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.

Tuberous Breast Malformation

Description of the Problem

Tubular breast or tuberous breast is a more complex problem which has many variations. The lower part (one or both lower quadrants of the breast) of the breast does not fully form and appears constricted by tight overlying skin. The fold under the breast can be shifted upwards and the remaining tissue tilts downwards. The nipple and areola may also be stretched. If the dermis of the areola is thin, breast gland may herniate through the areola creating a prolaps of the nipple-areola complex.

In its mildest form, the breast may simply be slightly flattened in the lower half. Many forms exist, but it is useful to distinguish between those of normal volume (normovolemic type) and those with small breasts (hypoplastic type) where the gland is also underdeveloped.

The surgical options depend on how the shape and size need to be altered.


Normovolemic type	Hypoplastic type

Figure 1: Two different degrees of tubular breasts in the same patient. The right breast shows a moderate form with particular abnormality of the areola. The left breast is more hypoplastic with very limited developement of the lower quadrants. The left breast has a clear tube-like shape.

Goals of the Surgery

The more complex forms of tuberous breast should be addressed in one or more operations. The skin of the lower part must be released and stretched. The areola may need reduction and/or lifting. Sometimes a simple breast lift is all that is required.

Surgical Technique

Three major steps comprise the approach to the tuberous breast.

Expansion of the breast base: this may be achieved in one visit with a fixed volume implant or may require the use of an expander. If an expander is used, the breast can be gradually stretched into shape and then exchanged for a permanent implant some months later.
Filling of the lower half of the breast: After expansion, or if the patient already has enough skin, the lower pole volume can be addressed. This can either be done with an implant or, in some cases, by moving tissue from elsewhere in the breast into this position. This leaves a scar around the nipple and a short vertical scar on the lower part of the breast.
Repositioning of the nipple: The areola may also need to be reduced during this process.
In the majority of patients, all three steps can be achieved through an areola incision.

Figure 2: (above) Mild presentation of bilateral tubular breasts. (below) Final result after expansion, permanent implant and lipofilling.

Figure 3: (a) Severe bilateral tubular breast deformation. (below) Final result after conventional breast lift on the left breast and tissue expansion followed by lipofilling only in the right breast.

What to expect after the operation

Dressings vary depending on the exact nature of the surgery. There will often be drainage tubes in both sides which can be removed after 1-2 days. Your recovery following surgery greatly depends on how extensive an operation was necessary.

Normal symptoms after surgery include:

Bruising
Temporary loss of sensation to the nipple, areola or surrounding skin
Swelling
Pain and discomfort
Restricted movement

Length of Stay

Minor corrections can be performed as day cases, whilst larger operations will require a stay of 1-2 days. A complete correction may need more than one procedure.

What to expect after discharge

If the wounds have been sealed with glue, the area can be showered the day afterwards. In other cases, you may have to wait for the wound to heal. Advice regarding bra use will be given on a tailored basis to taking into account the requirements of your operation. Sports and heavy work should be avoided for 4 weeks. Sleeping on your stomach should also be avoided during this time. It will be possible to do some normal housework within a few days

Potential Complications

Early:

Bleeding
Infection
Wound healing problems
Skin irritation

Late:

Permanent sensory loss in the nipple, areola or surrounding skin
Scar hypertrophy (thickening)
Asymmetry
Dissatisfaction with the final volume
Late effects of ageing
Implant problems (discussed in the augmentation section)

Financial Considerations

Tuberous breast is not a medical problem and does not cause any functional impairment per se. Depending on your health service or insurance, the operation may or may not be funded. It is important to clarify your funding status and the costs of the surgery with the surgeon and your insurer prior to surgery.