Question: How is a breast reconstruction done?
Breast reconstruction involves recreating the breast mound using tissue from the abdomen, back or buttock. The type of reconstruction chosen will depend on the patient having the right bulges or spare tissue at the right places to make up the volume of the “lost” breast and their acceptance of the scar in different areas of the body where the donor tissue is removed from. Scars are usually sited in acceptable areas, for instance with the abdominal and buttock flap, the scar is within the swimsuit line whilst with the back it is usually sited within the bra strap. If tissue from the back is chosen to reconstruct the breast mound, it is often necessary to use a silicone implant as well, as there is insufficient bulk from back tissue alone.
Question: When can one have a reconstruction after a mastectomy?
A breast cancer patient may choose to have her reconstruction done at the same time as the mastectomy, and this is known as immediate reconstruction. She may alternatively choose to have it done after completion of mastectomy, chemotherapy and radiotherapy. This is known as delayed reconstruction and usually takes place about one to two years following the mastectomy.
Question: Does breast reconstruction affect the management of breast cancer?
Immediate breast reconstruction does not increase the rate of recurrence, nor interfere with or delay the detection of recurrence. The reconstructed breast can be imaged with ultrasound, mammogram or the MRI to detect for recurrences. Chest wall recurrences, which are recurrences occurring behind the reconstructed breast is rare.
All the studies published have shown that most recurrences either occur on the skin, which can be easily detected, or in the lungs and liver, which are detected with routine check-ups.
Question: Are there any patients where reconstruction would not be suitable?
Patients who have chronic medical conditions, for instance, chronic heart, lung or kidney problems are not candidates for reconstruction. Patients who smoke heavily are at a higher risk. Similarly, patients who are grossly overweight are at a higher risk. By and large, most breast cancer patients are suitable.
In the past, reconstruction was not advised for later stages of breast cancer. But we know now and studies have shown that reconstruction does not interfere with the management of breast cancer and does not delay the detection of recurrence. Reconstruction is only contraindicated in patients with very advanced stage where the chest wall is involved or where distant metastases/spread is already present.
Q: How safe are silicone implants?
The Consensus Declaration of the European Committee on Quality Assurance and Medical Devices (EQUAM) in Plastic Surgery, written on July 4th 1998, in Regensburg after EQUAM’s Third Consensus Conference concludes that silicone implants are safe. The Federal Drug Authority in United States has lifted its moratorium on the use of silicone implants for augmentation since the results of studies show that there is conclusive scientific- clinical, immunologic, epidemiologic- data that silicone gel-filled breast implants do not cause any autoimmune or connective tissue diseases.
Updated studies continue to show that silicone gel-filled implants do not cause cancer or other malignancies. Silicone is a widely used and essential material in everyday life, at present. We have no better alternative material available as yet. In all fields of medicine and surgery, implants and medical devices made of silicone are essential, not only for well-being but often for survival.
Q: What happens if a silicone implant bursts?
It takes a lot of pressure to rupture a silicone implant. The weight of a normal person will not rupture the silicone implant. Once an implant is put into the body, the body will react by forming a fibrous capsule around the implant. If a silicone implant ruptures during an accident, the contents may remain within the capsule – this is known as a capsulated rupture. In a capsulated rupture, the patient may sense a softening and slight flattening of the breast mound. It may not be necessary to remove the implant, since the rupture is contained within the fibrous capsule. If the implant ruptures and the silicone contents leak out of the fibrous capsule (eg: with sharp or penetrating trauma), it will be necessary to remove the implant altogether and wash out the area during surgery.
Q: Is it possible to get an allergic reaction to silicone?
Allergic reactions can occur to almost any substance on earth. However, silicone allergies are very rare. We are exposed to silicone in our environment everyday. It is found in many household items, such as polishes, antiperspirants, make-up, soaps and processed foods.