It is sad that the incidences of breast cancers in Singapore as well as in many developing countries are on the rise. So much so that it has become the highest overall female cancers in Singapore with about 1,600 new cases each year.
In the past, breast was deemed as the functional organ nurturing the babies but now this perception has changed globally. It has an added component – it is treasured as a personal asset adding beauty to the women. Therefore any deformity and certainly loss of the breast due to disease or cancers would have deep and traumatic effects on the afflicted women. Some would feel permanently maimed while others may become suicidal.
The comforting solution is that now there are many restorative surgical procedures to help to minimise the body loss.
In the past, the options for restorative surgeries were not readily offered due to lack of good and acceptable surgical techniques. But now with advances in restorative surgeries, these are becoming increasingly acceptable. Thus, the women patients can have many options to consider.
Pure prosthetic replacement This procedure is best for those who have early localised cancers with just a lumpectomy to remove the tumours adequately. An appropriately sized prosthesis will help to restore the defects left. Sometimes for the bigger excisions it may be useful to have a tissue expansion prior to the final placement of the breast prosthesis. The latest available prosthesis is the anatomical cohesive gel prosthesis which does not leak will maintain its shape.
Another method is Prosthesis combined with a muscle and skin flap to provide better and more natural coverage. This is essential for those with the nipple and surrounding skin removed because of the spread of the cancers and removal of the lymph nodes. A Latissimus dorsi flap is the most used flap. The disadvantages are the scars in the back, slight weakness and a slight contour defect in the areas where the flap is taken from.
For those who would like a reconstruction with their own tissues completely, we can use the muscles with skin and soft tissues from the tummy to be brought up to the chest to build up the breast mound. This is called the TRAM flap. This is good for those with excess tummy tissues and skin. The tummy wall would also be tightened. However there may be a slight incidence of abdominal hernia. This can be minimised by the use of nylon mesh graft to strengthen the abdominal wall. Those prone to scar can develop them.
Use of free flaps from the buttock or tummy – this involves a complex microsurgical procedures lasting for long hours. The greatest risk is a flap failure with a complete loss of the tissues used.
Reconstruction of the nipple areolar complex
This can be done preferably after the reconstructed breast had settled down so that the level of the nipple can be well positioned and aligned. Autologous fat graft transfer can be used to improve the quality of the radiated skin due to the late stages of the cancers or when it has spread to the regional axillary lymph nodes.
It is always traumatic to lose a body part but more so for a lady to part with a diseased breast, which is her great personal asset. The comforting solution is that now there are many restorative surgical procedures to help to minimise the body loss.
However it must be stressed that no matter how perfect are the surgical alternatives, they will never be able to match what God had created in the women.