October is breast cancer awareness month. In today’s article, I will be writing about the different surgical options available to breast cancer patients to remove a tumour. Being diagnosed with breast cancer does not automatically mean you will require a mastectomy.
A mastectomy is the total removal of the breast organ on one side. A bilateral mastectomy is when the surgeon removes both the breast organs.
“There are certain times when one has to perform a mastectomy,” explains Dr Charles Serrurier, a specialist cosmetic and reconstructive plastic surgeon in Rosebank, Johannesburg. “If it is a large tumour, or when cancer appears over large areas of the breast, a mastectomy is the best option.” When the cancer is severe, like my own diagnosis, specialist surgeons almost always perform a mastectomy, followed by immediate reconstruction. The oncology surgeon then removes the breast organ and leaves behind the skin and the nipple, after which the plastic surgeon immediately replaces it with a similar size breast-shaped implant. Some-times, a lot of skin is lost during the mastectomy. The surgeon then uses a tissue expander, which is an inflatable device that allows the skin to be stretched slowly over time. “There are also many options when reconstructing the breast without an implant, using the patient’s tissue from donor sites,” explains Dr Serrurier.
“Common donor sites are flaps from the abdomen, inner thigh, lower back or buttocks.” The only challenge with using donor sites is what he calls “donor-site morbidity”, where the donor site has a scar and often weaker muscles. From a survival point of view, Dr Serrurier says the treatment outcomes of breast cancer patients are the same, irrespective of whether the tumour is small enough to remove or a mastectomy is done. “In 60 to 70 per cent of my breast cancer patients, it is possible to perform breast-conserving surgery. I remove the lump and then reconstruct the breast, either by a lift or reduction-type operation. Sometimes, I use a little tissue from underneath the arm or the upper part of the abdomen.” Breast reconstruction after a mastectomy is a prescribed minimum benefit (PMB).
When a patient is registered on the oncology benefit of a hospital plan or medical aid, the fund will pay for the reconstructive surgery. Dr Serrurier said all medical aids pay for breast reconstruction. However, “the lesser medical aids may have issues when making the natural breast similar in size and shape than the reconstructed breast.” Data reveals that patients who have had breast reconstructive surgery have a higher quality of life score. That is why Dr Serrurier always advises his patients to consider the procedure. Modern surgical techniques further help minimise scarring. “I can do a mastectomy on a medium-sized breast through a 75 mm cut,” he says. “When the tumour is in the upper quadrant of the breast, I cut around the nipple and go under the skin, which leaves the cleavage area scar-free.”
Post-operative scar management is also essential and involves taping, massaging, silicone dressings and, sometimes, steroid injections. Proper scar management leaves the scars aesthetically pleasing and often invisible. Although my journey has had several complications, including removal of the implant in my right breast because of an infection, I can honestly say that I made the right decision to opt for a bilateral mastectomy. The recovery process is long and hard, but worth it.
You can watch my video interview with Dr Serrurier on www.youtube.com/marisalouw.
