Delayed Reconstruction
Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery
Treatment Instructions
Delayed breast reconstruction refers to a situation where breast cancer patients do not choose to undergo breast reconstruction at the time of mastectomy, or they miss the opportunity for immediate reconstruction due to a lack of information. Some patients may temporarily decline reconstruction surgery due to fear of cancer, concerns about the success rate of the surgery, or other reasons. After completing breast cancer treatment, including chemotherapy and/or radiation therapy, they undergo breast reconstruction at a later time. This second surgery is known as delayed breast reconstruction.
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Medical Center Specifications and Equipment
The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe.
Is delayed reconstruction more difficult?
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Delayed breast reconstruction is slightly more challenging compared to immediate breast reconstruction. Factors such as insufficient skin, scar tissue from previous surgery, and underarm depressions after lymph node clearance are additional considerations.
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First, during a total mastectomy, if immediate reconstruction is not planned, the breast surgeon will remove excess skin and close the wound with a straight line. Therefore, in autologous tissue breast reconstruction, not only is fat from areas like the abdomen, back, buttocks, or thighs important, but the skin covering the area is also crucial. If the patient opts for implant reconstruction or desires scar placement similar to immediate reconstruction (limited to a smaller area), an additional step is required: inserting a tissue expander to stretch the skin.
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The second challenge is the scar tissue adhesions or fibrosis within the entire chest area. During the reconstruction surgery, the surgeon must carefully release these scars to create a well-shaped breast.
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The third issue is the noticeable depression in the underarm, caused by the removal of most lymph nodes. If this depression can be filled during reconstruction, the result will be much more satisfying, particularly improving clothing options and comfort, especially in summer.
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Another technical challenge arises with free flap breast reconstruction. The surgeon must find a healthy set of blood vessels in the chest to supply blood to the flap. In delayed reconstruction, the thoracodorsal artery may sometimes be unusable due to damage from the first surgery or because severe scarring makes dissection difficult. However, this issue is not the most difficult for experienced surgeons. Most skilled and up-to-date surgeons now use the internal mammary vessels for anastomosis. Although the internal mammary technique is more complex than using the thoracodorsal artery and less experienced surgeons may be hesitant to use it, it yields better results. The fat in the flap survives well due to the abundant blood supply.
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While delayed reconstruction presents certain challenges, these can be overcome by experienced surgeons. Delayed breast reconstruction can still achieve a natural and beautiful result, making it a highly recommended procedure. Breast cancer survival rates have significantly improved, and we sincerely believe that patients should not have to endure ongoing inconvenience or lifelong feelings of loss and regret due to the absence of a breast.
When can delayed reconstruction be done?
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According to research from the world’s leading cancer hospitals, it is now widely accepted that breast reconstruction can be performed at the same time as mastectomy without increasing the risk of breast cancer recurrence or interfering with the detection of any potential recurrence. As a result, this is not just a trend but the reason why every breast cancer patient, once diagnosed, is immediately referred to a plastic surgeon to discuss reconstruction options. Therefore, the best time for breast reconstruction is whenever the patient expresses a desire to undergo the procedure.
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In the past, doctors used to advise patients not to undergo reconstruction within two years of a mastectomy, as most breast cancer recurrences happen within this period. However, in recent years, this restriction has been lifted. In Taiwan, particularly at Chang Gung Memorial Hospital, the recurrence rate is 4-5%, while in the U.S. it is 2-3%. Considering the 4-5% recurrence rate versus the 95% of patients whose quality of life and psychological well-being can be improved, such advice now seems unreasonable and unfair. Helping patients feel truly free from breast cancer as soon as possible is the greatest mission and source of fulfillment for reconstructive surgeons.
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The current consensus is that if chemotherapy or radiation therapy is required after mastectomy, breast reconstruction can be done once these treatments are completed. It is generally recommended to wait about one month after chemotherapy and 3 to 6 months after radiation therapy before proceeding with breast reconstruction surgery.
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第一階段：植入組織擴張器，將其撐大至需要放植入物的大小
圖一、組織擴張器
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第二階段：移除組織擴張器，更換植入物（矽膠袋或生理食鹽水袋）
平滑面義乳
絨毛面義乳
香榭柔滴 Sebbin
Sebbin總部位於美學流行之都巴黎，是歐洲領先擁有35年製造醫療植入物的製造商，目前臨床已發表超過20篇國際期刊及10年追蹤報告。並提供10年安心保固服務。
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香樹柔滴隆乳的觸感是否自然？像真實的胸部嗎？
Sebbin 的乳房植體在硬度上、形狀、尺寸上有多種不同的選項，種類包含光滑的圓形植體、微紋理的圓形植體、解剖結構式的植體，可依據不同胸型提供不同選擇，採用極柔軟的觸感－Nanoskin科技，如同真實胸部的軟組織般柔軟自然。隆乳時使用FDA認證廠商出產的材料，更能確保身體的健康及安全。
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義乳內建識別碼，術後可追蹤品質
香榭柔滴Sublimity的微紋理圓形植體，除了為極高黏性材質且更為柔軟之外，每個植體皆帶有可識別的激光碼，可以用來追蹤植入物的信息。此編號位於植體隨附的標籤上，手術後會記錄在病患的病歷卡上。
臨床手術追蹤10年後，只有不到1%的手術者表示義乳有產生破裂或莢膜攣縮的症狀。這也證實了香榭柔滴Sublimity發生莢膜攣縮的機率極低，特殊的微紋理材質確實降低了攣縮機率。
※ 擁有10年安心保固服務
乳型定位不走山：「義乳按摩+彈性繃帶」一定要學會
平滑面的植入物必須定時按摩，每日按摩3次，1次10至15分鐘，將植入物往內、上、左、右等不同方向按摩運動，要按照醫師及治療師個別評估指導的 按摩方式為佳，按摩至少需要3∼6個月。也可以採用綁彈繃方式，每日約綁2個小時即可放鬆，1天可綁一至二1-2次，以及睡前可以趴睡的姿勢（術後滿1個月再執行）約15分鐘即可，以維持植入物空間的穩定。
What methods can be used for delayed breast reconstruction?
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The first method we need to mention is using implants, which can be saline or silicone gel implants. As previously mentioned, in delayed breast reconstruction, there is typically insufficient skin on the chest. Therefore, if implants are used for reconstruction, a tissue expander will be needed as a transitional phase. As the name suggests, a tissue expander is used to stretch the skin or tissue. It requires an initial surgery to place the expander under the skin. Typically, the skin is expanded to be slightly larger than the other breast. After about three months, once the skin has stabilized, a second surgery is performed to remove the expander and replace it with a permanent implant.
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The second method involves using local autologous tissue or performing breast reconstruction surgery with a free flap.
The most suitable methods for breast reconstruction after radiation therapy.
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If a patient has received radiation therapy, it is not recommended to use only tissue expanders and implants for reconstruction. This is because radiation therapy can cause fibrosis of the skin on the chest, which not only increases the risk of capsular contracture leading to a poor aesthetic outcome but also makes the skin more susceptible to poor wound healing and exposure of the implant.
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If autologous tissue is insufficient and the patient must choose implant reconstruction, it is recommended that the patient select a latissimus dorsi flap combined with an implant for reconstruction to achieve a result that is both aesthetically pleasing and safe.
Contact Dr. Cheng For A Consultation
If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients.