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.
Revisional surgery following breast reduction
Nipple-areola complex (NAC)
Circulatory disorders affecting the nipple and areola are rare but may cause a significant deformity in this area of the breast.
Blistering and crusting of the areola occurs if the lack of blood supply is temporarily reduced. The wound usually heals spontaneously but tends to leave an area of scar tissue which contains less pigment.
Once the scar has fully matured and if the basic structure of the nipple and areola has been preserved, this area can be tattooed, to restore the natural appearance of the areola.
If the blood supply is severely impaired, the nipple and areola may necrose. In this instance, the cosmetic deformity is much worse. The necrotic skin has to be excised and the healthy wound closed with stitches.
Once the scar has matured, nipple reconstruction can be performed
Breast tissue
This complication is extremely rare but has serious consequences.
Patients with a pre-existing vascular disorder and those in whom the wrong surgical technique is employed are at significant risk. A portion of their breast tissue may die and become infected following surgery. This can lead to abscess formation or a cutaneous fistula.
If large areas of the breast are involved, a significant loss of volume and extensive scarring may result.
In smaller areas, fat necrosis can occur. An area of breast tissue is transformed into a hardened mass, consisting of oil mixed with small cysts.
On palpation, an area of fat necrosis feels similar to a malignant lesion, although fat necrosis is an entirely benign process. However, it may cause confusion during mammography.
The treatment of fat necrosis varies. Small areas can be monitored but large areas may have to be surgically excised, if the wounds break down or tissue becomes infected.
Ideally, it is useful to wait, possibly for several months, to determine which areas of the breast tissue will recover.
If large areas are excised, it may be necessary to consider autologous breast reconstruction.
Scarring
Scars positioned on the lower part of the breast usually heal very well. The length of the scar tends to be proportional to the amount of breast tissue removed; the larger the breast reduction, the longer the scars.
Hypertrophic scarring occurs when excess scar tissue forms. The scar typically becomes red, raised, firmer and wider. This can be distressing for patients but is often genetically determined.
Hypertrophic scars are initially treated by regular massage and the application of pressure. This can be combined with a series of intralesional cortisone injections. In severe cases of hypertrophic scarring, surgical excision followed by local irradiation may be necessary.
Excess skin can sometimes gather at the lower aspect of the vertical scar or at both ends of the horizontal scar. This is known as a ‘dog ear’. These can be surgically excised if they are very prominent or if a patient finds them uncomfortable or unsightly.
Finally, all scars may stretch and become wider, warranting surgical revision to improve their appearance.
Assymetry
As with all breast operations, a small amount of residual asymmetry is inevitable, as no two breasts are entirely identical.
Any asymmetry may be related to the breast volume or shape. If there is a volume difference, this can be corrected by reducing the larger breast or by augmenting the smaller breast. The breast shape can be improved by resecting limited amounts of skin or by moving the position of the nipple/ areolar complex.
If the nipple/ areola complex ends up being positioned too high or too low on the breast mound, it reflects poor pre-operative planning. An areola that is too low can easily be corrected, using the same scars that were used for the breast reduction. However, an areola that has been placed too high is a much more difficult problem to correct. Lowering the areolar can leave significant scars that are visible when wearing a bikini or low cut top.
Nipple retraction
Nipple retraction may also occur following breast reduction surgery. The scar tissue that forms underneath the nipple/ areola complex can cause the nipple to be pulled inwards. This usually occurs due to the influence of gravity on the healed glandular tissue. Nipple retraction is however, surgically correctable.
Volume shape
Massive weight loss patients tend to lose a significant amount of glandular tissue, however, the surrounding skin does not change. As a result, the breasts tend to sag and lose projection.
A patient may opt to have the breast volume increased and this can be achieved using standard augmentation techniques. Alternatively, a breast lift may be performed to improve the breast shape.
Conversely, patients with significant weight gain tend to increase their breast volume. These patients may opt for a secondary breast reduction, which can be performed through their previous scars.
It is important that patients who are prone to weight fluctuations achieve a stable weight, which should be maintained for at least one year, before undergoing further breast reduction surgery.
As a result of the natural ageing process, the breast envelope can lose elasticity and firmness. It is especially common in the lower part of the breast, which is the area most effected by gravity. This results in an unattractive shape, where the areola remains in place, but the glandular breast tissue descends towards the lower pole of the breast. This deformity is particularly common after a vertical scar breast reduction.
It occurs because insufficient skin was removed from the lower pole of the breast at the first operation. In order to correct this, the glandular breast tissue needs to be reshaped and positioned higher. This can be done through the existing scars but often, it is also often necessary to excise skin at the lower poles, both horizontally and vertically.
Fig. 1a | Fig. 1b |
Figure 1: Pre-operative picture (a) of a breast reduction patient, in whom the nipple-areolar complexes were positioned too high on the breasts. Post-operative picture (b) demonstrating corrected nipple heights. The scars above the areolas are inevitable.