Immediate or delayed rebuild ?
Immediate reconstruction is not recommended for inflammatory breast cancer (IBC) for several reasons:
- the recurrence rate is high and it is important to be able to monitor the breast area;
- reconstruction may make it more difficult to detect a recurrence;
- the risk of complication (eg infection or healing problem) is higher with a mastectomy followed by immediate reconstruction than with only a mastectomy. Since inflammatory breast cancer develops in layers, such as cotton candy, and not a solid mass, it is more difficult to be certain that it has been removed during the mastectomy. radiation therapy is therefore a very important component of the treatment and aims to eliminate small cells that might have remained. A complication can delay radiation therapy and allow the remaining cancer cells to start growing again…
- with the required processing, the final result is better when the reconstruction is deferred:
- the failure rate is higher for implant reconstruction that takes place before radiation therapy;
- there is often a shrinking or adipose necrosis if autologous reconstruction is done before radiation therapy;
- the presence of a breast mound often requires higher energies to obtain the same dose of radiation therapy. This can increase the doses received by the healthy organs around, including the heart and lungs, and this is undesirable.
- some types of surgical procedures for reconstruction remove little or no skin. However, in case of IBC it is necessary to remove as much skin as possible since it is affected.
When to rebuild?
There was a time when reconstruction, even deferred, was totally discouraged. Now they say 2 years after the end of radiation therapy. Why 2 years? Because this represents the period when the risk of rapid recurrence is highest.
With which method?
3 factors always influence the choice of method in case of IBC since they are related to the required treatments:
- the extent of the mastectomy and the amount of tissue removed from the breast;
- other treatments received, including radiation therapy because it can cause skin changes;
- tissue health in the region to be rebuilt;
At the risk of repeating myself, the only surgery advised in the case of IBC is the modified radical mastectomy. This means removing the entire breast, the maximum possible skin (including the areola and nipple) as well as axillary lymph nodes on the affected side. Radiation therapy is mandatory and causes skin changes as the skin of the irradiated area becomes less flexible.
The extent of the mastectomy, the amount of skin removed and the lack of flexibility of the skin due to radiation therapy make it difficult to use a breast implant as a unique method when reconstructing after IBC. We must turn, at least in part, towards autologous methods. You have to look at the more personal factors to determine which one is best suited to your situation.
- MD Anderson Cancer Center. POE – The Role of Surgery in Inflammatory Breast Cancer Patients. Retrieved from https://www.mdanderson.org/transcripts/poe-ibc-surgery-role-lucci.htm.
- The IBC Network Foundation. Patient Resources – APP. Retrieved from https://www.theibcnetwork.org/patient-resources-app/
- Rose Magazine. Les choix de reconstruction mammaire après un cancer du sein. Retrieved from http://www.rosemagazine.fr/magazine/sante/article/reconstruction-mammaire-cancer-sein (in French)
- Canadian Cancer Society. Breast reconstruction. Retrieved from http://www.cancer.ca/en-ca/cancer-information/cancer-type/breast/supportive-care/reconstruction/?region=qc
- Institut National Du Cancer. Reconstruction mammaire – Cancer du sein. Retrieved from http://www.e-cancer.fr/Patients-et-proches/Les-cancers/Cancer-du-sein/Reconstruction-mammaire (in French)