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Breast Reconstruction

What is breast reconstruction?

Reconstruction of the breast after its removal due to breast cancer or other disease (mastectomy) is one of the most rewarding current surgical procedures for the patient. New techniques and the evolution of medical materials allow the surgeon to create a breast that is very similar in shape, texture and characteristics to the non-operated breast.

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Breast expansion

Reconstruction of the breast by expansion and prosthesis

Breast reconstruction using dorsal flap width and prosthesis

Breast reconstruction using TRAM flap

Who is a good candidate for breast reconstruction?

Most women who have had a mastectomy can be considered candidates for breast reconstruction, and almost all can do so at the same time as the breast is removed. The optimal candidate is one that can have the tumor completely removed during the mastectomy. The advantage of reconstructing the breast at the same time as the mastectomy is performed is that the patient wakes up from the intervention with an adequate breast contour, avoiding the experience of seeing the amputated breast. In some cases, however, reconstruction must be postponed. Some women are not comfortable talking about a reconstruction when they are still trying to digest the diagnosis of breast cancer; Other women simply do not want more interventions than are strictly necessary to cure the disease. In any case, the most important thing is to have adequate and clear information about what you can expect from your surgeon. In the pre-operative consultation, the surgeon will explain in detail the procedure and the actual results you can expect, and will show you photos of before and after the procedure.

Breast reconstruction surgery

The medical team that performs the mastectomy, oncologist and plastic surgeon, must coordinate to develop a strategy that results in the best possible result. The plastic surgeon is the specialist, who due to his training (specialist in Plastic, Reconstructive and Aesthetic Surgery) has the adequate technical and aesthetic resources to rebuild a breast with a natural appearance. After evaluating the general condition of the patient, we will inform her of the most appropriate options for her age, health, physical and anatomical characteristics and future expectations. For this reason, there must always be at least one plastic surgeon within the multidisciplinary team that deals with breast reconstruction.

Techniques to rebuild the breast

There are different types of operation to rebuild the breast:

Skin expansion techniques

The technique of cutaneous expansion is the most widely used and consists of expanding the skin to subsequently place a prosthesis. After the mastectomy, the plastic surgeon places an expander under the skin and muscle of the chest. Through a valve mechanism, introduce a saline solution once a week, for several weeks, until the expander is filled. Once the skin has given itself enough, this expander is removed and replaced by a silicone breast prosthesis. There are some expanders that are designed to stay as permanent implants. This intervention is performed under general anesthesia, with a hospital stay generally of 24 hours. The nipple and areola are then reconstructed, using local anesthesia and on an outpatient basis. The prostheses used in this type of breast reconstruction contain medical silicone. No relationship has been shown between breast cancer and the use of breast prostheses. Its use is approved in all European countries.

Techniques that use own fabrics

There is also a technique that uses its own tissues consisting of the mobilization or transplantation of tissues from other areas of the body such as the abdomen, back or buttocks. In some cases, these tissues remain attached to their original site, preserving their vascularity, and are transferred to the breast through a tunnel that runs under the skin. In other cases they are completely separated from their original site and are transplanted into the chest by connecting to the blood vessels in this area. This technique is more complex, leaves more scar and the recovery period is longer. However, the aesthetic result is much more natural. This technique is also performed under general anesthesia, with a hospital stay of 3 days.

Mixed Techniques

Currently we are performing with great success a technique that manages to combine the best of the previous two. It consists of combining the placement of a prosthesis with the injection of fat from the patient herself to achieve more natural contours both in sight and touch. This technique is especially indicated in patients who have undergone radiotherapy or who have a little elastic skin, since the injection of fat produces a very beneficial effect on the skin and the scar. In these cases we indicate a first session to extract the fat by means of liposuction, with the consequent improvement of the body contour when appropriate; in that same intervention, the fat is treated to purify it and is injected under the skin of the chest, around and inside the scar from the previous mastectomy. Subsequently, once the elasticity and thickness of the skin have been improved, the expander is implanted. Fat injection can be used again in the final phase of reconstruction to improve the contours or symmetrize both breasts, so we consider that this combined technique achieves aesthetic results very close to more complex microsurgical reconstructions and lacks many of its drawbacks.

Techniques for immediate reconstruction

Any of the three techniques can be used for immediate reconstruction (mastectomy and breast reconstruction are performed in the same surgical act). The cutaneous expansion technique will involve a second surgery to place the definitive implant, but in the case of an immediate reconstruction, the placement of the prosthesis can be achieved directly without going through the entire expansion process. This can be achieved thanks to the implantation of a special sheet that will protect the prosthesis without having to expand the skin for weeks. In this way, the patient who enters the operating room with the trance of undergoing a mastectomy, leaves it with her chest completely reconstructed in a single time.

The results

The results of a breast reconstruction are definitive and allow an absolutely normal life. In some cases the reconstructed breast may appear firmer and appear rounder than the other breast. The contour may not be exactly the same as before the mastectomy, and there may be some differences in symmetry with the non-operated breast. However, these differences are usually only visible to the patient, not being perceived by others.

For the vast majority of patients, breast reconstruction represents an absolute improvement in image, a complete body is seen again, and also provides a psychological balance.

It should be clear that reconstruction has no effect on recurrence of breast disease, nor does it interfere with chemotherapy or radiation therapy, although the disease recurs. It also does not interfere with subsequent studies that may be necessary in the reviews.

You should know that currently there are no contraindications since all the specialists in charge of evaluating these tests are fully aware of the normal changes that occur after the placement of a prosthesis.