Nowadays, 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.