Battling breast cancer ends fully only when the natural look of the breasts, disturbed by the oncological treatment, is restored. Despite the increased number of conservative breast surgeries in the last decade, it is estimated that over 40% of breast cancer cases require total mastectomy. Alas, this percentage is even higher in Poland. Fortunately, the group of women aware of modern plastic surgery increases, deciding to undergo the breast reconstruction surgery.
Breast reconstruction is a multi-stage process that ca be performed using:
Reconstruction can be performed immediately after mastectomy. Delayed reconstruction is usually an option for patients suffering from a advanced neoplastic process requiring adjuvant treatment as well as those suffering from concomitant diseases. Final qualification for the procedure is based on the performed physical examination and familiarisation with the medical documentation and results of additional tests.
This method consists in insertion of the tissue expander under the pectoralis major muscle, its gradual inflation with saline and, subsequently, replacement for the final breast implant. The expansion process usually lasts several to several doze moths when the expander is filled (every 2-4 weeks) util the desired breast size is obtained. Sometimes, in case of immediate reconstruction and proper anatomic conditions, breast implants can be inserted without first expanding the tissues.
The choice of the breast implant is based, inter alia, on desired size and shape of the breasts, body silhouette and personal preferences of the patient.
There are many methods based on autologous tissues. I my practice, I offer breast reconstruction with use of the latissimus dorsi muscle flap, autologous fat tissue transfer and microsurgical DIEP free flap.
The method consists in moving the latissimus dorsi muscle from the back to the chest to ensure proper coverage for the tissue expander and implant. This technique is usually applied in patients who underwent radiotherapy, frequently precluding insertion of the implant under the pectoralis major muscle. Use of the latissimus dorsi muscle does not result in any significant functional deficit in the trunk or upper limb.
This method consists in obtaining fat tissue from such areas as lower abdomen or thighs by means of liposuction. Then, after proper preparation of the obtained graft, it is inserted in the breast using a special cannula. This little invasive method can be performed individually. It is, however, more frequently combined with other breast reconstruction methods, especially with an expander and a breast implant.
Deep Inferior Epigastric Perforator (DIEP) flap is the most commonly performed form of microsurgical breast reconstruction. This method consists in dissection and transfer of the abdominal tissue flap to the breast deficiency site. Following vascular anastomoses, the flap is formed to achieve the breast shape. The flap allows to reconstruct the breasts, ensuring aesthetic appearance and consistency of real breasts. Furthermore, over the years, the reconstructed breast undergoes changes similar to healthy breasts. This method does not involve the use of an implant. Abdominoplasty provides an additional benefit for the patient. the DIEP flap is especially recommended in females who underwent radiotherapy and have extensive chest scars.
The reconstructed breast usually differs from the healthy breast in size. Therefore, to achieve their symmetrical appearance, a lift, augmentation (implant or autologous tissue transfer) or reduction of the healthy breast can be performed. This procedure is performed during the surgery consisting in replacement of the expander for an implant.
Reconstruction of the nipple-areola complex is the last stage of the breast reconstruction surgery. The nipple is usually formed after 6-12 weeks from replacement of the expander for the implant or reconstruction using autologous tissue. The nipple is formed using the surrounding skin and subcutaneous tissue. The areola is formed using skin micropigmentation (tattoo) after 6 weeks from nipple reconstruction.
The reconstructive treatment plan must be adjusted individually to every clinical case. The necessary steps include familiarisation with the medical documentation, patient's expectations and preferences as well as performing a physical examination. During the consultation, I present the treatment methods available for the given patient and the offered effects in detail. The final choice is made by the patient on the basis of the information presented by me in a comprehensible manner and based on her own preferences. On my part, I offer application (if there are no contraindications) of each of the above presented breast reconstruction methods, including the microsurgical techniques.
After the procedure, the patient is under care of qualified medical personnel. In case of most reconstruction methods, the patient is discharged on the second day after the surgery. Sometimes, it is necessary to leave the suction drains in – they are usually removed after several days.
Post-operative pain ailments are usually mild and can be treated with OTC pain relievers.
In case of breast reconstruction involving use of the tissue expander, the patient has to attend periodical check-ups to fill it.
Returning to cardio type sport activity is possible after ca. 2 weeks from the procedure. Exercises with additional load ca be resumed after not less than 6 weeks.