The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.
Breast reconstruction often involves multiple procedures performed in stages and can either begin at the time of mastectomy or be delayed until a later date.
Breast reconstruction generally falls into two categories: implant-based reconstruction or flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap (or autologous) reconstruction uses the patient’s own tissue from another part of the body to form a new breast.
There are a number of factors that should be taken into consideration when choosing which option is best:
- Type of mastectomy
- Cancer treatments
- Patient’s body type
The expansion of the remaining tissue, followed by the placing 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 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. 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.
Who is a good candidate for breast reconstruction?
You may be a candidate for breast reconstruction if:
- You are able to cope well with your diagnosis and treatment
- You do not have additional medical conditions or other illnesses that may impair healing
- You have a positive outlook and realistic goals for restoring your breast and body image
Although breast reconstruction can rebuild your breast, the results are highly variable:
- A reconstructed breast will not have the same sensation or feel as the breast it replaces
- Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy
- Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks
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 you must wear 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.