Dr Rica Farah Muhammad Abdullah Ichihashi, a consultant plastic and reconstructive surgeon at ParkCity Medical Centre, debunks the misconception that breast reconstruction is cosmetic or aesthetic, and explains that it is actually a procedure to restore the original breast form and symmetry.
For women in Malaysia, breast cancer is one of the most common forms of cancer that affect them. Treatment for breast cancer sometimes includes mastectomies where part or the entire breast is removed. After the procedure, women have the option of undergoing breast reconstruction.
Speaking to Calibre, Dr Rica acknowledges that while breast cancer patients are a main group of people that undergo breast reconstruction, any woman whose breasts have been disfigured or mutilated in some way can benefit from reconstruction.
Consultation & Methods
Dr Rica explains that more often than not, surgeons treating breast cancer patients would advise and educate their patients on what kind of breast reconstruction procedure to do. “It’s not really something that the patient themselves can choose, because they wouldn’t know what would be best for the situation they are in.”
Mainly there are three methods—an implant reconstruction whereby a saline or silicone implant is inserted, an autologous or flap reconstruction that uses a patient’s transplanted tissue, or sometimes a combination of both. Because there is also an exhaustive variant of techniques that can be used, some of which aren’t Googleable. It is best for the surgeon to determine which method is best for the patient based on their assessment. An open and comfortable consultation between the surgeon & patient is important. The decision for breast reconstruction and the type would be a joint discussion between the plastic surgeon, the patient and in some situations her family and loved ones.
For breast cancer patients, Dr Rica stresses the importance of a quick recovery so that the patient’s cancer can be treated, which is the priority. “The aim is for an uncomplicated, quick recovery so patients are ready for any other cancer treatment such as chemo or radiotherapy.”
Timing & Recovery
Much like the method, Dr Rica mentions that the timing of the procedure can also vary and is dependent on many factors. Apart from the surgeon’s skill set, other factors to take into consideration are the methods used and the number of surgeons working on the patient at any one time.
“Sometimes the reconstructive surgeon is the same surgeon taking out the patient’s tumour, so that procedure would evidently take up more time. But sometimes, if two surgeons are working simultaneously, the procedure would be completed quicker. Timing is quite subjective.” On average however, Dr Rica says a typical breast reconstruction surgery can take between an hour and a half to three to four hours.
“Post surgery, most patients don’t stay in the wards for more than a week. They would return after being discharged a week later for a follow up and to remove their stitches, and more often than not, they are fully recovered between a month to six weeks.”
As breast reconstruction is a surgery that’s meant to restore symmetry of the breast, there isn’t much change or adapting for the patient post-surgery. They are able to wear the same bras and clothes as before and if needed, proceed to undergoing their breast cancer treatments.
“Patients are usually also very concerned about pain, but seeing as everyone’s pain threshold is different, I would say it is subjective,” Dr Rica remarks. “Generally however, most patients are home within the week.”
Considering the Risks
Like other surgeries, breast reconstructions have similar risks but also some that are specific to this particular procedure. The risk of asymmetry is more common with implant reconstructions, and also carries an increased risk of the rare cancer, anaplastic large cell lymphoma (ALCL). “If a patient undergoes radiotherapy post-reconstruction, they could sometimes be subjected to slight impact on the skin from the radiotherapy,” Dr Rica says.
With autologous reconstructions, some risks are blood clots, necrosis of the transplanted tissue and weakness, pain or sensitivity around the donor sites. The interruption of the blood flow also can impact the way the tissue recovers post-reconstruction. However, since the tissue is the patient’s own, Dr Rica mentions that recovery might sometimes be faster with autologous reconstructions, and it might also yield better results. Some risk also include interruption of the blood flow to the reconstructed tissues, pain or sensitivity around the donor site.
Making an Informed Choice
Breast reconstruction offers women an opportunity for better quality of life, which is pertinent after going through an ordeal such as a mastectomy. By offering women this sense of normalcy after the loss of a breast, the procedure is one that is both healing and empowering. With so many considerations and risks to assess, it is important that women make informed choices about the procedure they choose to undergo, and to also be comfortable with the surgeon they consult with in order to get the best possible care.