Following mastectomy the entire breast can be reconstructed nicely using either implants or tissue or both. Common methods include tissue expander-implant combination or Latissimus Dorsi flap [flap of skin-fat-muscle from the back] or TRAM flap [tissue brought up from the lower abdomen]. Dr. Mohan chooses the best method after taking into consideration the oncological details of the case, body shape and tissue availability and patient preferences. Reconstruction may be combined with the mastectomy [Primary reconstruction] or more commonly done after the patient has completed her cancer treatments [Secondary Reconstruction]. Finally the nipple-areola is reconstructed and the opposite breast is also altered to achieve symmetry with the newly constructed breast.
A recent advancement is called Nipple and Skin sparing mastectomy [NSM] is usually done with primary reconstruction. This and variants on this theme are called Oncoplastic surgeries. Plastic surgeons are thus increasingly getting involved even in the cancer resection while keeping breast preservation in mind. At all times the safety in terms of assuring proper cancer removal is very important. Only selected patients with small early tumors are suitable for this. This type of skin-nipple preserving surgery is available in our service. Such cases are done along with the breast surgeon or the general surgeon in charge of the patient.
Even if reconstruction is not desired or recommended in the primary setting, a consultation with the plastic surgeon soon after the diagnosis and staging and prior to the mastectomy is useful – both for the patient to be aware of her options and for the plastic surgeon to collaborate with the general surgeon and oncologist for planning the delayed reconstruction. Sometimes the plastic surgeon is able to offer an oncoplastic surgery, perfectly safe for the malignancy while avoiding unnecessary mutiliation.