual attractivity, amongst others.
Modern breast reconstruction aims at the best possible aesthetic and psychological rehabilitation of the patient. Wearing an external prosthesis can be avoided, a feminine appearance is restored and the patient is not restricted in her choice of wardrobe.
The majority of scientific studies show a high degree of patient satisfaction with respect to social, sexual and psychological function.
There is currently no evidence that any method of breast reconstruction adversely affects adjuvant treatment, tumor recurrence or mortality.
All methods of breast reconstruction are successful if correctly employed. There is a trend towards better aesthetic outcomes with autologous breast reconstruction using the patient’s own tissues. At Trinidad Institute of Plastic Surgery our preferred approach is the transverse rectus abdominis (TRAM) flap using the tissue in the lower abdomen, which is normally discarded during an abdominoplasty (tummy tuck). Its many modifications make it a versatile option for most breast reconstructions. We do employ it as a microsurgically transplanted flap and in its muscle sparing and perforator based variation (DIEP) flap should the circumstances make this the preferred option.
Breast reconstruction is part of an integrated approach. Close coordination with the oncologic surgeon, radiotherapist and oncologist is essential.
While breast reconstruction is an almost uniformly successful undertaking, substantial committment by the patient is required, particularly if complex autologous methods of reconstruction are desired.