Breast reconstruction

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Breast reconstruction is an intervention on which people call on to improve self-image and self-trust, likewise the life quality of a woman who lost one or both breasts because of breast cancer or accidents.

Breast reconstruction can begin in the same time with mastectomy or after the healing post-mastectomy and/or other treatments. There are more techniques of breast reconstruction, the following being most often used. The expansion of the remaining tissue, followed by the placing of a silicone implant, is the most simple and frequent way of reconstruction. Under the pectoral muscle an expander will be inserted (a temporary implant). This will be filled, step by step, with physiological serum, with the purpose of relaxing of the remained tissues and to allow the insertion of a definitive implant, which will have the same dimensions of the healthy breast.

Afterwards, the reconstruction of the areola and of the nipple is done, only after the skin is used with the new vascularization. A second breast reconstruction technique uses the patient’s own tissue: back, buttocks, thighs or abdomen flaps. These will be transferred at the anterior thorax level. By using the latissimus dorsi flaps, the muscle with this name gets mobilized, along with the skin, under the armpit, until the breast level. So, the vascularization is kept, but the introduction of an implant is necessary, the muscle not having enough volume. Using abdominal flaps assumes using abdominal tissue from the pubis until under the navel, these islands channeling under the abdominal teguments until the ready-to-be reconstructed breast, sometimes advanced microsurgical techniques being necessary to move these tissues at distance (last statistics show an advantage of the free DIEP transfer towards the pedicle flaps from the abdominal level).

As an elementary rule, for all the patients who never had radiotherapy treatment it is chosen for reconstruction an expander and a prosthesis, and for the irradiated ( radiotherapy treatment ) patients it if preferred the healthy own tissue transfer , either by free transfer DIEP or by pedicle flap rotation of the latissimus dorsi. The surgical intervention is made under general anesthesia and it is necessary the overnight hospitalization after the intervention. The duration of the intervention Is 1,5- 4 hours, depending on the complexity of the procedure. After this it is necessary the wearing, of a special bra for the breasts support and for a correct healing, for a period strictly defined by the doctor. The scars will never disappear, but their aspect will greatly fade in time.

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PRE–OPERATORY

Surgical consultation
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Choosing the prostheses
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Blood samples
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Electrocardiogram (ECG)
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Breast echography
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Anesthetic consultation

POST–OPERATORY

Minimum 24hrs hospitalization
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Bearable post-operatory pain
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Sustaining Bra minimum 3 weeks
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Avoiding physical effort for 6 weeks
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Avoid loose arm movements minimum 6 weeks