Breast reconstruction following breast cancer is an acceptable modality and it can either be carried out at the same time as the mastectomy or as a delayed procedure. Immediate breast reconstruction is the standard of care these days, as it avoids a future surgery and also avoids the psychological trauma, which a patient faces after removal of the breast. Many studies have proven beyond doubt that it does not interfere with the oncological clearance of the cancer and that patients with breast reconstruction enjoy a better quality of life. Then why is it that Indian patients are not opting for breast reconstruction? The patients are not the only one to be blamed for this. Physician related factors are equally important in this regard.
The first and the foremost reason is lack of awareness. Many patients are unaware of these reconstructive modalities and don’t inquire about these options from the treating surgeon. Another important factor in India is the lack of awareness/ expertise about these reconstructive modalities among surgeons. There are only a handful of centres in India which offer breast reconstruction.
Breast Cancer is now the most common cancer among urban India women and the incidence is going up each year. Majority of our patients still present in an advanced stage and require mastectomies as a part of their treatment. With the improvement in the treatment modalities, many of these patients are cured of their disease and live a relatively normal life afterwards. As majority of these patients present in the advanced stage, they receive chemotherapy before surgery (neo-adjuvant chemotherapy). During this period, tackling with the side effects of chemotherapy shadows all other thoughts in their minds and they only think about surviving the onslaught of chemotherapy. By the time they get over with their chemo, they are mentally and physically so exhausted that they stop thinking about their quality of life after their treatment. This is another reason why they don’t opt for reconstruction at this stage.
Another important point is the lack of guidance/ counselling. We are fortunate to have a dedicated Breast Counsellor in our unit, who happens to be a breast cancer survivor as well. We have seen a more positive attitude towards the diagnosis and management in patients who have been counselled properly.
If more awareness is created among the patients and surgeons, more patients can benefit from these reconstructions and have a better quality of life.
Various Reconstructive Options after Mastectomy are:
- Microvascular free flap reconstruction: These flaps are the standard of care these days. It can either be a DIEP (deep inferior epgastric artery perforator) flap, in which fat is taken from the abdomen to reconstruct the breast or an ALT (antero-lateral thigh) flap, in which muscle and skin is taken from the thigh.
- Pedicle flaps: Latissmus dorsii flap – tissue take from the back or TRAM (transverse rectus abdominus myo-cutaenous flap) – tissue taken from the abdomen
- Implant based reconstructions using silicone implants.