Reconstructing the breasts after surgery (Part 1)

In our continued observance of Breast Cancer Awareness Month, All Woman presents a two-part series on breast reconstructive therapy. Part 1 looks at the options available, and Part 2, which will be carried in next week’s edition, will look at how the various procedures are executed. We will also feature the testimony of one patient who has had her breasts reconfigured following lumpectumy.

While the incidence of breast cancer is worryingly on the increase here in Jamaica and abroad, there is optimism on many fronts. The most encouraging sign according to Dr Guyan Arscott, plastic surgeon and breast reconstruction specialist, the dreaded disease is being picked up much earlier than before and many lives are being saved.

Currently 70 per cent of breast cancer patients are being diagnosed at stages 1 and 2 compared to before, and this is very good news. In addition to saving lives, early detection lends itself to a range of reconstructive therapies, allowing patients to lead a normal life following surgery,” Dr Arscott revealed in an interview with All Woman.

In the middle of what appears to be a busy afternoon session at his Seymour Park practice, the doctor put his patients on hold as he outlined with great care the intimate and complex procedures of the breast conservation and reconstructive therapies available to persons facing the prospect of losing their breasts to cancer .

As explained by Dr Arscott, breast conservation is simply saving the breast while treating cancer, and breast reconstructive therapy is the actual reconstruction of the breast mound which may be done artificially by silicone or saline implants, or naturally by using tissues from other parts of the body.

“Not all women with breast cancer will be keen on breast reconstruction. Roughly 30% of women diagnosed find the disease so overwhelming that all they want to get on with the treatment, and nothing else matters.

“Another 30 per cent are concerned with their body image as well, and are therefore scared to be losing one or both of their breasts, while another 30 per cent with the disease are ambivalent.

“Those who are particularly keen on reconstructing their breasts are those most concerned about their body image,” said Arscott who believes that every woman with the disease should be afforded the opportunity to reconstruct her breasts if she so desires.

However, before the decision is taken to conserve or reconstruct the breast, the patient must be properly guided and so team work is crucial.

The management team which consists of a general surgeon, an oncologist (responsible for chemotherapy and radiation treatments), the plastic surgeon who will do the reconstructive and cosmetic work and the ancillary (support) groups such as Reach to Recovery and the Cancer Society, will work closely with the patients to determine which options are best exercised.

How the disease is treated will largely determine the patient’s options for reconstruction.

“Most persons in the early stages will require a simple lumpectomy followed by chemotheraphy and or radiation. For some, a segmentectomy or partial mastectomy is done. If the patient has small breasts and the cancer has invaded a large section, then a simple mastectomy or a partial modified mastectomy would be performed. The difference here is that with the latter, the chest wall muscle and lymph nodes will be left intact, making it easier for the plastic surgeon to reconstruct the breast mounds.

“After a lumpectomy or partial mastectomy, the breasts may be deformed, especially if the cancer was concentrated in the nipple area. This can be very obvious, especially for persons with large breasts,” Dr Arscot outlined.

Most recently, he added, doctors both here and abroad have been practicing what is called a skin-sparing mastectomy where the entire breasts is removed, leaving the skin envelop intact. This can also be done, he said with the nipples left in place. There is also the option of taking off the nipples and banking them in the groin or thigh for future reconstruction.

-To be continued next week