Case study ( 6603 views as of February 16, 2019 )
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.Author: Dr. Nancy Van Laeken