Before undertaking breast reconstruction surgery, we must first consider the patient’s overall health which can be affected by many factors including: age, medical conditions, level of fitness, smoking and medications:
Age:
Some 70 year olds are far fitter than people 20 years younger who may be much less active.
Medical Conditions:
Poorly controlled diabetes, high blood pressure, heart or lung conditions may mean that a complex reconstruction, requiring a long anaesthetic, may not be safe.
Smoking:
Giving up is hard to do, but the vast majority of patients with a new cancer diagnosis have an extra inventive to stop. This will help with the risk of deep vein thrombosis (DVT) and clots on the lung (pulmonary embolus) but also reduces the risk of wound breakdown and problems with the microsurgery required for complex breast reconstruction .
Medications:
Steroids affect the skin and slow down wound healing while some of the immunosuppressants used for rheumatoid arthritis/transplants increase the risk of infection. Aspirin, clopidogrel and warfarin make you bleed more in surgery. Chemotherapy agents such as Herceptin can have major side effects on the heart and its ability to function normally.
Immediate:
For some the concept of being without a breast is too much to consider on top of the cancer diagnosis, in which case an immediate reconstruction may be best and more of the natural breast skin can usually be preserved. However, the patient goes to sleep with a breast but wakes up with a reconstruction which may be quite different to what was there before.
However, sometimes patients are not fit enough to have cancer surgery and reconstruction in one go. Moreover with more advanced cancers, it may be sensible to move on with the cancer removal and additional (adjuvant) medical treatment such as radiotherapy and chemotherapy, before addressing reconstruction when the dust has settled.
Delayed:
Equally for other patients, the reconstructive options are secondary to the initial cancer treatment and they may wish to proceed with mastectomy as soon as possible. This does mean that more of the native breast skin is removed (go flat) in order to get the wound healed and minimise the risk of collections occurring below the breast skin.
Advantages include that it may be easier to get on with subsequent chemo-radiotherapy as there is less down time and the reconstruction can be performed at a subsequent and more convenient time. Also people can optimise their fitness, lose weight and recover from the side effects of chemotherapy.
It helps to know the details of any operation you’re going to have. Watch this short video to find out what happens before, during and after breast surgery…
FAYE WYMER
