Modern implants consist of an outer silicone shell (roughened or textured) and an inner compartment that can be filled with saline (salt water) instead of silicone gel. Implants having a similar shape to the natural breast have recently been introduced. Your breast surgeon will explain the pros and cons of the various types of implant available to you.

 

The cosmetic outcome of SSM and implant-based reconstruction

This 46 year old lady had right skin-saving mastectomy and immediate reconstruction using an implant alone

 

Right SSM and implant reconstruction

Right SSM and implant reconstruction 1


Flap Reconstruction


A portion of the patient’s skin and underlying fat and/or muscle (with blood supply), called a flap, is moved to the mastectomy site in order to build a new breast. Two types of flap are commonly used in breast reconstruction: in the first method, the flap is taken from the back; the second uses a flap taken from the abdomen (tummy tuck). It is also possible to rebuild the breast using a flap from the buttock. The flap choice depends upon the breast size and shape and the woman’s build. The LD flap (from the back) is the simplest and most robust method of flap-based reconstruction. The steps and final result of the procedure are demonstrated on the previous page. The other flap commonly used is called DIEP (deep inferior epigastric perforator) flap and allows simultaneous tummy-tuck procedure. However this type of reconstruction takes several hours and can be performed in a selected group of patients only.

This lady had right SSM and LD flap reconstruction

 

This 52 year old lady had right skin-saving mastectomy and immediate breast reconstruction using a skin and muscle flap from the back for early breast cancer. She also had nipple reconstruction and enlargement of the opposite breast in order to achieve symmetry. (The procedure was performed by the author KM in 2003)

 


The back scar resulting from the use of LD flap
Back scar of LD flap

 

 

Below:

 

This 41 year old lady had right skin-sparing mastectomy and immediate reconstruction using a tissue flap from the back (LD flap) combined with the sentinel node biopsy for 3 small cancers in the right breast. The procedure was performed by the author Kefah Mokbel in 2003. The patient remains free from disease.

 

Right skin-sparing mastectomy and immediate reconstruction using a tissue flap from the back (LD flap) combined with the sentinel node biopsy for 3 small cancers in the right breast (performed by the author)

 

 

Right skin-sparing mastectomy and immediate reconstruction using a tissue flap from the back (LD flap) combined with the sentinel node biopsy for 3 small cancers in the right breast (performed by the author)

 

 

Nipple Reconstruction


It is also possible to reconstruct the nipple using local skin, a portion form the opposite nipple, or a skin graft taken from the groin (Figure 9). The new nipple can be tattooed to make it a similar to that of the opposite nipple. A disposable tattooing instrument is used to minimise the risk of disease transmission.

 

Left nipple reconstruction using the local flap technique following mastectomy and LD reconstruction for breast cancer
This 42 year old doctor had right skin-saving mastectomy and flap reconstruction followed by nipple reconstruction using a local flap



Nipple Preservation

In selected cases the nipple can be preserved during skin-saving mastectomy and reconstruction in order to achieve a superior cosmetic result. The photo below shows the excellent cosmetic result from bilateral nipple-saving mastectomy and reconstruction in a 40 year old diagnosed with breast cancer:

 

This 42 year old lady had bilateral nipple-preserving SSM and implant reconstruction

The result of bilateral nipple-preserving skin-saving mastectomy and immediate reconsruction using implant

This 38 year old lady had bilateral nipple-preserving SSM and implant reconstruction

Bilateral NP-SSM plus implant reconstruction

Bilateral NP-SSM plus implant reconstruction 1



Treatment of Non-invasive Breast Cancer


In non-invasive breast cancer, the cancer cells remain confined to the ducts or lobules. The medical name for non-invasive breast cancer is ductal carcinoma in situ (DCIS) if it occurs in the milk gland ducts (tubes), or lobular carcinoma in situ (LCIS) if it occurs in the gland lobules.
LCIS is not considered cancer as such. The presence of this abnormality in a breast biopsy means that the patient has an increased risk of developing breast cancer. The risk means that about 1 in 3 women with LCIS will develop breast cancer within 30 years of being diagnosed with the original condition.
DCIS usually appears as small white spots on the mammogram, called micro-calcifications (Figure 10). Occasionally, it shows as a lump in the breast or as a blood stained nipple discharge. However, this type of cancer does not usually spread beyond the breast. It is a relatively commonly finding in women participating in the screening programme. The likelihood of non-invasive cancer/DCIS spreading to the lymph glands in the armpit is approximately 1 in 200 cases. This small number is why armpit surgery (axillary dissection) is not routinely performed for DCIS, unlike the invasive type of breast cancer.
 

Figure 10. A mammogram showing white spots of calcium (micro-calcifications) suggestive of non-invasive breast cancer (DCIS)

 

 

Figure 10. A mammogram showing white spots of calcium (micro-calcifications) suggestive of non-invasive breast cancer (DCIS)


Like invasive breast cancer, DCIS is graded as low, intermediate or high. High-grade DCIS is relatively aggressive, especially if associated with cell death, and is thought to be more likely to progress into invasive cancer.

 

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