Mastectomy with Implant Reconstruction in Breast Cancer Patients

Introduction

Breast cancer is the second most common cancer in Myanmar according to GLOBOCAN Data 2022 for Myanmar. Breast cancer is the most common cancer in women in Myanmar¹ According to the cancer registry 2017 (Yangon General Hospital), breast cancer accounts for 17 to 19% of all types of cancers.

The incidence rates of breast cancer increased in most countries whilst the mortality rates declined in most nations. Breast cancer incidence was found to increase in a substantial number of countries in the younger population. With the ageing and growing population, and the increasing prevalence of many risk factors, a further substantial rise in the incidence of breast cancer could be expected.³

Despite advances in conservation of breast cancer treatment, many patients still undergo therapeutic mastectomy which is advised when a conserving surgery would lead to distortion of the form and contour of the breast, when tumor is multifocal, or when most of the breast is involved.⁴

Breast implants remain the most common implanted medical devices in plastic surgery operating rooms. Over 350,000 women underwent cosmetic breast augmentation in the Unites States in 2021, making it the second most popular aesthetic procedure next to liposuction.⁵

Immediate reconstruction has been considered the golden standard of breast reconstruction by many centers. Patients with immediate breast reconstruction have been suggested to experience less emotional distress and fewer depressive symptoms.⁶

The timing of the breast reconstruction does not influence the HRQL in long-term follow-up in patients with mastectomy and breast reconstruction. Thus, both the method and timing of the reconstruction should be determined in cooperation with the surgeon and patient, depending on patient characteristics, preferences, and the profile of the disease.⁷

Immediate breast reconstruction after mastectomy is a feasible procedure. Immediate reconstruction with breast implant is rare in the developing countries. Implant reconstruction is starting recently in Myanmar.

This study is a case series of implant reconstruction after mastectomy.

The study was carried out according to the guidelines of the research and ethic committee of Yangon General Hospital and University of Medicine 1, Yangon.

Case 1

A 35-year-old woman presented with right breast lump for two months. Core-needle biopsy was carried out and ductal carcinoma in-situ was detected. Total mastectomy and immediate reconstruction with breast implant were carried out. (Fig. 1) The post-operative period was uneventful.

Case 2

A 43-year-old woman came to the out-patient department with left breast lump of three months’ duration. Core-needle biopsy showed DCIS. Total mastectomy and immediate implant reconstruction was performed. (Fig. 2) There was no significant post-operative complications and regular follow-up was carried out.

Case 3

A 39-year-old woman presented with right breast lump of three months duration. Excisional biopsy was carried out in a district hospital. Biopsy result showed mucinous micropapillary carcinoma of right breast. The patient underwent right total mastectomy and axillary sampling and immediate implant reconstruction. (Fig.3) The patient developed seroma in the post-operative period and repeated needle aspirations were carried out. The patient is satisfied with her shape.

Case 4

A 49-year-old woman presented with left breast lump for two months duration. Excisional biopsy showed invasive duct carcinoma. The patient underwent left total mastectomy and axillary dissection and immediate implant reconstruction. (Fig. 4)

Case 5

A 24-year-old woman presented with right breast lump for two months duration. She underwent excisional biopsy. Histology reported as right DCIS. She continued to right mastectomy and immediate implant reconstruction. (Fig. 5)

Case 6

A 40 year old woman presented with right breast lump for four months duration. She underwent excisional biosp and the result was invasive duct carcinoma. She underwent underwent total mastectomy and axillary dissection (level 2) and adjuvant chemotherapy and rediotherapy. She had delay implant reconstruction.(Fig. 6)

Discussion

Total mastectomy was commonly performed in developing regions in spite of more conservative surgery in developed countries. Patients may encounter both physical and psychological impact after mastectomy. Immediate reconstruction after mastectomy can reduce the physical and psychological impact and can improve the quality of life after mastectomy.

Post-mastectomy breast reconstruction affords psychological, social, emotional, and functional improvements and enhances self-esteem, sexuality, and body image. Patients requiring breast reconstruction face complex decisions regarding reconstruction type and timing.⁶

An increasing frequency of post-mastectomy breast reconstruction procedures is evident, with a predominant trend toward implant breast reconstruction. Analysis of breast reconstruction statistics using the HIRA Big Data Hub is helpful in predicting breast reconstruction trends and provides useful information to patients. It was indicated that NHIS coverage of breast reconstruction has led to annual increases in the breast reconstruction.⁸

In this case study, total mastectomy and implant reconstructions were carried out with good patient satisfaction and post-operative outcomes. Breast reconstruction service needs to become more accessible.

Conclusion

Breast cancer is the commonest among women. Mastectomy is commonly performed. In the early phase of the breast clinic, only a few patients received breast reconstruction. Both physical and psycho-social well-being should be considered in treatment of breast cancer patients. Breast reconstruction with implant can improve the psycho-social well-being in breast cancer patients. More team work and co-operation are needed to establish comprehensive service for the breast cancer patients.

Conflict of interest

There is no conflict of interest.

References

Globocan. (2022) Estimated cancer incidence, mortality and prevalence worldwide. Available from: https://gco.iarc.fr/today/data/factsheets/populations/104- myanmar-fact-sheets.pdf
Cancer registry 2017, Yangon General Hospital
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Fig. 1 a 35-year-old woman with right breast DCIS. Total mastectomy and immediate reconstruction with breast implant were carried out.

Fig. 2. A 43-year-old woman with left DCIS. Total mastectomy and immediate implant reconstruction was performed

Fig.3 A 39-year-old woman with right ca breast underwent right total mastectomy and axillary sampling and immediate implant reconstruction

Fig 4. A 49-year-old woman with carcinoma of left breast who underwent total mastectomy and axillary dissection and implant reconstruction

Fig. 5 A 24-year-old woman with right DCIS who underwent right nipple sparing mastectomy and immediate implant reconstruction

Fig.6 A 40-year-old woman with rght ca breast who underwent total mastectomy and axillary dissection (level 2) and adjuvant chemotherapy and rediotherapy, and delay implant reconstruction

Author Information

Sie Thu Myint^1,2, Zin May Win^1,2, Aung Myat Thu³, Nay Nay Win, Thiri Aung¹, Soe Lin^1,2, May Thwe Thwe Win¹, Naing Lin Zaw¹, Htun Thuya^1,2, Thein Lwin¹