New graft hope for cancer sufferers

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Muscle and skin from a wo-man's back can now be used to correct breast disfigurement after surgery for cancer, doctors heard yesterday.

Speaking at the British Association of Plastic Surgeons' winter meeting, CC Koo - until recently a senior registrar in plastic surgery at Stoke Mandeville Hospital, Aylesbury - said that "very high rates" of patient satisfaction were reported after using this method.

The trend in the treatment of breast cancer, the most common malignancy in women, has shifted from mastectomy (removal of the entire breast) to breast conservation surgery (removal of only the diseased area).

However, as this treatment has gained popularity it has now been realised that the disfigurement which it can cause can be more upsetting than a mastectomy.

The treatment which has been pioneered at Stoke Mandeville, involves using muscle and skin from the woman's back, the latissimus dorsi myocutaneous flap. This muscle is hardly used at all "unless you are a champion climber", said Mrs Koo. After the diseased area has been removed, the muscle is used to reconstruct the affected breast so that it appears symmetrical to the other.

The operation, which is carried out by a plastic surgeon and a breast surgeon, takes two hours on average and the patient will usually have to stay in hospital for a week afterwards. This compares with a complete mastectomy which takes four to six hours and with a patient staying in for two weeks on average.

Each year in the UK there are 35,000 new cases of breast cancer and 15,000 deaths per year. A woman has a one in twelve chance of developing breast cancer in her lifetime. Mrs Koo estimated that this procedure would be suitable for 80 per cent of women with breast tumours.

At Stoke Mandeville, this procedure has been tried on 40 patients so far, with high rates of patient satisfaction. The women were aged 50 on average, and were in hospital for about a week. Of those who were suitable for the treatment, 60 per cent agreed to try it.

Complications were minimal. A few patients had fluid collecting in their backs, which was easily removed, and two had minor wound infections. In all cases the tumour was completely removed. "Since 1994 our experience with the first 40 cases has shown this method to be a simple yet effective way of treating the increasing number of women presenting with early breast cancer. The most important result is the high patient satisfaction rate." said Mrs Koo.