Breast reconstruction
Breast cancer is the most common malignancy in the female population. The good news is that most women are cured, as prevention, early diagnosis and treatment often allow for complete recovery, or long-term survival with a satisfactory quality of life.
Breast reconstruction surgery after mastectomy is the solution provided by plastic surgery, restoring the shape, volume of the female breast, the nipple and the areola in case they have been removed.
The international trend is for women after mastectomy to undergo breast reconstruction.
The breast expresses feelings of motherhood and femininity for a woman, and its loss is a blow to her psyche, as it creates a feeling of inferiority, reduced self-esteem, loss of sexual interest, and quite often the appearance of depression with all the consequences that this brings both to her professional career and to her personal relationships.
Most breast cancer patients are candidates for breast reconstruction, which can be performed at the same time as the mastectomy. In cases mainly for medical reasons, breast reconstruction is performed at a later date.
Ideally, the woman should be informed about the possibility of reconstruction as soon as she is diagnosed with breast cancer and begins discussing her treatment. The breast surgeon may refer her to the plastic surgeon for more detailed information and to complete the surgical plan of the preoperative planning.
The complete information process enables women to deal more positively with breast cancer, opening a window of optimism for the future.
We mean the surgery to reconstruct – restore the breast that was removed by mastectomy.
It can be done immediately with the mastectomy or after some time.
Plastic surgery
offers modern breast reconstruction methods, each with its own advantages and disadvantages.
The goal in each case is to ensure a better quality of life, with as little burden on the patient as possible and ensuring a long-term satisfactory outcome.
The differentiations and classification of rehabilitation depend on the rehabilitation period and the methods and surgical technique that will be followed.
Immediate Breast Reconstruction
Posterior (Delayed) Breast Reconstruction
Delayed Immediate Breast Reconstruction
(tissues from the patient's body)
Using alloplastic materials, implants and expanders
Combination of autologous tissues and implants
Simultaneously with the reconstruction, the contralateral breast can be subjected to augmentation, lift or reduction for reasons of symmetry for even more impressive results.
In the majority of cases, the aesthetic result after the procedure is satisfactory and contributes significantly to the better quality of life of women.
Breast reconstruction is completed by restoring the nipple-areola complex through a minor operation with local anesthesia to create the nipple and usually with tattoo techniques to color the skin, giving a more natural result.
The advantage of immediate reconstruction is that the woman after surgery has the sensation of her breasts again and does not experience the traumatic experience of a mastectomy amputation. A good reconstruction always begins with a good mastectomy. It is very important to have good vascularization of the mastectomy flaps, which requires a particularly atraumatic technique from the oncologist surgeon in order to properly prepare the ground for the reconstruction (skin/nipple sparing mastectomy). A complication can delay postoperative treatments, reducing their effectiveness.
The surgery is performed when the cancer treatment (chemotherapy-radiation) is completed and may be performed months or even years later. There is no specific time or age limit and it should be performed when the patient is mentally and physically ready to proceed with breast reconstruction. The advantage of the method is that any possible delay in starting complementary cancer treatments, such as radiation, in case of postoperative complications due to immediate reconstruction is avoided.
Taking advantage of the advantages of immediate and distant reconstruction without exposing the new breast to the risks and complications that may arise from radiation.
Immediately after the mastectomy, a special skin expander is placed under the pectoralis major muscle, located behind the breast. Through a valve, the expander is periodically expanded with saline until it reaches the desired limit.
If further radiation therapy is not needed based on the histological report, the stent is removed and replaced with a permanent implant or autologous tissue. Some stents remain permanently so that in this case a second surgery is not needed.
If additional radiation treatment is needed, we wait for the completion of the treatment and then, after at least 6 months, rehabilitation follows.
The most important advantage of the method is the creation of a skin envelope using a stretcher immediately after mastectomy surgery.
It is the method of choice in irradiated breasts, in cases of large sagging contralateral breast, when the patient does not wish to use implants.
