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

Case study ( 13374 views as of May 22, 2024 )

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.


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 "

  • In the past, lung cancer was broadly categorized into two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These classifications were based on histological and microscopic characteristics of the cancer cells. However, advancements in research and technology have allowed us to delve deeper into the underlying biology of lung cancer, leading to a more refined understanding of the disease. Currently, lung cancer is classified into several subtypes based on specific molecular and genetic alterations found within the cancer cells. These alterations can be identified through various diagnostic tests, such as genetic sequencing and biomarker analysis. The identification of these specific alterations has enabled the development of targeted therapies that can selectively inhibit the cancer cells' growth and survival, leading to improved treatment outcomes. For example, in NSCLC, mutations in the epidermal growth factor receptor (EGFR) gene and rearrangements in the anaplastic lymphoma kinase (ALK) gene have been identified as important drivers of the disease. Targeted therapies, such as EGFR inhibitors and ALK inhibitors, have been developed to specifically target these genetic alterations, resulting in more effective treatment options with fewer side effects compared to traditional chemotherapy. In addition to targeted therapies, immunotherapy has also emerged as a promising approach for treating lung cancer. Immune checkpoint inhibitors, such as drugs targeting programmed cell death protein 1 (PD-1) or its ligand PD-L1, have shown significant benefits in a subset of patients by enhancing the immune system's ability to recognize and attack cancer cells. Overall, the improved understanding of the molecular drivers of lung cancer has paved the way for personalized medicine approaches, where treatment can be tailored to the specific characteristics of an individual's cancer. This progress has significantly impacted the field of lung cancer research and has the potential to improve patient outcomes in the future.
  • The main reasons individuals seek brachioplasty are significant weight loss and loose, sagging skin due to factors such as aging or genetics. The excess skin on the inner aspect of the arms, often described as a "batwing deformity," can be bothersome both aesthetically and functionally. It may cause self-consciousness and make it difficult to find properly fitting clothing. Before undergoing brachioplasty, it is important for patients to have reached a stable weight. Significant weight fluctuations after the surgery can affect the results and may necessitate additional procedures or revisions. It is advisable to consult with a qualified plastic surgeon who can assess your individual case, discuss your goals, and determine your suitability for the procedure. During the consultation, the surgeon will evaluate your medical history, assess the quality and elasticity of your skin, and discuss the potential risks and benefits of the surgery. They will also provide you with pre-operative instructions and information about the recovery process. Like any surgical procedure, brachioplasty carries risks, including infection, bleeding, scarring, changes in sensation, and asymmetry. It's important to have realistic expectations and understand that the procedure can leave a permanent scar, typically located on the inner side of the arm. However, the scar is usually well-concealed and fades over time. Recovery from brachioplasty may involve wearing compression garments, limiting arm movement, and following post-operative care instructions provided by your surgeon. It's essential to attend follow-up appointments to monitor healing progress and address any concerns during the recovery period. Overall, brachioplasty can be a beneficial procedure for individuals seeking to improve the appearance and contour of their upper arms. However, it is crucial to consult with a qualified and experienced plastic surgeon to determine if it is the right option for you and to ensure you have realistic expectations about the results and recovery process.
  • Breast cancer treatment often involves surgical intervention, and various surgical options are available depending on the individual's condition. These procedures may include a partial mastectomy (also known as a lumpectomy) or a total mastectomy. It is important for patients to know that they have the opportunity to undergo breast reconstruction after such surgeries, either on the same day or in a delayed fashion after the cancer has been treated. If a patient wishes to explore breast reconstruction options, they will be referred to a plastic surgeon specializing in breast reconstruction by their general surgeon or family doctor. During the consultation with the plastic surgeon, the patient will learn about the different techniques and approaches available. There are generally two main types of breast reconstruction: autologous reconstruction and implant reconstruction. Autologous reconstruction involves using a portion of the patient's own body tissue to reconstruct the breast. This method provides a more natural feel and eliminates the need for an implant. If the reconstruction is performed on the same day as the mastectomy, the patient will wake up with a newly reconstructed breast, excluding the nipple. Implant reconstruction can be done either as a direct-to-implant procedure on the day of the mastectomy or as a two-stage technique involving a temporary implant followed by a permanent one. The choice of reconstruction technique depends on various factors, including the patient's age, the size of the breast requiring reconstruction, and any adjuvant therapies such as chemotherapy or radiation therapy. These factors may influence the type of reconstruction that can be offered. It is crucial for patients to have an opportunity to discuss their options with the plastic surgeon. They should request a referral from their general surgeon or family physician to seek the necessary information and guidance regarding breast reconstruction. Please note that the content provided is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. It is always recommended to consult with a qualified healthcare professional for personalized guidance and care.
  • Breast cancer is indeed a common form of cancer among women, and while it is less common in men, it can still occur. The statistics you mentioned are generally accurate, stating that approximately one in eight women will develop breast cancer in their lifetime, and about one in six of those cases will be invasive breast cancer. Prevention of breast cancer involves various factors, including lifestyle choices. Women can take steps to improve their diet, engage in regular exercise, limit alcohol consumption to seven to nine drinks per week, and maintain a healthy weight. These lifestyle changes can contribute to reducing the risk of breast cancer. Additionally, there are certain factors that women may not be aware of but can help in preventing breast cancer. For instance, having a later onset of menstrual cycles or entering menopause earlier can be protective. Having multiple children at an early age and breastfeeding them can also have a preventive effect. Breast self-exams are still recommended, despite some controversy surrounding their effectiveness. Women should perform breast self-exams once a month to familiarize themselves with the normal look and feel of their breasts. It enables them to detect any changes or abnormalities and promptly consult their physician for further evaluation. It is essential for women to have regular check-ups with their physicians, including a yearly breast exam. Starting at the age of 40, annual mammograms are recommended to screen for breast cancer. It is worth noting that while some women believe mammograms are required every two years, the current recommendation is to have them yearly. This frequency helps in detecting breast cancer at its earliest stages, increasing the chances of successful treatment. However, if a woman has a close family member who developed breast cancer at a young age, it is necessary to start having mammograms earlier. The recommended guideline is to begin mammograms ten years earlier than the age at which the family member was diagnosed with breast cancer. If anyone has questions regarding the screening processes or breast self-exams, it is crucial to consult their physician. Medical professionals can provide guidance, address concerns, and recommend appropriate measures based on individual risk factors and medical history.
  • Do they use breast implants in reconstruction surgery ? Or do they use tissue ?
    • @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.
  • Would the newer surgery options leave less scarring than older methods ?
  • 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.
    • 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.
  • 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 ?
    • 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
  • Men should also have this checked, as men can also get breast cancer.
    • Such an important thing to remember. Men also have to be aware of changes to breast tissue
  • 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.
    • 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.
    • 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
  • It was my understanding that family history of breast cancer is just as important as whether the patient carries the BRCA1 gene
    • 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.
  • I think it is wonderful that breast reconstruction can occur during the mastectomy procedure and that another separate surgery is not required.
    • 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.
    • @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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