Breast reconstruction after mastectomy for cancer is changing. And the pandemic has accelerated this change. In this year, in fact, the cases of immediate reconstruction have increased, performed during the same operation in which the tumor is removed, and without the need to return to the operating room.
According to a survey conducted by the Beautiful After Breast Cancer (Babc) association which involved 13 of the major Breast Units of the peninsula, the number of “one-step” reconstructions – in which the definitive prosthesis is inserted from the beginning and no longer under the pectoral muscle, but above – it grew by more than 15%. It is the only countertrend, that is positive, in a period marked by the decline in the diagnosis of breast cancer and, consequently, in operations.
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What is reconstruction with pre-pectoral prosthesis
In general, however, the statistics of the 13 centers interviewed are better than expected and do not show a reduction in reconstruction interventions like the one that had been envisaged: the decrease was on average just 5%. Instead, it will be necessary to wait for national data to get a more general idea of how many reconstructions are left behind, especially in small hospitals.
“In large breast centers, reconstructions have continued despite the pandemic, with numbers comparable to those of the pre-Covid years,” he says. Marzia Salgarello, director of the plastic surgery department of the Gemelli University Hospital Foundation in Rome and president of Babc: “It is a positive fact, especially if we consider that in other European countries, such as the Netherlands and the United Kingdom, breast reconstructions have completely stopped. Italy did not share this thought and reconstruction with pre-pectoral prostheses in just one time, which began to spread about six years ago, proved to be the gold standard “.
The advantages are different, continues Salgarello: “First of all it requires a mastectomy that I call ‘anatomical’, in which only the mammary gland is removed, respecting the surrounding tissues and vascularization. Since it is not necessary to ‘lift’ the pectoral muscle, surgery is less aggressive. Moreover, it does not require an expander, a sort of balloon that inflates little by little to accustom the tissues before inserting the definitive prosthesis, about a year after the first operation. in shorter times in the operating room, in fewer days of hospitalization and fewer visits to the hospital for dressings: important factors in times of pandemic. There are also advantages from a functional and aesthetic point of view, because over time the reconstructed breast will behave exactly as it would naturally. “
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But the tumor must be small
Not only the needs dictated by the health situation have played in favor of the diffusion of this reconstructive technique. This is made possible by early diagnosis, thanks to which tumors are increasingly discovered when they are still localized and small. Added to this is the increasingly widespread use of neoadjuvant therapy, which is administered before surgery and which has the effect of reducing the size of the tumor, sometimes until it disappears. In the event of a mastectomy, the subcutis, the skin and the areola-nipple area can be preserved and there is no longer any need to cover the prosthesis with resistant tissue such as muscle.
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The Donna x Donna project
Babc’s investigation is part of the “Donna x Donna” project, an all-female initiative that for three years has brought together 21 specialists in plastic-reconstructive surgery, breast and psycho-oncologists. The experts collect their patients’ doubts and answer them in a publication that can be downloaded for free.
The first year the topic addressed was the risk of lymphoma associated with breast implants, the second year the reconstruction of the breast with implants in the pre-pectoral area, while this year the brochure is dedicated precisely to doubts about Covid, vaccinations and reconstruction .
Like this: I have breast implants. Could the vaccine cause allergic reactions or inflammation in the breast? “We must not underestimate the fears of patients, because even today many women postpone breast examinations and even reconstruction for fears related to the coronavirus“, explains Salgarello: “Due to the stop and delays in screening programs, we expect a period in which we will see more advanced diagnoses again. But it will be short if we encourage women to return to hospitals, which are now safe places. “
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Messages from Bra Day
There is another important message to get across: the plastic-reconstructive surgeon should be present in all multidisciplinary breast care centers. Only in this way will it be possible to guarantee quality reconstruction for women. It was launched by the Italian Society of Reconstructive-Regenerative and Aesthetic Plastic Surgery (Sicpre) which for the Good Day, the International Day for Breast Reconstruction Awareness which took place on October 20, organized the “Free to Choose” event, in which reconstructive surgeons from 33 breast centers answered live questions from patients. More than 3,600 women participated in the meeting (which can be seen on the Sicpre Youtube channel).
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“Often women do not know the different possibilities to reconstruct the breast after a tumor, nor do they know that the reconstructive surgery is completely covered by the National Health Service and therefore takes place at no cost to the patient”, she says. Carlo Magliocca, Sicpre president and head of the Breast Unit of the Fatebenefratelli Hospital in Rome. The concept from which we start is that reconstruction does not concern femininity, but the integrity of a person: it is not unrealistic – and therefore postponable, because it is seen as a ‘habit’, but it can have “extremely positive effects in terms of greater well-being and better physical and psychological recovery “.
All Breast Units should have the dedicated plastic surgeon
Another concept to remember is that today reconstruction can and must be personalized, like other cancer therapies. All-in-one surgery, for example, cannot be done when the breast has been treated with radiotherapy or if there has been a previous conservative surgery. In addition, there are cases where prostheses are not indicated and patients who simply do not want them.
“For these women there are other solutions – remembers Salgarello – they are more difficult and demanding reconstructions, but that every breast center must be able to offer”. In Italy, there are an estimated 50,000 new breast cancer diagnoses per year (55,000 in 2020, the latest available data). In about 80% of cases, conservative surgery can be used, while 10-12 thousand patients each year undergo mastectomy. Of these, half reconstruct their breasts: “A percentage – concludes the expert – is actually considered high. But still not enough”.
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