Prevention
Modern medicine is increasingly transitioning towards preventive care. This shift towards prevention has also been observed in breast cancer care in recent years, particularly with the discovery of the BRCA gene. Subsequently, multiple genes and risk factors have been identified. Depending on these factors, a personalized screening strategy can be chosen. Therefore, it is crucial to understand these genetic and risk factors.
Diagnosis
I was diagnosed with cancer ... This website serves as a portal designed to assist you and your loved ones in accessing personal information and finding solutions to your concerns.
The primary goal of this website is to offer guidance and support to patients as they navigate their journey toward recovery and improved quality of life. The "Diagnosis" section of our website is divided into two main categories. Firstly, under "Anatomy and Physiology," we provide fundamental knowledge about the breast. Secondly, in the "Tumors and Disorders" section, we delve deeper into various breast-related conditions.
Moreover, we aim to provide information to women who may be concerned about potential breast issues but are hesitant to seek immediate medical advice. Knowledge and information can often offer immediate reassurance if a woman is able to identify the issue herself and determine that no specific treatment is necessary. Conversely, we also strive to educate women who have received a diagnosis of a serious breast condition, such as breast cancer, and wish to approach their doctor well-informed and prepared.
Treatment
The treatment for breast cancer should immediately include a discussion about reconstruction. Our foundation has no greater goal than to raise awareness of this among patients and oncological surgeons. By making an informed decision beforehand, we avoid closing off options for later reconstruction while still considering the oncological aspect. Of course, survival is paramount, and the decision of the oncologic surgeon will always take precedence.
The "Reconstruction or not?" page contains all the information you can expect during an initial consultation before undergoing tumor removal. This page is comprehensive, and your plastic surgeon will only provide information relevant to your situation.
"Removing the tumor" details the surgical procedure itself. This is the most crucial operation because effective tumor removal remains paramount. We guide you through the various methods of removal, a decision often made by a multidisciplinary team comprising oncologists, radiologists, pathologists, radiotherapists, breast nurses, gynecologists, oncological surgeons, and plastic surgeons.
The "Breast Reconstruction" section includes information and illustrations of the different reconstruction options along with corresponding steps.
Revalidation
Those treated for cancer often need a long period to recover.
Cancer is a radical illness with a heavy treatment. Often, people have to deal with psychosocial and/or physical problems afterwards, such as stress, anxiety, extreme fatigue, painful joints, reduced fitness, lymphedema... This can have a major impact on general well-being.
There are rehabilitation programmes offered by most hospitals. We cover some of the major topics here.
Quality of life
Quality of life is a key factor in coping with breast cancer. Therefore, it is important to find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, physical exercise... Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping, as well as focusing on mental strength to allow the patient to move on with life. In this section we are addressing some topics that patients experience during and after treatment and we are providing information to address them.
Abdomen - Free TRAM
The free Transverse Rectus Abdominis Muscle (TRAM) flap was developed to address some of the concerns with the pedicled TRAM flap.
In a free TRAM flap the same amount of skin and fat are harvested from the abdominal wall, but only the lower part of the rectus abdominis muscle is sacrificed. Blood flow to the tissue is supplied by the deep inferior epigastric artery and vein which are divided in the groin and the TRAM flap completely detached from the patient (fig. 1).
The tissue is transferred to the chest wall where both the artery and vein are reconnected to similar vessels, either in the armpit (thoracodorsal vessels) or beside the sternum (internal mammary vessels). These blood vessels have a diameter of 15 to 25 mm and are joined together under the operating microscope. This is very delicate, precise surgery which prolongs the operating time.
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| a | b |
Figure 1: The free TRAM flap gets its normal blood flow from vessels coming from the groin (the inferior epigastric artery and vein). (b) These vessels are hooked up to recipient vessels through microsurgery.
A similar amount of skin and fat can be utilised, but with a smaller piece of the rectus abdominis muscle. This is called a muscle sparing free TRAM flap (fig. 2). It causes less muscle weakness post-operatively and a lower incidence of abdominal wall problems.
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| a | b |
Figure 1: The muscle-sparing free TRAM flap gets its normal blood flow from the same vessels coming from the groin (the inferior epigastric artery and vein). (b) Similar to the free TRAM flap, these vessels are hooked up to recipient vessels through microsurgery.
It is the microsurgical connection or anastomosis that can potentially give rise to problems. A blood clot (thrombosis) occurs at this site in approximately 3 to 4 % of patients. It most frequently happens during the first 48 hours following surgery and therefore every patient is closely monitored by specialized nurses during this period. If a thrombosis occurs, a further operation is required to remove the clot and re-establish the blood flow. If the clot cannot be removed this leads to complete loss of the flap (0.5 to 1% of cases).
However, in addition to reducing the abdominal wall deficit, the free TRAM has an improved blood supply because there is no twisting of the flap during transfer. It is also easier to create an aesthetically pleasing breast shape.
Incidence of complications:
| Pedicled TRAM | |
| Return to theatre | 2 |
| Partial flap necrosis | 11.1 |
| Fat necrosis | 6.4 |
| Total flap loss | 1.3 |
| Seroma | 8 |
| Haematoma | 2.2 |
| Infection | 4.1 |
| Abdominal bulge | 6.9 |
| Abdominal hernia | 3.4 |
References
Blondeel N, Boeckx WD, Vanderstraeten GG, Lysens R, Van Landuyt K, Tonnard P, Monstrey SJ, Matton G. The fate of the oblique abdominal muscles after free TRAM flap surgery. Br J Plast Surg. 1997;50(5):315-21.
Larson DL, Yousif NJ, Sinha Rk, et al. A comparison of pedicled and free TRAM flaps for breast reconstruction in a single institution. Plast Reconstr Surg. 1999;104:674-680.
Blondeel PN, Arnstein M, Verstraete K, Depuydt K, Van Landuyt KH, Monstrey SJ, Kroll SS. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg. 2000;106(6):1295-9.
Kroll SS. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg. 2000;106:576–583.
Blondeel PN. Venous augmentation of the free TRAM flap. Br J Plast Surg. 2002;55(1):87.
Man LX, Selber JC, Serletti JM. Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review. Plast Reconstr Surg. 2009;124(3):752-64.
Blondeel PN. Discussion: perfusion-related complications are similar for DIEP and muscle-sparing free TRAM flaps harvested on medial or lateral deep inferior epigastric artery branch perforators for breast reconstruction. Plast Reconstr Surg. 2011;128(6):590e-2e.
Blondeel PN, Neligan P. Are bilateral TRAM flaps as good as bilateral DIEP flaps? Plast Reconstr Surg. 2011;128(2):590-1; author reply 591-2.