Breast Cancer and Reconstruction
Reconstruction after breast cancer surgery is becoming more common. More than 70% of women, who have mastectomies at our institution, undergo immediate reconstruction. Breast reconstruction can be performed immediately after breast removal or can be delayed for a later date. Both the timing of the surgery, and the type of reconstruction performed, are decisions made between the patient and her surgeon.
Skin Expansion: A common procedure for breast reconstruction utilizes a tissue expander, which is inserted beneath the skin and chest muscle. Over time, the expander is slowly filled with a salt-water solution until the skin over the breast area has been adequately stretched. While some expanders are designed to be left in place as the final implant, other inserts are available for implantation once the tissue expander has been removed. The nipple and the areola are then reconstructed. This type of reconstruction requires three surgical procedures including expander placement, implant exchange, and nipple reconstruction.
Flap Reconstruction: Another alternative approach involves using a flap of skin and muscle transferred from another area of the body (i.e., abdomen, back, thigh or buttocks) to reconstruct the breast. The flap can remain attached to the donor site and rotated into the breast area, maintaining its blood supply. Alternatively, the flap can completely be disconnected from the donor site and relocated over the breast area where the blood vessels will need to be reconnected. The flap can be used in conjunction with a saline implant or alternatively can be used alone to reconstruct the breast.
Follow-up procedures may need to be performed in order to obtain a symmetrical result for both breasts. This may include enlarging, reducing, or lifting the other breast to match the reconstructed breast.
Individuals at greater risk for developing skin cancer are those who have:
- High exposure to ultraviolet radiation from the sun, sunlamps, or tanning booths
- Fair skin type that freckles easily
- Light-colored hair and eyes
- A large number of moles, or moles of unusual shape or size
- A family history of skin cancer or a personal history of blistering sunburn
- Received therapeutic radiation treatments for adolescent acne
Types of Skin Cancer
Basal cell carcinoma is the most common form of skin cancer. It is the least dangerous type of skin cancer. This form grows slowly and rarely spreads beyond the point of origin. Should basal cell carcinoma be left untreated, it can grow deep beneath the surface of the skin and spread into the tissue and bone underneath.
Squamous cell carcinoma is the second most common type of skin cancer and is most commonly found on the lips, face, or ears. In some instances, it will spread to areas such as the lymph nodes or internal organs. If left untreated, squamous cell carcinoma can be life threatening.
Malignant melanoma is the least most common form of skin cancer but is also the most dangerous type. The incidence of melanoma is increasing, especially in the Sunbelt states. If the melanoma is diagnosed early enough, it can be completely treated. However if treatment is not obtained quickly, it may spread throughout the body, and can be fatal.
The ABC’s of Recognizing Skin Cancer
Asymmetry — a growth with unmatched halves
Border irregularity — ragged or blurred edges
Color — a mottled appearance, with shades of tan, brown and black, sometimes mixed with red white or blue
Diameter — a growth more than 6 millimeters across, or any unusual increase in size
Diagnosis and Treatment
Diagnosing skin cancer involves removing all or part of the growth and examining the cells under a microscope.
Treating a small sized skin cancer can be completed quickly and easily, typically in an outpatient setting. The procedure may involve scraping the site to remove the growth, or a simple excision. Treatment of larger skin cancers, or cancers that have spread within the body, often requires major surgery, including skin grafting, local and distant flaps.
Additional treatments include the use of cryosurgery (freezing the cancer cells), radiation therapy (using x-rays), topical chemotherapy (anti-cancer drugs applied directly to the skin), and Mohs surgery, a special procedure where the cancer is shaved off one layer at a time. Mohs surgery is done in areas such as the face to be sure all the margins are clear while limiting the size of the excision.