For many years, treatment of breast cancer focused solely on prevention and removal of the actual tumour. Often far too little attention was paid to the physical and emotional effects of stressful cancer treatments. The current options presented by onco-plastic surgery are holistic treatment concepts that allow for the best possible coordination of tumour removal and breast reconstruction.
The ultimate goal of any breast cancer treatment is always the complete removal of the tumour. Through a better understanding of tumour biology, the approach to the treatment of breast cancer has shifted increasingly in favour of breast-conserving therapy. However, the complete removal of the breast is unavoidable in around one third of patients. Only a small fraction of these patients decide on an immediate breast reconstruction. This is in spite of the fact that the quality of life of these women can be significantly influenced by the procedure, and it has no disadvantages for the outcome of the disease. The prognosis is no better if the breast reconstruction is only carried out a number of years later. Before beginning the first treatment, it is important to create a plan that includes all oncological aspects as well as any fears of possible disfigurement.
The options for reconstruction have improved considerably in recent years. With the current radiotherapy methods, more effective medication and progress in reconstruction methods, especially with autologous tissue, immediate reconstruction is now one of the options of first choice. Immediate breast reconstruction can be carried out as early as the final stages of chemotherapy or shortly afterwards. In contrast to earlier times, radiotherapy is now possible immediately following breast reconstruction. There are no medical reasons to delay reconstruction of the breast. Developments in the field of breast reconstruction are now so advanced that there are several different options and appropriate techniques for each woman. Individual wishes are always at the centre when decisions are made. For an immediate reconstruction
, first a “skin-sparing” mastectomy is carried out. The breast tissue is removed through a small incision around the nipple, while the entire skin is retained. There are then three main types of breast reconstruction: 1) with a silicone implant, 2) combined with the patient's own tissue from the back or 3) using only the patient's tissue from the abdomen, thigh or buttocks. These days, implants of the highest quality are available in a very wide range of sizes and shapes, so the reconstruction of a breast that is as natural as possible is also a realistic outcome using an implant. If only an implant is used, it can be supplemented with an additional matrix that covers the implant. Recently, the most significant progress has been made using techniques with the patient's own (autologous) tissue: because, in most cases these days, fat reserves rather than muscle tissue are transplanted to reconstruct the new breast, these interventions have become much gentler and also more permanent.
Many patients only consider breast reconstruction at a later time: through their own preference or because they were not given the information about the current possibilities with onco-plastic surgery and, at the time of the disease, were not aware of the options open to them. However, breast reconstruction – a so-called secondary reconstruction
– is still possible at a later stage. In some patients, the desire for breast reconstruction only arises after some time. In contrast to immediate reconstruction, which takes place simultaneously with the removal of the tumour, subsequent breast reconstruction is associated with additional surgery. Depending on the situation, the aesthetic results are unfortunately not always comparable to those for an immediate reconstruction.
The goal of any breast cancer treatment is to go directly to the desired outcome with as few complications as possible for the patient and as little effort as possible on their part. The best cancer treatment will always go hand-in-hand with maintaining the patient's quality of life and physical integrity.