Rehabilitation after mastectomy

Breast cancer has ceased to be life-threatening, therefore, the number of women seeking rehabilitation after mastectomy is increasing, says the president of the Hellenic Cancer Society, Evangelos Filopoulos, on the Fm Agency and on the 104.9 MYSTIKA HYGIAS show

In an attempt to answer questions that trouble those patients who feel that the ultimate symbol of their femininity is being attacked, he talks bluntly about what they can expect from such an operation. What are the differences between an oncological reconstruction and a simple breast prosthesis and which method is safer? Will the breast ever be the same again? In which cases is the nipple preserved and what do recent studies say?

Breasts will never be the same again

Most women have the impression that reconstruction means reformation of the breast, that is, they think that it will be done exactly as it was before, but this is not the case, as Mr. Filopoulos says. “The breast mass is restored and a nipple can still be made, since it is missing after the mastectomy, but it is definitely not the breast it was before the surgery. Nevertheless, the woman can comfortably wear both her clothes and her bathing suit and feel much better herself. That is why we have seen an increase in the number of women seeking rehabilitation in recent years. And this also happens because of the fact that breast cancer is no longer life-threatening and in fact most women after this adventure live many years with an excellent quality of life."

Contraindications for rehabilitation

"Rehabilitation is not allowed in patients who are in an advanced stage of the disease, in patients who have inflammatory cancer, in cases of local recurrence and of course when the general state of the patient's health is poor with a lot of comorbidity."

The differences between breast implants and oncological reconstruction

"Fortunately, we don't have to do as many mastectomies as we used to, because now we do simple or partial lumpectomies. In cases where there is an indication of a mastectomy, after the operation where the breast mass was, a transverse or slightly oblique scar remains in the flattened area. In breast augmentation the scar is almost invisible. This is the first difference (although today in cases of skin-preserving mastectomies, the scar is small and very good aesthetically).

The second difference is that in breast augmentation, a purely aesthetic operation, the implant is placed at the back of the breast, while in oncological reconstruction the implant is inserted behind the pectoralis major muscle. This results in the regenerated breast being firmer than the healthy one, regardless of the woman's age. A third difference is that in order to rebuild the breast, the proper space and proper stretching of the flattened tissues must be created.

What does an expander do?

This is achieved by placing a dilator, i.e. a bag that progressively inflates with the administration of serum. This happens gradually. When the size of the tissue stretch reaches the desired size, usually after 3-6 months, the expander is removed, through an incision in the old scar, and the implant is placed. The expander is needed because the implant will be inserted under the pectoralis major muscle, a practice that allows the doctor to palpate the area of the operation in order to discover in time, any occurrence of local recurrence. This won't be possible if the implant gets between the skin and the muscle and that's a mistake that can put patients' lives at risk."

Because the two breasts are often asymmetrical, together with the insertion of the implant, the second healthy breast is also lifted. In cases where the breasts are small and perky, this process is simpler and faster. Restoration with implants is the most commonly used restoration method.

There are other methods, such as using tissue from another part of the patient's body. That is, to bring from the lower part of the abdomen or from the back of the patient (as is usual) a piece of skin and muscle, and make a breast mass. These practices create additional scarring, are technically more difficult, and require longer operating room time. However, they produce a more natural effect."

Immediate or later rehabilitation and in which cases?

When there is a need to supplement the surgery with further treatments, such as chemotherapy or radiation therapy, many doctors prefer later rehabilitation, after the woman has successfully completed all her treatment, says Mr. Filopoulos. Regarding the operation in which mastectomy and reconstruction are performed at the same time in the same operating room, Mr. Filopoulos states that it is a practice that has been gaining ground in recent years, but its application has certain peculiarities. "The results are safer in patients with early cancers and in cases where it is possible to apply techniques that ensure the preservation of a sufficient amount of breast skin. Immediate restoration is also chosen in cases where the mass gland is removed, with preservation of the skin with or without preservation of the nipple (which is more common in prophylactic mastectomies)".

Instant recovery doesn't always mean you get a new breast at the same time

Many women are under the impression that they will go into surgery to have a mastectomy and come out with a new breast. This, however, only applies in cases where the breast is small and flaps (skin tissues from another part of the body) are used, as Mr. Filopoulos says. "It should be pointed out that immediate restoration often means that simply together with mastectomy, the recovery process begins, which is the placement and filling of the dilator, which lasts for several months and we have already described. In any case, whether it will be done immediately or in a second year, mainly concerns criteria related to the tumor and the patient's condition".

How painful is the recovery process?

"Recovery is not as painful as many women think. Of course there is pain and they should know that, but it is a pain that can be tolerated for a few days and in certain phases of the process and is treated with painkillers."

In what cases is the nipple preserved?

Regarding the preservation of the nipple, it is a question for doctors, as the president of the Hellenic Cancer Society points out. "Until a few years ago there were reservations that if the nipple is preserved, local recurrences may occur more often. In recent years there have been many studies that show that it can be a safe practice for some cases, such as e.g. when the tumors are at an early stage and small in size, when they are far from the nipple and without lymphatic infiltration, or when the mastectomy is performed preventively.

How natural is a fake nipple?

In the context of breast reconstruction, nipple shaping surgery offers an aesthetic result that is sometimes very good, sometimes just satisfactory. In any case, it is about reshaping the image and not the feel of the nipple. The methods used are by taking skin from the upper part of the thigh or part of the other nipple (if it is large) or tattooing.

Personal testimony

Research from the University of Toronto, recently published in the journal Plastic and Reconstructive Surgery, reports that breast reconstruction immediately after mastectomy may protect patients from a period of psychological distress, poor body image and reduced sexuality, compared to those who wait some time before undergoing it. Of course, the research refers to candidates who meet the medical criteria for immediate rehabilitation, such as the journalist Mary Kontolouri who recently underwent a double mastectomy and speaks to APE-MBE about her personal experience: "Coming out of the surgery with a breast dummy it is a great consolation. You don't get to see yourself mutilated! Even this youthful image of the breast is important for the psychology of the woman who is fighting a cancer. It is an optimistic moment, in an extremely difficult phase. Your image, if you've also gone through chemotherapy, has changed so much, as you have no hair, and you've probably gained weight too... Certainly losing your breasts is a heavy blow. Immediate rehabilitation worked for me "therapeutically" as far as my psyche is concerned.

Source: Mastectomy Recovery - What Women Need to Know | iefimerida.gr
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