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.
The future of Breast Reconstruction
Plastic surgeons are uniquely equipped to deal with the complex reconstruction of the breast. Based on the defining principle of replacing ‘like with like’ perforator flaps represent the current ‘gold standard’ of reconstructive options.
The essential component of perforator flap surgery is an intimate understanding of the blood supply of tissues and a customized approach to their transfer, offering the best functional and aesthetic outcome to our patients with the least donor site morbidity.
Since the early 1990’s, perforator flap surgery has blossomed and the number of citations in the world’s scientific literature has increased exponentially. This is due to the high success and patient satisfaction that this technique delivers.
Over the next decade further application will undoubtedly improve our understanding of potential flap designs, indications, contraindications and potential results. With communication and careful clinical study, plastic surgeons will further refine perforator flap surgery in the field of breast reconstruction.
Unfortunately, significant controversy still exists surrounding the financial implications of providing perforator flap surgery for breast reconstruction patients. The learning curve is steep and novice surgeons may take more time to dissect these flaps than the more conventional musculocutaneous approach. This means heavier initial investment, both in real and financial terms, from insurance companies, hospitals, surgeons, and patients. In the current climate of health care cutbacks, it is not always easy to justify the long-term benefits to insurers, administrators or even colleagues. However, substantial evidence exists supporting the cost-effectiveness of perforator flaps for breast reconstruction and in our opinion, the long term clinical benefits for our patients are so important that this investment of time and money is absolutely essential.
The perforator flap concept is equally applicable to the transfer of whole units of tissue. As outlined in Ian Taylor’s angiosome theory, tissue including bone, muscle, tendons, fascia and nerves can be transferred on a single blood vessel. The extrapolation of this is that surgeons can harvest other tissues, in addition to skin and fat, to augment a reconstruction, where deficiencies exist. Attempts are being made to transfer large volumes of fat to the breast but without this source blood vessel and rich vascularized network in place, long term fat survival has so far been disappointing.
Recently, allotransplantation (the transfer of tissues from one human body to another) of the larynx, face, arm and hand, has been employed worldwide with excellent results. The main restriction in its adoption is the difficult problem of immunosuppression, as foreign tissue is always rejected by the body. If this can be overcome, we may soon be in a position to surgically transfer subunits of tissue including the ear, nose, thumb or even breast.
However, applying the principles of perforator flap surgery in future allotransplantation is probably just an intermediate step in the whole new area of “regenerative medicine”. Instead of transplanting tissues within the same body or from a different person, we may soon be able to generate tissues in a laboratory environment, both small and large or simple and complex. “On demand” tissue could possibly be grown depending on the exact type, size and composition of the defect. Harvesting of tissues will no longer be required, avoiding complex surgery and unsightly donor area scars. More importantly, no immunosuppressive drugs will be required.
That being said, a perfect knowledge of vascular anatomy and in particular, the perforator vessel network will be absolutely crucial to manufacture these tissue units. We strongly believe that the work of the perforator flap surgery pioneers and their clinical experience in autologous tissue transplantation will be the cornerstone of future vascular constructions and modern complex tissue engineering.
It is difficult to say exactly how far we are away from this dramatic revolution in tissue replacement but once we are able to build a three-dimensional vascular structure comparable to the subcutaneous perforator vessels, the gateway will be open to the creation of autologous, tissue engineered, complex and implantable 3-dimensional composite tissues, announcing the arrival of a whole new era of tissue transplantation.