When it comes to choosing a breast reconstruction, patients are guided by their surgeons toward what should be the best choice. What if the best choice isn’t necessarily an option? What then?
Nearly every article I write is prompted by an interaction with a patient. I am asked questions every day in the outpatient clinic that I have addressed in this blog. But occasionally, I receive emails from women who have already seen other surgeons, who feel that perhaps they haven’t been offered the best option for them. I have written previously about the fact that surgeons can have a profound influence over their patients’ choices.
I recently received an email from a patient looking for some information about her options. This lady has recently been diagnosed with a new, second primary tumour in her right breast. She had previously had chemotherapy, a lumpectomy, and then radiation to that breast. With the new diagnosis, she is now looking at a mastectomy to treat the cancer, as well as a risk-reducing mastectomy on the other side. She is a young, slim woman, although she has been told she has sufficient abdominal tissue to allow for a DIEP flap. The problem for her is that a DIEP will only offer her a very small reconstructed breast, and the surgeons she has consulted feel that she would do best with a Latissimus dorsi flap. The thought of using the LD muscle from the back worries her however – this lady would prefer a DIEP, even if the volume of the reconstruction is small. There are other concerns also, including whether the blood vessels in her abdomen are adequate, whether muscle would be taken with the flap, and if so what this would mean for her down the track.
The options for bilateral breast reconstruction in a slim, small breasted woman are quite specific. In a patient who may not be able to adequately reconstruct the breast volume using abdominal tissue alone, there is a need to consider alternative techniques. There’s certainly plenty to discuss. These are all quite meaty issues, and they are really very common. So, over the next few articles, I will try to cover alternatives to DIEPs, and when & why whose alternatives are required; we’ll think about the issues of symmetry and also reconstructing a larger breast; and obviously it is past time for me to explain the use of CT scans for DIEP flaps in the pre-operative work-up. And lastly, I will get onto a rather contentious issue: the incidence of hernias and bulges after abdominal free flaps and what it means to patients.
More to come, very soon!