Breast Reconstruction

Introduction

Recently in Korea, breast cancer occurs in younger patients than in USA and its incidence is increasing. Breast is the symbol of feminicity and resection of the breast due to the cancer can do harm on patientss psychosocial status. Without reconstruction, patient may have discomfort resulting from the asymmetric chest. Breast reconstruction helps to overcome this discomfort and is proven to have no hostile effect on the treatment of the cancer. Breast reconstruction is now considered not to be luxurious but to be indispensible for the quality of life including the cosmetic concern.

Timing of surgery

It depends on the patients' need, age, and the stage of the breast cancer itself. Immediate breast reconstruction is more favorable in early stage of breast cancer with close cooperation between the general surgeon and plastic surgeon. Delayed breast reconstruction can be another option for the patients who cannot go on with the immediate reconstruction due to any reasons.

Effect on the cancer therapy

There are no known studies reporting the bad effect of breast reconstruction on the treatment or prognosis of the cancer. Following the breast reconstruction, patient can take any kind of cancer therapy including chemotherapy, radiotherapy, and hormone therapy.

Reconstruction modality
Implant

With sufficient skin left, implant can be inserted under the pectoralis major muscle. Artificial dermis can be added for the coverage of the implant.
 

Tissue Expander

With insufficient skin left, tissue expander is inserted and followed by expansion and permanent implant change.
 

Latissimus dorsi (LD) musculocutaneous flap / Perforator flap

LD musculocutaneous or perforator flap is available for the reconstruction of breast. However, if patient need large volume of breast, tissue expander or implant may be necessary in addition to the LD flap.
 

Transverse Rectus abdominis musculocutaneous flap (TRAM):

Pedicled TRAM / Free TRAM / Free DIEP
TRAM is very versatile and robust flap in breast reconstruction and most commonly used for breast reconstruction in our clinic. TRAM is superior to implant and tissue expander for its versatility, natural tactile sensation, and possible recruitment of large reconstructive volume. TRAM is also favorable in patients who want to be pregnant after the reconstruction without complications regarding spontaneous vaginal delivery. Contrary to LD flap, TRAM flap doesn't bother patients' range of motion of upper arms. In addition, even after the TRAM flap, there is no definite limitation of abdominal fuction.
 

Hospitalization period

It takes about 1 week of convalescent period.
 

Nipple reconstruction

About 6 months later the reconstruction, nipple and areolar complex can be safely reconstructed. Intradermal tattooing is then performed about 2 months later.