Using belly fat to reconstruct breasts for women with cancer

Ho Chi Minh City Ms. Hoa, 45 years old, has breast cancer, had surgery to remove the tumor and combine it with taking autologous fat from her abdomen to reconstruct her bust.

Ms. Hoa discovered a tumor in her left breast three months ago. The results of a fine needle aspiration and biopsy showed stage one breast cancer. Her doctor advised her to have a mastectomy on one side, but she was afraid that the breasts would not be asymmetrical and would affect her appearance. She came to Tam Anh General Hospital in Ho Chi Minh City hoping to have breast reconstruction right after the cancer surgery so that she could quickly return to work and be more confident after treatment.

On November 24, Dr. Huynh Ba Tan, Department of Breast Surgery, said that the patient weighed 84 kg, was 1.6 m tall, and had a lot of excess fat around her waist. Therefore, the doctor advised removing the left breast gland, reconstructing the breast using the patient's rectus abdominis muscle flap (TRAM flap) combined with abdominal shaping.

After anesthesia, Dr. Tan used a pen to draw on the patient's chest and abdomen, determining the incision points. Then the doctor cut off the left breast, leaving the areola and nipple, and removing some excess skin.

The surgeon makes an incision along the line drawn on the abdomen, peels off the skin flap of the left rectus abdominis muscle. The team creates a tunnel from the abdomen to the left chest, and threads the skin flap and abdominal fat up to the chest wall. Next, the surgeon creates a new areola position, grafts the nipples, and sutures the wound, restores and shapes the abdomen.

Doctor Tan (left) and the Breast Surgery team perform surgery on a patient. Photo: Nguyen Tram — Doctor Tan (left) and the Breast Surgery team perform surgery on a patient. Photo: *Nguyen Tram*

According to Dr. Tan, thanks to the use of tissue flaps from the patient's own body, the reconstructed breasts are softer, the abdomen is flatter, and complications such as slow wound healing and easy infection when reconstructed with latissimus dorsi muscle flaps are avoided.

After 5 days of surgery, Ms. Hoa was discharged from the hospital with a note of caution when bending, standing, and holding and carrying objects to ensure safety after surgery.

Breast cancer treatment must combine safety and aesthetics. Early detection of the disease makes the treatment process simpler. Western women have large breasts, effective screening programs should detect early, most of them are treated conservatively - removing the tumor and part of the breast around the tumor. Meanwhile, most Asian women have small breasts, partial breast removal surgery does not achieve high aesthetic results, so breast-conserving surgery is not the best choice.

Breast reconstruction using a rectus abdominis flap is a difficult technique, according to Dr. Tan, requiring a surgeon with a lot of experience and high expertise. This technique uses skin and fat tissue from the patient's own lower abdomen, bringing softness and naturalness to the reconstructed breast.

Because the reconstructed breast is made from abdominal fat tissue, the size of the reconstructed breast will change according to weight. During the surgery, the doctor combines abdominoplasty (reducing the waistline) and does not need to perform complex microvascular surgery.

Patients are reconstructed immediately after breast cancer surgery to help the breasts look natural, save costs and avoid further surgery. Thanks to that, patients also avoid the feeling of severe illness and are more confident about their appearance.

Nguyen Tram

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