With the development of microsurgery in plastic surgery, it is possible to transfer flaps, pedicles or free autologous tissues from a distant donor area, and to glue vessels (arteries and veins) with a diameter of less than 3 millimeters under the magnification of an electron microscope, for breast reconstruction.
In these procedures, an area of dermo-fatty tissue is removed along with the vessels that supply it and is transferred to the chest, in order to restore the skin and volume of the breast.
The dermal adipose tissue of the abdomen, the free DIEP-SIEP flaps, the pedunculated TRAM flap, are considered the most ideal choice for breast reconstruction, as they resemble the normal breast in color and fat composition.
Alternative donor areas are the back area (the broad dorsal flap), the inner surface of the thighs (TUG flap) and the buttocks area (S-GAP or I-GAP flap). Dr. Maltzaris has been using liposuction for breast reconstruction after radiation in recent years.
The fat is taken by liposuction from other areas of the body (abdomen, buttocks, inner thighs) and after appropriate treatment with growth factors-platelet rich plasma, it is transferred to the breast area.
The advantages of the method are the reconstruction of the breast without incisions and without the use of foreign materials with excellent and permanent results.
The method is indicated for relatively small breasts and usually requires 2 sessions.
In cases where symmetrizing of the healthy breast is needed, reduction or elevation is performed.
The technique preferred by the majority of women for breast reconstruction after mastectomy is the use of silicone or polyurethane implants, mainly because it is a less serious operation and usually has a faster recovery.
The reconstruction is performed with or without a tissue (skin) expander and implant in one or two surgeries. It is a safe method with excellent results, provided that there is a correct indication. In cases of mastectomy with or without nipple preservation, a special skin expander is placed for reconstruction. Through a valve, the expander is expanded with saline at regular intervals until it reaches the desired limit, creating excess skin and skin envelope.
After the completion of the complementary chemotherapy and a period of at least 3 months, the expander is replaced with a permanent implant. In cases of subcutaneous mastectomy with or without nipple preservation, or in cases of prophylactic mastectomy and immediate reconstruction, the advantage of a single surgery can be applied to indications such as the type and location of the tumor, the thickness of the skin, and the condition of the lymph nodes.
A silicone implant or mesh (titanium or dermal) is placed below (subpectoral breast reconstruction) or above the pectoralis major muscle (prepectoral breast reconstruction). Particularly in cases where the implant can be placed above the muscle within a dermal mesh without disturbing the pectoralis major muscle (prepectoral breast reconstruction), the patient has a satisfactory aesthetic result with less pain and in a single operation.
This specific method is indicated in small to medium-sized breasts and only if specific oncological parameters are met.
It uses the advantages and naturalness of autologous tissues in combination with the use of implants to achieve the most ideal aesthetic result and the ideal volume and shape of the breast.
The choice of technique must take into account the characteristics of the tumor, personal and family history, age and health status, the woman’s body type, the shape and size of the opposite breast, the possibility of mastectomy in the other breast, possible testing for the BRCA 1 and 2 genes, the woman’s interests and her desires.
Breast reconstruction in any case has no effect on the disease or the shorter survival of women who undergo it and does not prevent the postoperative administration of prophylactic chemotherapy or radiotherapy.
Although breast reconstruction cannot physically restore the breast that a woman lost due to the disease, the benefits are significant. The new “breast” that will be created is better and more acceptable than an external prosthesis attached to the bra.
The woman is significantly facilitated in her daily activities (e.g., dressing, exercising), resulting in regaining her lost self-confidence.
Like any surgical procedure, breast reconstruction has early and late complications. Thus, depending on the method, we distinguish complications such as infection, necrosis of skin flaps, exposure of the prosthesis, bleeding or hematoma, capsule formation, asymmetry in relation to the other breast, complications from the donor area (collection, hematoma, delayed healing, hernia, necrosis of skin flaps).
