Options for reconstructive surgery

Nadine Wilson

Monday, October 15, 2012

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LOSING a breast to cancer is a big concern for women all over, but thanks to increasing options in reconstructive surgery, a woman does not have to suffer so much following a mastectomy.

"If you do a mastectomy only, you would have a straight line scar on the skin and no breast, so you have this psychological concern and loss of body image and also some degree of depression," said general surgeon Dr Michael McFarlane.

Breast reconstructive surgery can be done immediately after a mastectomy or it can be delayed. If done immediately, it usually requires both the general surgeon and the plastic surgeon working together at the same time to restore the woman's figure.

"Once you can do a method that helps to allow the woman to have normal contours and when it is well done, to allow the breast to look almost exactly as it did before, you get the best of both worlds. You get to treat the cancer as well as be able to restore confidence and self-esteem," Dr McFarlane noted.

Apart from the fact that immediate reconstruction would lessen a woman's feeling of loss, getting the surgery done immediately also cuts down on costs. This is because you would be doing just one general surgery instead of two separate procedures.

But while there are benefits to doing the reconstructive surgery immediately rather than delaying it, plastic surgeon Dr Rajeev Venugopal said not everyone qualifies for this surgery.

"If their cancer is very aggressive and requires additional treatment with radiation, maybe reconstruction will have to be delayed for a while," he explained.

"I generally tell them that you have to wait about six months until a year after finishing your chemo. It can take a toll on you and so it's best that you approach it carefully," he said.

If you are about to do a mastectomy or have already done one, don't despair. You can have a newly shaped breast with the use of a breast implant or your own tissue flap. Here are some of the options Dr Venugopal suggests:

1. TRAM flap (or transverse rectus abdominis muscle flap). This uses tissue from the tummy to shape the breast and give you a tummy tuck at the same time.

Con: Can be challenging if you've done certain types of abdominal surgeries in the past, such as a tummy tuck.

Also, if you are too heavy, your chance of having complications with the TRAM goes up and if you are a smoker, this also increases your risk.

2. Latissimus dorsi flap. This is a much smaller operation that utilises muscle and skin from the upper back to do the reconstructive surgery.

"Unless you have an A-cup or you are fixing a A-cup, you would need more than a latissimus, because it is a shorter operation," said Dr Venugopal.

3. Prosthetics (Implants). You can also use implants to restore the affected breast or to match it up with the other one.

Cons: They do not last a lifetime and so you are required to change them every 10 years. Also, they can cause infection and pain and can also shift.

Surgeons are becoming more creative and skilled at restoring hope to women who have to undergo mastectomies. Jamaica for the most part has been able to keep up to date with most of the trends, although not everything is widely practiced here.

"There is another flap where they transfer tissue from the buttocks, but it's a much longer operation and it takes more time to do, so we generally don't practice it that much here," said Dr Venugopal.




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