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.
DIEAP - Introduction
Since the evolution of plastic surgery, the lower abdomen has been an abundant and reliable source of well vascularised material. Originally, pedicled and tubed flaps were used to transfer this tissue to distant sites. The lower abdominal skin and fat was then discovered to be the ideal material for breast reconstruction and the transverse rectus abdominis musculo-cutaneous (TRAM) flap was introduced. The pedicled TRAM was subsequently replaced by the free TRAM because this offers better tissue perfusion from the dominant deep inferior epigastric system.
In the mid-1980’s, it became apparent that a single large peri-umbilical perforating vessel (fig.1) originating from the deep inferior epigastric artery was adequate for complete flap perfusion. This was confirmed in 1989 when Isao Koshima (Tokyo) first published two cases of “deep inferior epigastric skin flaps without rectus abdominis muscle”. Robert Allen (New Orleans, U.S.A.) and Phillip Blondeel (Gent, Belgium) then expanded the use of the deep inferior epigastric artery perforator (DIEAP) flap for breast reconstruction and technically refined the procedure. The DIEAP flap quickly gained popularity as it produced comparable results to the TRAM flap but without the added morbidity of rectus abdominis muscle sacrifice.
Fig. 1: Schematic representation of perforator vessels traversing muscle to reach the overlying fat and skin.
The lower abdomen is supplied by both the deep and superficial inferior epigastric arteries and surgeons then transferred the same anatomical unit based on the superficial inferior epigastric artery (fig. 2). James Grotting (Birmingham, U.S.A.) in 1991 was the first to use the superficial inferior epigastric artery (SIEA) flap for breast reconstruction. The SIEA flap has even less donor site morbidity than the DIEAP flap, as the fascia overlying the rectus abdominis muscle is not breached.
Fig. 2: Vascular anatomy of the trunk: DIEA: Deep Inferior Epigastric Artery; SIEA: Superficial Inferior Epigastric Artery; SEA: Superior Epigastric Artery; IMA: Internal Mammary Artery (recipient vessels for free flap surgery).
In this era of rapidly evolving scientific discovery, these perforator flaps represent the current gold standard in soft tissue reconstruction. They offer the best potential results to patients with the least donor site morbidity. In our opinion, the DIEAP and SIEA flaps should therefore be the first reconstructive options considered for breast reconstruction in appropriately selected patients.
