Breast Cancer

Breast cancer in brief

Breast cancer is the most common malignancy in the female population, as 1 in 8 women will get sick during her lifetime, while the appearance of the disease at a younger age is becoming more and more common. It develops gradually from the glandular cells of the pores or lobes. It can damage adjacent organs and tissues, such as the skin, muscles, lymph nodes, and can also metastasize to distant organs.

In contrast, benign breast tumors are usually smooth and do not spread to other organs. The removal of benign tumors results in the treatment of specific lesions.

Screening tests, as for any disease, are the most powerful weapon in the treatment of breast cancer.

The treatments for breast cancer are:

• Chemotherapy or targeted therapy with biological agents
• Surgery (lumpectomy, partial mastectomy, total mastectomy, removal of axillary lymph nodes)
• Radiotherapy
• Hormone therapy

Developments in the treatment of breast cancer are rapid and if detected in the early stages the disease is considered treatable. Surgical oncology refers to the surgical management of tumors. Surgical removal of the tumor is often the only treatment option that can be led to the complete treatment of cancer.

Overview of the breast reconstruction surgery

We understand that deciding whether patients should undergo breast reconstruction surgery is a difficult process, especially when it comes to diagnosing and treating the disease. Although we can advise and support you as much as possible in choosing the best method, the final decision is yours to make and should be considered at the same time as what is best for you and your health. Although all women who have had a mastectomy will have to undergo breast reconstruction surgery, there is no right or wrong if you choose this in your case.

Breast reconstruction surgery can be performed at the same time as the mastectomy (also known as first-year reconstruction or primary reconstruction) or later (second-year reconstruction or delayed reconstruction). If one is in doubt or when there is a medical reason it is equally acceptable for someone to proceed to reconstruction at a later stage. In general, breast reconstruction can be performed using either a silicone implant or an implant (flap) from an area of ​​the patient’s body where available – “disposable” tissue (back, abdomen, buttocks) or although in some cases a combination of both methods can be done, the method to be performed should be discussed during your session with Mr. Konstantinos Benetatos, in order to decide the technique that best fits the patient.

More information on Breast Reconstruction can be found below. Please do not hesitate to contact us if you have any questions or would like to receive further information on the operation.

Why and When Breast Reconstruction Should Be Performed

Breast reconstruction is not part of cancer treatment, but should always be offered to patients who have undergone or will undergo mastectomy.

It is important to understand that breast reconstruction, from the simplest technique to the most complex one, involves an additional operation and additional possible complications. Of course, it is a fact that today techniques have evolved so much that the results are really impressive.

The decision of when the patient should undergo reconstruction surgery will depend on the choice of each patient under the guidance of Mr. Konstantinos Benetatos. If it is believed that patients will need further treatments in the future, especially treatments using radiation, it is recommended that the reconstruction operation is performed at a later time. Nipple Reconstruction surgery can be performed at the same time as Breast Reconstruction surgery or most commonly at a later stage.

Primary Breast Reconstruction

This operation refers to the reconstruction of the breast, which is performed at the same time as the surgery to remove breast cancer – mastectomy. However, patients should always remember that a breast reconstruction surgery can also be performed at a later date, after the completion of cancer treatment.

Primary breast reconstruction surgery has several advantages as well as potential disadvantages.

Advantages of Primary Breast Reconstruction

• The biggest and most important advantage of primary breast reconstruction is that the patient never experiences the trauma of an amputation and all that the mastectomy implies for the psychosynthesis of the female nature.
• Primary breast reconstruction using autografts (tissue from the patient’s own body) means a single surgery, and therefore faster recovery of the patient.
• In addition, primary reconstruction has a much better result for the patient, especially when the mastectomy is performed through the perimeter of the nipple with preservation of the dermal fold of the breast (subcutaneous mastectomy or mastectomy with preservation of the skin) thus giving an unsurpassed aesthetic result that no other kind of reconstruction could achieve.
• Konstantinos Benetatos sometimes restores the nipple at the same time as the primary reconstruction operation, when said operation is performed with tissue from the back or abdomen, but not when it is done with a silicone implant.

Disadvantages of Primary Reconstruction

• Understanding the surgical procedure of breast reconstruction and patients deciding on a primary reconstruction, which will extend their stay in the hospital, will inevitably add further stress at an already difficult time.
• There may also be postoperative complications from the reconstruction surgery, which will delay the completion of supplementary cancer treatments, such as chemotherapy and radiation. Of course, this will not affect the treatment and the outcome of cancer at all, but an additional surgery will need to be performed, to make sure that any complications that arise will be treated immediately.
• In the event that radiation is required as an additional treatment for cancer, the aesthetic effect of the reconstruction may be affected. In these cases, after mastectomy, reconstruction is recommended at a later stage. Of course, this problem is solved today with the most modern method of reconstruction, the “Delayed Primary reconstruction”.

The percentage of postoperative complications from a primary reconstruction is slightly higher than that of the delayed breast restoration and mainly concerns the survival of the breast skin after mastectomy.

