Plastic surgery is not intended only for women wishing to be more beautiful. In certain cases, it is even necessary for restoring patient’s normal course of life. For some women, breast reconstruction after a cancerous disease may have a similar importance as the removal of the tumour itself. It helps them mentally cope with the disease they have just overcome and makes their return to everyday life easier.
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Breast reconstruction following a cancerous disease has a big importance for patient’s mental condition after having lost her breast or its part as a consequence of an oncological intervention.
The breasts have always been and always will be perceived as part of each woman’s personality. They are a symbol of womanhood. Therefore it is no wonder that a woman having lost a breast in oncological operation usually suffers from mental problems associated with an impairment of her body. Particularly younger women after a partial or total loss of breast may suffer from dysmorphobia, in other words fear from one’s own ugliness. Already from 1977, when the first breast reconstruction was performed following a cancerous disease using a Corin’s implant, the associated mental problems of afflicted women have been supressed with a partial success.
After a successful radiotherapy and chemotherapy, the oncologist frequently recommends to the patients to undergo breast reconstruction. As breast tumours are one of the most frequent types of cancer, their surgical treatment itself as well as the subsequent reconstruction of damaged breasts has seen a revolutionary progress during the last decades. Presently the patients can choose from a number of surgical methods and, besides a reconstruction based on a breast implant, they can also decide for a reconstruction using their own tissue.
Methods of breast reconstruction following a cancerous disease can be divided into immediate and delayed interventions. An immediate intervention is performed simultaneously to the removal of mammary gland, therefore the plastic surgeon works together with the general surgeon. The patient thus avoids the mental consequences of the loss of her breast. An immediate reconstruction is appropriate particularly during a preventive removal of a mammary gland causing health risks. If the patient already suffers from a cancerous disease, she usually needs to undergo a delayed intervention in 12 to 24 months from mastectomy.
more informationNowadays, a number of types of reconstruction are available, from which the surgeon selects the most appropriate one after consulting with the patient. Following a radical mastectomy, the patient needs to undergo a reconstruction of the entire breast, otherwise a partial reconstruction is sufficient.
Reconstruction of entire breast: The entire breast is usually reconstructed using synthetic materials. By far most common are silicon implants filled with gel or saline. If the patient has a sufficient skin cover, the implant can be simply inserted into the breast. If the skin cover is insufficient, silicon bags are inserted under the skin and the surgeon gradually fills them with saline solution. The skin is thus expanded and the breast enlarged.
Breast reconstruction with autologous tissue and synthetic materials: For some patients that do not have a sufficient quality of skin or whose healthy breast is too voluminous or sagged, a common silicon implant cannot be used. In such cases, autologous, in other words patient’s own natural tissue is used in combination with synthetic materials.
The source of autologous tissue is either the skin flap rotated from the side of the chest, the abdominal flap or the rotated big dorsal muscle. The flaps are used to cover the implant. This type of intervention is rather time demanding and the reconstruction of areola and nipple is not possible earlier than three months from surgery.
Breast reconstruction with autologous tissue: When reconstructing a breast with autologous tissue, the surgeon does not use any synthetic material for breast augmentation. This type of intervention represents a big progress in breast reconstruction following an oncological disease. However, it is rather time demanding.
The autologous tissue is taken from the abdominal flap providing a sufficient amount of skin and fat even for a reconstruction of a large breast. The surgeon uses either the transverse abdominal flap or the free abdominal flap. An intervention using the free abdominal flap is more progressive and gentle, however, it can only be performed at a clinic with a highly professional microsurgery team.
Reconstruction of part of breast: Breast reconstruction techniques gradually change depending on the development of surgical breast treatment. Nowadays it is possible to remove certain types of tumours with maintaining the remainder of the breast. Also in such case, the breast is damaged, however, the change is not as radical as in case of overall mastectomy.
If the tumour is removed and the remainder of the breast maintained, the plastic surgeon performs a partial breast reconstruction. These procedures are highly varied, as they are always based on the size and location of the removed tumour. The surgeon can perform breast modelling similar to modelling of sagged breasts – usually it is necessary to modify the healthy side. However, the breast can also be reconstructed using flap plastic surgery in combination with synthetic materials or implanting a breast enlargement prosthesis. A range of methods are available, and the most appropriate one shall be selected together with the patient.
Areola and nipple reconstruction:This is the final phase of breast reconstruction after mastectomy. For most women, this process is a symbol of a complete breast reconstruction, after which they can finally resume their full personal and social life. The breast assumes a natural and symmetrical look, and the patient can return to perceiving her body as an integral unit.
Several methods of areola reconstruction are available. The surgeon can create a new areola for instance by transferring a part of the areola from the second breast. Another possibility is grafting the skin from locations with a more intense pigmentation. The areola can also by created by artificial tattoos. When reconstructing the nipple, it is possible to use a part of the nipple from the healthy breast, artificial tattoos or local flaps.
The time required for breast reconstruction depends on the type of intervention and amounts from 45 minutes to 4 hours.
Breast reconstruction is a demanding procedure that does not always evolve in the same way. The time required for convalescence depends for example on whether an immediate or delayed reconstruction was performed. With an immediate reconstruction, the patient’s body must cope with the mastectomy itself at the same time.
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The convalescence also depends on the type of reconstruction. More demanding is recovery following a reconstruction of the entire breast; if the surgeon modifies the breast after a partial mastectomy, the intervention into patient’s body is much less significant.
The duration of convalescence depends on the method of reconstruction and usually ranges from 2 weeks to 2 months.
Breast reconstruction is certainly not an easy type of plastic surgery. That is why the choice of most appropriate method of intervention and its precise execution are of utmost importance. The patient should decide for a fully qualified plastic surgery clinic, in which she can be assisted for instance by the general surgeon carrying out the mastectomy.
However, complications may occur also when the reconstruction is carried out properly. The cause is often a lack of tissue after irradiation or an unfavourable overall health condition of the patient. Problems can be caused for instance by obesity, immunity defects, diabetes, endocrinology diseases, cardiovascular diseases, smoking or even an advanced age of the patient.
A breast reconstruction may involve a variety of complications. When synthetic materials are used, they may include building up of a hardened encapsulation around the implant. With a reconstruction using local flaps in combination with implants, the edge of flap may exceptionally detach and leave the implant uncovered. In such case, the implant must be removed and the procedure repeated after several months.
Other potential complications include infection in the wound, hardening of post-surgery scars and swellings caused by an accumulated spinal fluid. However, the aforementioned complications occur in less that 15 % of reconstructions performed.
A broad variety of preventive measures applied before, during and after the intervention further reduce the occurrence of these complications.
Here, you will find all of the preoperative evaluation and instruction prior your operation.
May not be performed sooner than 14 days before the operation.
Take the evaluation report with you on the day of your operation.
Please note, that patients with an incomplete preoperative evaluation cannot be operated.
No other intervention is usually performed simultaneously with breast reconstruction. Exceptionally, an adjustment of the second breast is carried out, for instance its remodelling.
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