More options for mastectomy patients

An inequality in breast reconstruction options for mastectomy patients has been highlighted by a West Sussex hospital. The Queen Victoria Hospital (QVH) announced that women considering breast reconstruction following breast cancer are often not given the full range of options available for reconstruction in what can sometimes be a ‘postcode lottery’ – and may end up choosing an option that isn’t right for them or which requires further plastic surgery in the future.

In light of this, the hospital has launched a free DVD, available nationally, which gives comprehensive information about the reconstruction options available, as well as information on ‘finishing touches’ such as nipple reconstruction and nipple tattooing.

The DVD (breastreconstructionforlife.org.uk) includes the personal journey of a woman undergoing the procedure, and interviews with other women in the process and gives expert advice on the best options and how to go about accessing them.

According to Charles Nduka, consultant plastic surgeon at QVH who directed the DVD:

“There are four different options for breast reconstruction following mastectomy but not all of these are offered as a standard, and indeed in hospitals where there isn’t a plastic surgeon the patient may never know the full range of alternatives. This DVD seeks to raise awareness of the options and techniques so that women can make the right choice for their lifestyle.”

The situation was also highlighted by the First Annual Report of the National Mastectomy and Breast Reconstruction Audit 2008, prepared in association with organisations including the British Association of Plastic, Reconstructive and Aesthetic Surgeons, The Royal College of Nursing and the Healthcare Commission. Patients surveyed mentioned a number of problems including:

• Poor quality of information provided
• Breast reconstruction sometimes offered in a ‘discouraging way’
• Not enough information provided early on in treatment

The four main techniques for breast reconstruction include the use of a silicone implant; the latissimus dorsi flap, (which takes skin and muscle from the patient’s back and can be used with or without implant); the pedicled TRAM flap (where abdominal skin and fat as well as much of the abdominal muscle is tunnelled up to the chest); or the free TRAM flap and DIEP flap, both of which use skin and fat from the abdomen and which is then re-attached using microsurgery. The DIEP flap, allows the tissues to be harvested without removing any muscle at all from the abdomen by teasing out the blood vessels from between the muscle fibres.

Says Mr Nduka, who is a member of the British Association of Aesthetic Plastic Surgeons (BAAPS):

“The advantage of the methods which only use abdominal skin and fat is that they can offer a natural-looking breast reconstruction for life, as no implant is required. Whilst an implant-only approach may seem to be the simplest option, and is most suited to slim, small-breasted women, the overall appearance of the reconstructed breast can deteriorate with time, as the other breast continues to droop with gravity.

“Other methods such as DIEP flaps may require more complicated operations or a slightly longer recovery time, but they have a success rate of over 95%. The possibility of capsular contracture should also be considered with the implants option, a risk which increases not only with time, but also in those requiring radiotherapy. In severe cases this may require the removal and replacement of the implant even years after the original surgery.”

A woman’s decision to undergo one particular reconstructive option over another will depend on a number of factors, such as her general fitness, her breast size, the requirement for cancer treatment after mastectomy, such as radiotherapy and also her social support and family commitments.

The DVD follows one patient along her journey through the process of a breast reconstruction immediately following a mastectomy, and also includes interviews with women who have undergone a TRAM or DIEP flap procedure. The DVD also features interviews with a variety of surgeons discussing their personal philosophies of breast reconstruction, as well as discussions with a breast care nurse and an anaesthetist.

The operative footage of a DIEP flap, a nipple reconstruction and nipple tattooing is also included for those who are interested to see how these techniques are performed - and a gallery of images showing a variety of results is featured to give patients an idea of achievable results.

The DVD is available from September from Breastreconstructionforlife.org.uk and is free of charge, although there is an optional facility to make a donation to a breast cancer charity.

Mr Nduka concluded: “We hope this DVD will not only be informative for women who have undergone mastectomy, but educate and empower them to seek the full options and ask questions, so ultimately they can make the best decision to suit them and their lifestyle.”