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Reconstructive surgery

Reconstructive surgery restores the shape, and where possible the function, of a part of the body changed by cancer treatment. The best-documented example is breast reconstruction after mastectomy, which can use an implant or the patient's own tissue and can be performed at the same time as the mastectomy or months to years later. The choice of method and timing depends on factors such as body build, planned radiation therapy, and the patient's preferences.

How it works

In implant-based breast reconstruction the surgeon usually first places a tissue expander under the skin or chest muscle and gradually fills it, then replaces it with a permanent saline or silicone implant. In autologous (flap) reconstruction the breast is rebuilt from the patient's own tissue — skin, fat, and blood vessels taken from the abdomen, back, thighs, or buttocks (techniques such as the DIEP, TRAM, or latissimus dorsi flap); a flap may stay connected to its original blood supply or be reattached to blood vessels in the chest using microsurgery. Implant reconstruction means a shorter operation and recovery, with risks including infection, fluid buildup (seroma), implant rupture, and capsular contracture. Flap reconstruction may look and feel more natural and can replace tissue damaged by radiation, but the operation is longer and carries risks such as bleeding and partial tissue necrosis. Radiation therapy can cause wound-healing problems in a reconstructed breast, which is one reason reconstruction is sometimes delayed.

Used in

Invasive Breast Carcinoma C50

Breast reconstruction after mastectomy: implant-based (usually a two-stage procedure) or autologous tissue. Immediate implant reconstruction usually remains an option when radiotherapy is planned, whereas autologous reconstruction is generally reserved for after radiotherapy.

Pre-Invasive (In Situ) D05

The same pathway applies to patients with in situ disease undergoing mastectomy — the method and timing of reconstruction depend on the planned adjuvant treatment.

Sources

  1. NCI – Breast Reconstruction After Mastectomy ↗