The modern alchemy of breast reconstruction
Reconstructive Solutions Breast cancer patients now have high expectations of reconstruction, so surgeons need expertise in both reconstructive and cosmetic techniques.
Breast reconstruction is now integral to breast cancer care and an outdated, 'one technique for all' approach no longer suffices.
So says Paul Harris, Consultant Plastic Surgeon at The Royal Marsden NHS Trust and Vice President of the British Association of Aesthetic Plastic Surgeons (BAAPS).
“Patients want a result that looks and feels natural, not just something to fill the bra,” he says, “so surgeons must be fully trained in all aspects of reconstructive and aesthetic breast surgery.”
Multiple techniques are now used to create a bespoke solution for each patient. “The older patient who has had radiotherapy and chemotherapy and a flat chest wall for a few years needs a different combination of techniques to the younger woman having a double mastectomy because she has a genetic predisposition to breast cancer,” says Harris.
Reconstructions are no longer limited to implants, but can also use dermal matrices - sheets of deeper layers of animal skin, processed to remove the skin cells, leaving only the collagen.
“Matrices have made implant surgery a one-stage procedure,” says Harris. “In the past, implants could not fill out the whole breast, so a tissue expander was used before the more permanent implant was inserted during a second operation. Now, the muscle of the chest wall is used to cover the upper part of the implant, while the matrix covers the lower part, so one operation gives a full breast.”
Minor adjustments can be made using another new technique: lipofilling. This involves removing fat tissue from the patient's thighs, belly, or buttocks by liposuction and injecting it into the breast area.
“This mix of implants, dermal matrices and lipofilling is becoming standard in the NHS and the NHS is supporting surgeons to learn techniques from the cosmetic sector to achieve better outcomes,” Harris says.
Patients may also have subsequent surgery to adjust the remaining natural breast to achieve symmetry – another mix of cosmetic and medical procedures, available in the NHS.
In the future?
Harris says: “Soon we expect the introduction of lighter implants and greater understanding of why they sometimes fail. Longer term, gene therapy may be used to protect the reconstructed breast from the damaging effects of radiotherapy.”