An expert in breast reconstruction in post-cancerous breast removal, Venkat V. Ramakrishnan explains how much this procedure can help women. “Removal of the breast is a huge blow to feminity. Every woman who has had a breast removed must be offered the possibility of reconstruction,” he tells Ramya Kannan. A consultant Plastic and Cosmetic surgeon in Essex, United Kingdom, Dr. Venkat was in Chennai, and at the meeting of the Royal College of Surgeons in Bangalore recently, to share his expertise.
“In the last fifty years, there have been great advancements in breast reconstruction techniques. As breast cancers are being detected early enough to be ‘cured,' women live longer and would like to get to normal as soon as possible,” Dr. Venkat says. His passion for micro surgery is obvious in the excitement in his voice and the sparkle in his eyes.
The fact is that 10 per cent of women in any population will get breast cancer. And for those with the BRACA 1 and 2 genes, there is almost a 100 per cent certainty that they will land up with breast cancer. In fact, there are women in Britain who come to the clinic to undergo the gene test, and if they test positive, even ask for removal of breasts in order to avoid cancer.
“Of course, this is only a small group. The presence of the BRACA genes is so strong an indicator of cancer that we do breast removal and since these women are really young, also offer reconstruction,” he says. Reconstruction implies today that a specialist surgeon can build a live breast (unlike silicon implants) using the patient's own tissue, and a blood vessel. “Now we can make breasts look almost as good as normal and have also recorded long-lasting results,” Dr. Venkat adds.
While Americans started reconstruction many years ago, Dr. Venkat says his programme in the UK began in 2002 with 22 surgeries. A manifold increase has resulted in about 340 surgeries last year. In India, he says, clinicians have recognised that reconstruction is the next step, but surprisingly, there is insufficient patient demand. In fact, there are instances when patients reject outright the idea that they could have breast reconstruction after a mastectomy. Earlier, Dr. Venkat explains, the fear was that it would hide the cancer. “But local control is very good and we are more confident of doing breast reconstruction surgery now.”
“There is no reason why it should not be offered here (in India) as well. The psychological impact of breast reconstruction on a woman who has had mastectomy is immense,” he says, adding though that the costs may be high, as people in India have to pay out of pocket for healthcare. While in India, breast reconstruction is considered as “cosmetic” surgery, in the UK and US, it is considered as part of the treatment of cancer, and therefore costs are covered.
The technique itself involves removing tissues from the patient and finding the fine blood vessel that would make the breast ‘live.'