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.
Complications Autologous
Complications with the tissue transferred to the breast
Any surgical procedure is associated with possible risks and complications. These include: bleeding, infection (fig. 1, 2), haematomas (large collections of blood), delayed wound healing, deep vein thrombosis and more rarely pulmonary embolism.
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| Fig. 1 | Fig. 2 |
Microsurgery carries its own particular set of complications and these apply to any tissue that is transferred to the breast for reconstruction. The most important microsurgical complication is a blood clot at the site where the vessels have been reconnected (fig. 3a-c). This may occur due to problems with the vessel wall (e.g. atherosclerosis), clotting abnormalities, post-operative compression of the vessels or rarely, a technical error.
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| Fig. 3a | Fig. 3b | Fig. 3c |
Microsurgical complications almost always present within the first 72 hours following surgery. Once a free flap passes through this time frame, the vessels are permanently healed and the tissue should survive. Therefore within this early post-operative period, nurses regularly monitor the flap, initially every hour and then every two hours, to check the blood flow. This monitoring starts in recovery and continues when a patient is back on the ward. The medical staff and your surgeon are immediately informed if there is any change. A decision may be taken to return to theatre, remove any clot and restore blood flow (revascularisation). We currently have a re-exploration rate of approximately 3%.
Rarely, in approximately 0.7% of the flaps, it is not possible to restore blood flow and total flap loss occurs (fig. 4). However, over 99% of our patients do have a successful outcome and have a breast reconstruction that will last a lifetime. In the unusual event of complete flap failure, a future consultation can be arranged, in which other methods of breast reconstruction can be discussed.
Fig. 4: total flap necrosis
Partial flap necrosis, due to poor tissue perfusion or anatomical variations in blood supply, is seen in 7% of free DIEAP flaps (fig. 5). Isolated fat necrosis is seen in 6% of cases but this figure can be higher in smokers or patients who receive post-operative radiotherapy. Fat necrosis is felt as a firm nodule in the breast. The majority of areas soften over time and radiological imaging can be used to differentiate them from recurrent breast cancer. In cases that persist for more than one year or if there is any oncological doubt, the fat necrosis can be surgically excised.
Fig. 5: partial flap necrosis
Complications at the donor site
The same general complications apply to the donor site (fig. 6). Delayed wound healing occurs in up to 6% of patients but is often associated with smoking. A seroma, which is a collection of clear wound fluid, develops in about 2% of DIEAP flaps but it is much more common following SIEA flaps because of the more extensive dissection required in the inguinal region. Finally, lower abdominal bulging after DIEAP flap harvest is seen in less than 1% of patients. We have never encountered a true incisional hernia. This represents a major improvement over the TRAM flap and is a clear demonstration of how donor site morbidity is reduced by perforator flaps. Following TRAM flap reconstruction the lower abdominal wall may be weakened, leading to hernia formation but this can be surgically corrected.
Fig. 6
Possible complications of autologous free flap breast reconstruction:
| Pedicled TRAM | |
| Return to theatre | 2 |
| Partial flap necrosis | 11.1 |
| Fat necrosis | 6.4 |
| Total flap loss | 1.3 |
| Seroma | 8 |
| Haematoma | 2.2 |
| Infection | 4.1 |
| Abdominal bulge | 6.9 |
| Abdominal hernia | 3.4 |
