Like chemotherapy and hormone therapy, targeted therapy is an adjuvant treatment that complements the surgical procedure. Targeted therapy therefore focuses on cells that have become detached from the original growth (metastatic cells).
Read here more about targeted therapy in general.
In breast cancer, the most commonly used targeted therapies are trastuzumab (Herceptin), pertuzumab (Perjeta) and bevacizumab (Avastin).
About 1 in 5 breast cancers are HER2 positive, which means that the breast cancer cells on their surface have a lot of HER2 / neu proteins. Herceptin can work in these women. If you are not HER2 positive, Herceptin will not work.
Reconstruction after breast cancer treatment
- Plastic surgery
For whom is plastic surgery after breast cancer suitable?
Plastic surgery techniques are getting better and safer. The possible physical and psychological benefits also ensure that this type of surgery can be proposed to all patients who need to have a mammectomy. Any woman, regardless of her age or the stage of her illness, can request a reconstruction if she wishes.
When is the best time for this?
Usually, a period of several months after the initial operation (mammectomy) is waited to perform such a reconstruction. However, it is also possible to reconstruct the breast during the mammectomy. The breast is usually reconstructed after the end of chemotherapy or radiotherapy treatments. In some cases, the future reconstruction technique before the mammectomy is chosen so that the surgeon can take it into account when making his incisions.
The reconstruction with prosthesis
The most important factor in choosing this type of reconstruction is the quality of the skin. There must be enough skin and it must be supple. With too thin skin, this reconstruction will sooner or later fail. Good skin is therefore essential for a safe placement of the prosthesis. This way the chest will also be round enough. There are different types of prostheses, such as those with a silicone shell containing silicone gel or physiological serum.
This is placed under the pectoralis major muscle and the anterior toothed muscle to prevent the formation of a hard connective tissue capsule and a stiff-looking chest. The fixed volume of these prostheses is a disadvantage because it does not adapt when you lose weight or gain weight.
Prosthesis due to tissue expansion
With tissue expansion, a balloon is placed under the skin or under a muscle and gradually inflated over a few weeks, until the volume is large enough and the curve of the breast is good. This type of reconstruction is only possible if the skin is healthy and has all the elastic properties. So she must not have been irradiated.
The main disadvantages of this technique :
- The expulsion takes a long time and is sometimes unpleasant
- The reconstructed breast has little or no mobility
- The breast does not follow the natural collapse you get as you get older
- Biggest advantageof this technique: this is a much lighter operation than that needed for a reconstruction with skin-muscle flaps.
The reconstruction with living tissue
The reconstruction with a flap of the straight abdominal muscle
The surgeon may decide to use one of the abdominal muscles, the so-called ‘straight abdominal muscle’, and some skin and fat to reconstruct the chest (the ‘TRAM technique’). Patients are often seduced by this technique because they get a new breast and a flat stomach in one operation. However, it is not a minor procedure and one has to take into account the risk of a hernia at the level of the abdomen.
The reconstruction with a skin flap of the large back muscle
This technique uses the skin of the armpits (the so-called ‘lily technique’). That skin zone is divided into 3 ‘petals’ that are supplied with blood vessels by the large back muscle. After breast cancer treatments, the breast is then reconstructed with this tissue.
The free tissue reconstruction
There are other tissue zones that are useful for breast reconstruction. For example, there is the large back muscle opposite the operated chest or the large buttock muscle. The surgeon uses these different flaps to remove as few muscles on the abdominal wall as possible.
Advantages of living tissue reconstruction
- The reconstruction is final.
- The chest is flexible and has a natural shape and firmness.
- The amount of fat it consists of evolves naturally as you lose or gain weight.
- The reconstructed breast ages with the body, so the breasts remain symmetrical for longer than with a prosthesis.
Symmetry and nipple reconstruction
The breasts are made symmetrical by reducing or enlarging the other breast. If necessary or if the patient chooses, this is done at least 3 months after reconstruction so that the reconstructed breast can find its final shape and volume. At the same time, the nipple of the new breast is also reconstructed.
The nipple is usually reconstructed several weeks and even months after breast reconstruction. This waiting time is necessary because the new tissue has to find its place, so that the nipple cannot be placed too early.
The nipple reconstruction is done either:
With the tattoo technique (in most cases)
With removed tissue (from the inside of the buttocks, at the back of the ears or even the vulva)