According to a survey by the National Cancer Institute (INCA), the estimated incidence of breast cancer in women in 2020 was around 66,000 new cases. Skin cancer, in turn, accounts for 27% of all malignant cases in Brazil.

On World Cancer Day (02/04/21), I answer the main questions I receive daily here at the office:

When is breast reconstruction indicated?

First, it is necessary to analyze the proposed oncological treatment, as breast reconstruction with a silicone implant cannot always be performed immediately, especially in cases where a lot of skin is removed or when it precedes complementary treatment with radiotherapy. Depending on the disease's staging (determined by lesion size, location, lymph node involvement, and presence of metastasis), mastectomy (breast removal) may be indicated, and it is at this moment that breast reconstruction can make a difference for restoring female self-esteem and confidence, even contributing to strengthening the battle against the disease.

I consider it extremely important to emphasize that mammography is essential for early diagnosis. Therefore, do not fail to perform it, as this examination can reduce mortality by up to 30% when done periodically.

What is the result of a reconstructed breast?

Unlike aesthetic surgery, a reconstructed breast has distinct characteristics. The nipples often need to be recreated. The reconstructed breast will not have the same appearance as a healthy breast, as it may have scars and feel firmer. Therefore, I always advise the patient to seek psychological support to understand the situation.

It is a woman's right to have breast reconstruction through the Unified Health System (SUS) and health insurance plans in Brazil, as well as plastic surgery on the opposite breast for symmetrization and harmonization. Reconstruction, whether immediate or delayed, must be individualized, respecting both the patient's wishes and the clinical conditions and treatment they will undergo.

What are the skin signs that indicate seeking a specialist, and what are the types of skin cancer?

When you find the following changes in a suspicious lesion or mole, a method known as ABCDE:

A – Asymmetry: when one part of the lesion is different from the other;

B – Border: irregularities in the outline;

C – Color: different colors within the same mole or lesion;

D – Diameter: when it is larger than 6 millimeters;

E – Evolution: notice if the lesion grows, changes shape, or color.

Wounds that do not heal after three weeks or that bleed easily should also be investigated.

There are several types of skin cancer, but the three most common in Brazil are: basal cell carcinoma, squamous cell carcinoma, and melanoma, the latter being the most serious, with a risk of developing metastasis and potentially leading to the patient's death.

Do dermatologists and plastic surgeons work as a team in cases of skin cancer?

Typically, the dermatologist makes a suspected diagnosis through dermatoscopy, an examination performed with a magnifying lens. Biopsy and anatomopathological study are necessary to confirm the diagnosis. Depending on the location of the lesion, in the case of more delicate and exposed areas of the body, such as the face, the patient is referred to a plastic surgeon, who performs the removal and reconstruction if necessary.

After the disease has been staged, i.e., identified how far it has advanced, the involvement of other specialists, such as an oncologist, may be necessary to continue the treatment.

*Dr. Fernando Amato is a plastic surgeon, a full member of the Brazilian Society of Plastic Surgery, a member of the International Society of Aesthetic Plastic Surgery (ISAPS), and the American Society of Plastic Surgeons (ASPS).