Beautiful After Breast Cancer Foundation


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.


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.


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.


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 - Surgical Technique

The DIEAP and SIEA flaps consist of skin and fat from the lower abdomen. In contrast to the TRAM flap, no fascia or muscle is sacrificed when these flaps are harvested. As a result, there is no functional loss or weakening of the anterior abdominal wall.

During DIEAP flap dissection, the rectus abdominis muscle is opened along the line of its fibres (fig. 1). The perforating vessels which pierce the muscle to supply the overlying skin are then freed from their surrounding connective tissue (fig. 2). The rectus abdominis muscle is therefore kept intact and its blood supply, nerve supply, function and strength are all preserved.


Fig. 1a Fig. 1b Fig. 1c

Figure 1: Schematic representation of a DIEAP flap (a, b) and the resulting scar on the lower abdomen (c). 

Fig. 2: Splitting the rectus abdominis muscle in the line of its fibers exposes the underlying vessels and nerves.

The deep inferior epigastric vessels are then divided in the groin. This temporarily stops the blood supply to the flap but the tissue can survive like this for 6 hours. The flap is then transferred to the chest wall and positioned over the mastectomy defect. An artery and vein have simultaneously been prepared next to the sternum at the level of the 3rd or 4th rib. These are the internal mammary or internal thoracic vessels (fig. 3), comparable to the deep inferior epigastric vessels, with dimensions of between 1 and 3 mm. Both sets of arteries and veins are then sutured together using an operating microscope. Once connected, blood flow is restored and the flap quickly recovers.

Fig. 3: Possible vessels that serve as recipient blood vessels to connect the flap to.

The final step is to shape the abdominal tissue into an aesthetically pleasing three-dimensional breast, which matches the contralateral side. In a delayed breast reconstruction, there will still be a scar across the new breast, but below this there will be abdominal skin and subcutaneous fat (fig. 4 a-d). A further scar is present along the crease where this abdominal tissue meets the chest wall. In an immediate breast reconstruction, the scars will vary from a nipple-shaped circle to a larger oval, depending on the extent of surgery required to safely remove the tumour. In both forms of breast reconstruction, the abdominal scar lies above the pubic area, passing from hip-to-hip. There is also a scar around the umbilicus (belly button).

Fig. 4a Fig. 4b
Fig. 4c Fig. 4d

Figure 4: Schematic representation of secondary breast reconstruction with a DIEAP flap.

At the donor site, the fascia covering the rectus abdominis muscle is repaired. This closure is tension-free, as no fascia has been resected and synthetic mesh is never required. The remaining skin is then undermined up to the costal margin, the umbilicus brought out again, suction drains inserted and the abdomen closed in layers. Finally, skin adhesive (surgical glue) is applied to the incisions, providing an additional layer of support to the wounds and also acting as a waterproof dressing.

It is possible to restore sensation to the DIEAP flap, if the perforator selected is accompanied by a sensory nerve. This nerve is the anterior cutaneous branch of one of the mixed segmental nerves which supply the rectus abdominis muscle. The lateral cutaneous branch of the 4th intercostal nerve is the preferred recipient nerve, if it can be retrieved at the mastectomy site. When a connection is possible, there is improved sensory recovery in the new breast.

In contrast, the SIEA flap is more suitable when only a moderate amount of tissue is required for breast reconstruction. This is because the perfusion to the flap is less reliable than that in a DIEAP flap and seldom crosses the midline. Overweight patients can be good candidates for an SIEA flap because their superficial vascular system is often well developed and half of a large abdominal panniculus may be more than enough for unilateral breast reconstruction. Bilateral breast reconstruction is another ideal indication for the SIEA flap because it avoids any intramuscular dissection and finally, partial breast reconstruction where a limited volume of tissue is required to correct a secondary deformity following breast-conserving surgery.

Women undergoing DIEAP and SIEA perforator flap reconstruction usually return to their normal routine 6 weeks after surgery. This includes sport, hobbies and professional activities.




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