Prevention
Modern medicine is increasingly transitioning towards preventive care. This shift towards prevention has also been observed in breast cancer care in recent years, particularly with the discovery of the BRCA gene. Subsequently, multiple genes and risk factors have been identified. Depending on these factors, a personalized screening strategy can be chosen. Therefore, it is crucial to understand these genetic and risk factors.
Diagnosis
I was diagnosed with cancer ... This website serves as a portal designed to assist you and your loved ones in accessing personal information and finding solutions to your concerns.
The primary goal of this website is to offer guidance and support to patients as they navigate their journey toward recovery and improved quality of life. The "Diagnosis" section of our website is divided into two main categories. Firstly, under "Anatomy and Physiology," we provide fundamental knowledge about the breast. Secondly, in the "Tumors and Disorders" section, we delve deeper into various breast-related conditions.
Moreover, we aim to provide information to women who may be concerned about potential breast issues but are hesitant to seek immediate medical advice. Knowledge and information can often offer immediate reassurance if a woman is able to identify the issue herself and determine that no specific treatment is necessary. Conversely, we also strive to educate women who have received a diagnosis of a serious breast condition, such as breast cancer, and wish to approach their doctor well-informed and prepared.
Treatment
The treatment for breast cancer should immediately include a discussion about reconstruction. Our foundation has no greater goal than to raise awareness of this among patients and oncological surgeons. By making an informed decision beforehand, we avoid closing off options for later reconstruction while still considering the oncological aspect. Of course, survival is paramount, and the decision of the oncologic surgeon will always take precedence.
The "Reconstruction or not?" page contains all the information you can expect during an initial consultation before undergoing tumor removal. This page is comprehensive, and your plastic surgeon will only provide information relevant to your situation.
"Removing the tumor" details the surgical procedure itself. This is the most crucial operation because effective tumor removal remains paramount. We guide you through the various methods of removal, a decision often made by a multidisciplinary team comprising oncologists, radiologists, pathologists, radiotherapists, breast nurses, gynecologists, oncological surgeons, and plastic surgeons.
The "Breast Reconstruction" section includes information and illustrations of the different reconstruction options along with corresponding steps.
Revalidation
Those treated for cancer often need a long period to recover.
Cancer is a radical illness with a heavy treatment. Often, people have to deal with psychosocial and/or physical problems afterwards, such as stress, anxiety, extreme fatigue, painful joints, reduced fitness, lymphedema... This can have a major impact on general well-being.
There are rehabilitation programmes offered by most hospitals. We cover some of the major topics here.
Quality of life
Quality of life is a key factor in coping with breast cancer. Therefore, it is important to find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, physical exercise... Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping, as well as focusing on mental strength to allow the patient to move on with life. In this section we are addressing some topics that patients experience during and after treatment and we are providing information to address them.
Autologous - Lumbar
In 1999, Kato et al described a pedicled lumbar artery perforator (LAP) flap, used to reconstruct defects in the lumbosacral area. The lumbar artery perforator flap can also be harvested as a free flap but although the vessels are large, the pedicle is relatively short and almost always needs artery and vein grafts from the groin to overcome this deficiency.
The lumbar arteries arise posterolaterally from the descending abdominal aorta at the level of the upper four lumbar vertebral bodies. The perforators are located between the inferior margin of the twelfth rib and the iliac crest (Fig. 1).
Fig. 1: The vascular anatomy of the lumbar region, showing the lumbar artery (LA) and its perforators.
Lumbar artery perforator flaps are designed with their axis in a transverse or oblique direction from the midline posteriorly to the anterior superior iliac spine (fig. 2). The flap can be extended to beyond the midaxillary line.
Fig. 2: The skin island of the lumbar artery perforator flap.
The lumbar artery perforator flap consists of skin and subcutaneous fat, supplied by a pair of blood vessels. Like the abdominal and gluteal perforator flaps, the lumbar artery perforators are dissected from between the muscle fibres of the back, which remain intact and functional. The LAP flap can be transferred to the chest in a similar manner to the other autologous tissue flaps, although vessel grafts are almost always required. The LAP flap has an abundance of fat tissue that can be taken from the lower back and the upper border of buttock. This facilitates shaping of the new breast. Also the consistency of the fat is very similar to the breast.
Main disadvantage of this flap is the very short vascular pedicle that in all cases necessitates bridging by a vascular graft. This vascular graft is often taken from the groin area. This prolongs the operation by about an hour.
 |
 |
| Fig. 3a | Fig. 3b |
 |
 |
| Fig. 3c | Fig. 3d |
Fig. 3: Pre-operative (a, c) and post-operative pictures (b,d) of a delayed reconstruction of the left breast by a free Lumbar Artery Perforator (LAP) flap in a patient who already had undergone an abdominoplasty. Nipple reconstruction and tattoo have not been performed yet. The donor scar is low and can be easily hidden (d).
