Beautiful After Breast Cancer Foundation

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 - Pedicled TRAM

The skin and fat of the lower abdomen between the umbilicus (belly button) and the pubic area are kept attached to the underlying rectus abdominis muscle. The muscle is divided at its lower end and rotated through a subcutaneous tunnel onto the chest wall. The origin of the muscle stays connected to the edge of the rib cage and therefore the blood supply to this tissue (superior epigastric artery) always remains intact.


There are two major disadvantages of the pedicled TRAM flap. Firstly, either one or both of the rectus abdominis muscles have to be sacrificed and this can lead to functional problems. Patients may notice a decrease in core strength during flexing or bending of the torso. Bulging of the abdominal wall or a hernia can also develop at the site of muscle harvest. Secondly, the blood supply to the overlying tissue is not always ideal because of the long distance it has to travel. Twisting of the muscle during transfer can also compromise the blood supply.


A pedicled TRAM flap therefore has a higher incidence of both partial necrosis and fat necrosis. In addition, it is more difficult to shape, and there is often a bulge in the upper abdomen corresponding to the subcutaneous tunnel. However, a pedicled TRAM is technically less challenging in comparison to a free TRAM or free DIEAP flap because no microsurgery is involved.

a b

Figure: The pedicled Transverse Rectus Abdominis Muscle (TRAM) flap: the flap is based on one or both rectus abdominis muscles (only right rectus muscle in this drawing) (a) and is transfered to the chest wall through a subcutaneous tunnel (b).

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


Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction: an experimental study and clinical case report. Scand J Plast Reconstr Surg. 1979;13:423.


Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a trasverse abdominal island flap. Plast Reconstr Surg. 1982;69:216-225.


Moon HK, Taylor GL. The vascular anatomy of the rectus abdominis muscolo-cutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg. 1988;82:815-822.


Nair N, Atisha DM, Streu R, Collins ED, Diehl K, Pearlman M, Alderman AK. An innovative approach to the primary surgical delay procedure for pedicle TRAM flap breast reconstruction. Plast Reconstr Surg. 2010;125(4):173e-174e.


Berrino P, Santi P. Preoperative TRAM flap planning for postmastectomy breast reconstruction. Ann Plast Surg. 1988;21(3):264-72.


Bostwick J 3rd, Jones G. Why I choose autogenous tissue in breast reconstruction. Clin Plast Surg. 1994;21(2):165-75.


Clugston PA, Gingrass MK, Azurin D, Fisher J, Maxwell GP. Ipsilateral pedicled TRAM flaps: the safer alternative? Plast Reconstr Surg. 2000;105(1):77-82.