The Breast Reconstruction Procedure " Susan a 45-year-old mother of two children "

Case study ( 6401 views as of December 17, 2018 )

Susan, a  45-year-old mother of two children, presents to the office with a recent diagnosis of breast cancer. A mammographic abnormality was picked up on a screening mammogram and the patient underwent a core biopsy. She has been advised that she has multifocal disease involving the left breast and a mastectomy has been recommended.

Susan visits a plastic surgeon for discussion on breast reconstruction. She does not smoke or drink excessively and is not overweight. She has a strong family history for breast cancer in her mother, her mother’s sister, and her grandmother, all of whom succumbed to the disease.

This patient is an excellent candidate for consideration of breast reconstructive surgery. Because of her strongly positive family history, it will likely be recommended that she undergo a mastectomy on the cancer side for treatment purposes and undergo a prophylactic mastectomy on the non-cancer side, because of her high risk of breast disease developing on that side secondary to her family history.

Before a decision is made regarding the prophylactic mastectomy, there will be some discussion and consideration of genetic testing for the presence of the disease. If in fact Susan is deemed to be gene positive for breast cancer, then she will also require a gynecological workup for assessment of the need for oophorectomy, because of the increased risk of ovarian cancer in patients with the BRCA1 gene.

Susan was made aware of the types of breast reconstruction, which are broken up into autologous techniques. These techniques involve using the patient's own tissue, such as the latissimus dorsi muscle from the back or the tram flap from the abdomen, or the newer possibility of a microvascular free tissue transfer called a DIEP flap from the abdomen as well.

The implant-based reconstructions would include the use of a dermal matrix so that the breast mound could be fully reconstructed the day of the mastectomy, or a two-stage reconstruction with a tissue expander, depending on the location of previous scars, the size of the breast to be reconstructed, and the history of radiation. Susan will require a multidisciplinary team approach to include plastic surgery, oncology, general surgery, possibly gynecology, and radiation therapy.

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Conversation based on: The Breast Reconstruction Procedure " Susan a 45-year-old mother of two children "

The Breast Reconstruction Procedure " Susan a 45-year-old mother of two children "

  • Do they use breast implants in reconstruction surgery ? Or do they use tissue ?
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    • @K.Michael - I've read that breast reconstruction can be done using either implants, or using tissue from your body (tummy, thighs, etc). I think there are considerations in both types of procedures that will need to be thoroughly discuss with your plastic surgeon.
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  • Would the newer surgery options leave less scarring than older methods ?
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  • I feel this patient's multidisciplinary team should also include a psychologist. Not only has she just been faced with the news of having cancer, but she is undergoing major surgery and changes to her body. She must be feeling so many different emotions.
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    • That is a very good point. It mentions that there is a history of breast cancer in her family. Speaking to a psychologist or counselor over the course of her treatment would be beneficial for her overall mental health.
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  • Understanding that breast reconstruction surgery can be done at the same time as a mastectomy procedure, is it recommended to do this considering there can be risk of infection that may hamper the healing ? What steps can be taken to lower the risk of infection after surgery ?
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    • I know there are some standard steps they recommend - don't smoke, wash with an antibacterial soap for two days prior to surgery, advise them if you have come in contact with anyone that is ill. Also I don't think that reconstruction during mastectomy is possible for all women. Some women aren't candidates and have to wait for reconstruction
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  • Men should also have this checked, as men can also get breast cancer.
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    • Such an important thing to remember. Men also have to be aware of changes to breast tissue
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  • Having breast cancer in your family can be quite scary and anything that can help a person ease their worries is great. Genetic testing has come so far over the years and I wouldn't hesitate to do it.
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    • I absolutely agree. If I had breast cancer in my family I would be looking into genetic testing right away. I guess the thing you have to be prepared for is making a decision on what to do if you are BRCA1 positive.
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    • My grandmother died of breast cancer and my mother of lung. Two of my aunts also have had breast cancer. I was told that until one of the family members with breast cancer had the genetic testing done, there was no value in my having it done. They needed a "baseline" before my testing would really mean anything
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  • It was my understanding that family history of breast cancer is just as important as whether the patient carries the BRCA1 gene
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    • While the BRCA mutation is one of the most significant genetic risk factor for breast and ovarian cancer, there are also other famly-associated risk factors. Anyone with cancer histories in the family should discuss his/her concern in detail with a family physician and to follow up with the appropriate specialists.
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  • I think it is wonderful that breast reconstruction can occur during the mastectomy procedure and that another separate surgery is not required.
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    • I agree as well. But it is a very serious procedure, with risk of infection and higher pain. My aunt had a double mastectomy 5 yrs ago, and reconstruction at the same time. She was still undergoing treatment but infection at the site did hinder her treatment. And it was horribly painful for her. It is good to have an option, but something people should consider very carefully.
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    • @dbutchar - I agree wholeheartedly. No longer do women have to wait until their cancer treatment is over to get reconstructive surgery
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