Delayed Breast Reconstruction

This surgery is performed once the cancer treatment has been completed and possibly months or even years later. There is no set time or age limit, and it should only be performed if the patient is ready, both physically and mentally, to undergo additional surgery.

Some patients choose reconstructive surgery at a later stage, to others it is simply recommended by their doctor, and others do not initially want to undergo breast reconstruction surgery but decide after some time that they are ready to undergo this surgery.

Benefits of Delayed Breast Reconstruction

• By delayed reconstruction, we avoid possible delays in starting supplementary treatments for cancer, such as radiation or chemotherapy, in the event of postoperative complications due to primary reconstruction.
• Yes, the aesthetic effect of primary restoration is superior to that of delayed reconstruction, however, adding radiation to a primary reconstruction will have the exact opposite effect. Of course, in the case of delayed breast reconstruction, the possible effects of radiation (hardening, shrinking, and deformation of the breast) are avoided.
• The patient will not need to discuss surgery or make any immediate decisions regarding breast reconstruction at the time of diagnosis and during cancer treatment.
• In addition, this method has a slightly lower rate of complications compared to primary reconstruction surgery.

Disadvantages of Delayed Reconstruction

• Patients will have to live with the results of the mastectomy until the reconstructive surgery is performed, which might be after several months to a year, depending on the case of each patient.
• The aesthetic effect may not be as satisfactory, as in primary restoration the skin of the breast is often preserved and used to cover the reconstruction, thus giving a more natural result, as opposed to delayed reconstruction surgery. In these cases, as there is no skin on the breast, skin is transplanted from the back or abdomen, which will have a different shade initially and there will also be larger incisions in the breast area.
• The difference in the appearance of the skin of the breast will be less apparent if a silicone implant is used, as the skin is initially stretched with a balloon dilation device.
• In patients undergoing radiation, it is an absolute contraindication to place a silicone implant for the restoration, as the possibility of complications is very high, and in this case tissue transfer from the back or abdomen area is required for the restoration of the breast.

Radiation and Breast Reconstruction

For some breast cancer patients, radiation is a very important part of treatment, and especially for those who have undergone a partial mastectomy (breast-conserving surgery), as it has been shown to greatly reduce the chances of recurrence of mammary gland cancer. It has been shown that breast-conserving surgery (lumpectomy – wide local excision- quadruplectomy) in combination with radiation can have the same results as a mastectomy.

However, it has been observed that some patients who have undergone mastectomy will also benefit from supplementary radiation therapy. However, the need for radiotherapy is confirmed after mastectomy and histological examination of the surgical preparation.

Supplementary radiation therapy, in addition to destroying cancer cells, also causes damage to normal tissue in the area, leading to changes in the patient’s breast skin, such as discoloration, sclerosis and shrinking, or even necrosis of healthy breast tissue. It can also have the same effect on tissues used to repair a breast (skin and fat from the abdomen or back). Particular attention should be paid in cases where a silicone implant has been used with supplementary radiotherapy, as there is a high risk of complications that may be up to 30%; said complications include the formation of a capsule, inflammation, exposure of the implant, severe deformity and pain and even complete failure of the reconstruction and subsequent compulsory removal of the implant.

Problems that accompany radiation can be limited in breast reconstruction using the following methods:

• In most cases, if radiotherapy is planned or has already been administered, breast reconstruction surgery with a silicone implant should be avoided.
• In case radiotherapy is considered necessary after mastectomy, delayed reconstruction is recommended until all required treatments are completed. It is frustrating for both the patient and Mr. Konstantinos Benetatos when very good breast reconstruction is ruined by radiation.
• If on the other hand radiotherapy is required, then it is preferable for the patient to choose a Delayed Reconstruction or even better a Delayed Direct Reconstruction which is analyzed later in this section.
• It should be noted, however, that not all patients suffer from the harmful effects of radiation and although it can make the final decision quite difficult, nevertheless, Mr. Konstantinos Benetatos will consult each patient on the best treatment based on their individual needs.

Delayed Primary Breast Reconstruction

This is the best method of breast reconstruction that combines the advantages of Primary Reconstruction while protecting the new breast from the risks and complications that may arise from radiation. This method initially involves placing a stretchy skin under the pectoralis major muscle in the same surgery as the mastectomy. A prerequisite for the success of the technique is to perform a subcutaneous mastectomy with preservation of the breast skin. After histologically examining the removed breast the reconstruction plan is decided.

There are two possible scenarios – first, the breast does not need further treatment with radiation, so in the next two weeks we can proceed to the final phase of recovery, either with a permanent silicone implant or autologous tissues – the second scenario is that the patient needs additional radiation treatment so we wait for its completion to avoid all the unpleasant effects of radiation on the new breast, and then after a reasonable amount of time (3-6 months) we continue with the reconstruction with autologous tissues (abdomen or back) without the use of a silicone insert.