Breast Reconstruction in Breast Cancer; To Do Before or After Radiotherapy?

Breast Reconstruction in Breast Cancer; To Do Before or After Radiotherapy?

Oncoplastic Breast Surgery

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Oncoplastic techniques, discuss with your breast surgeon.

Oncoplastic breast surgery is an advancement in breast cancer surgery to achieve widened surgical margin and to optimize cosmetic outcome while maintaining reduced local recurrence rate altogether.

The importance of a woman’s breasts shouldn’t be underestimated as it provide a sense of being whole to a woman.

Some women would rather avoid treatment altogether if she learns that she needs radical surgery, ie. mastectomy.

Thus, oncoplastic breast surgery should be explored at all times with patients who are diagnosed with breast cancer.

Adjuvant Radiotherapy

Adjuvant radiotherapy to breast or chest wall (after mastectomy) significantly reduce local recurrence rate down to 0.4% – 1.1% at 5 years time (one local recurrence of breast cancer in 100 – 200 patients).

Another way to look at the benefit of adjuvant radiotherapy is that it prevents 8 local recurrence and 2 breast cancer deaths in every 100 patients.

Together with regional lymph nodes (SCF +/- axilla +/- internal mammary) radiotherapy, it helps to improve loco-regional control and disease free survival (DFS).

The choice of radiation technique is very important, especially in breast cancer due to the long life expectancy after the treatment.

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Advanced radiotherapy techniques, VMAT and IMRT for breast radiotherapy. VMAT is more superior than IMRT in all dosimetric parameters. Both techniques allow simultaneous boost without needing additional days for radiotherapy and thus allowing shorter treatment time. Another benefit of VMAT is lower radiation doses to the heart and lungs. 

Breast Reconstruction: Before or After Adjuvant Radiotherapy?

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Based on the above systemic review, it was reported that there were more complications (48.7% vs 19.6%) and a higher revision rate (42.4% vs 8.5%) if an implant reconstruction was performed after vs before radiotherapy.

For autologous reconstructions, no statistical differences were found between total complication rates or revision surgery. Only fibrosis occurred less if autologous reconstruction applied after radiotherapy (2.7% vs 36%).

Implant reconstruction: Breast implants require a two-part procedure. The surgeon may first need to insert a temporary tissue expander to create space underneath the layer of skin and fat for the implant. A few months later, the surgeon removes the expander and inserts an implant in the newly created pocket. For some patients, however, doctors can immediately place the implant, depending on evaluation of the patient meeting certain criteria. Two options for breast implants are silicone and saline implants.

Autologous reconstruction: Autologous reconstruction involves using abdominal fat, skin and fatty tissue from your lower abdomen or other areas, such as the back, to recreate a breast. Two kinds of autologous tissue reconstruction are TRAM (transverse rectus abdominis muscle) flap and DIEP (deep inferior epigastric perforator) free flap techniques.

Nevertheless, there were no large differences seen between patient and physician satisfaction on cosmetic outcome between implant or autologous reconstruction.

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