Breast Reconstruction

There are several factors to ponder when looking to get a breast reconstruction before cancel or another breast disease.

Even though breast reconstruction techniques have improved greatly in the last few years, you must bear in mind that the reconstructive process is not simple, and though the results are very good they are never perfect.

These procedures allow not only the recovery of the lost body balance, but also to restore the emotional wellness of the patient.

When should I get a reconstructive surgery?

Reconstruction may be started immediately after the mastectomy has been done or some time later.

Being plastic surgeons, we inform the patient about the various reconstructive possibilities.
There are mainly two methods to reconstruct a breast: the one using alloplastic materials (implants) and the reconstruction using autologous tissue (flaps).

Which are the different options?

The first options consists in placing a silicone gel or physiologic solution implant under the skin, subcutaneous tissue and muscle from the thorax, to recreate the shape and look of a breast.

The second one transfers skin, fat tissue and muscle from the abdomen or the back (and less frequently from other parts of the body), to the breast region. In some cases, both possibilities are combined.

For patients who have elastic and healthy skin with a small contralateral breast, the implant to match both breasts may be enough. If this is not the case, it may be necessary to expand or stretch the tissues for some time, with the progressive use of an “expander”; witch is gradually filled with sterile physiological solution through valve.

How does the expander work?

The tissue expanding process is very similar to what happens during pregnancy.

After 3 to 6 months, with a second intervention, the expander is replaced with the definitive prosthetic.

There’s also a possibility to place a definitive “expander-implant” which combines both functions in a single surgery.

The reconstruction method using an expander and implant is widely known. This method doesn’t usually need other scars than those caused by the mastectomy and is extremely versatile.

Women who have undergone radiotherapy associated to a mastectomy, show a higher failure percentage in this procedure.

Using an expander and a prosthetic may present other complications, such as retractile fibrous capsule, infection, extrusion, valve malfunction, deflation, asymmetries, etc.

The reconstruction with tissue of the patient (autologous tissue) needs to transfer a part of the skin, fat tissue and muscle from a part of the body to the breast region.

The most common surgery nowadays is the one that uses flaps from the lower part of the thorax, TRAM (transverse rectus abdominis muscle).

TRAM can be done through pedicle flap operation, carrying the rectum muscle; or free, if the transference can be done with a microsurgery.

There are obvious benefits when using this method, since there is no external device placed in the body, which allows a breast to be reconstructed with the same shape as a natural one, giving a very natural feeling.

At the same time, this technique reduces the amount of excess abdominal tissue, which will cause a flatter abdomen.

This is an ideal option for patients with large scars in the thorax region, very fine flaps or who have been treated with radiotherapy. It is also ideal for reconstructing large breasts, patients who do not want synthetic materials in their body, patients who do not want a reduction or contralateral pexia, and also in those cases in which other techniques have failed.

Patients must be aware that this is a major surgery, which is why it must be performed with general anesthesia and hospitalization. The surgery is done all at once and it leaves an abdominal scar similar to the one caused by an aesthetic abdominal surgery.

Patients who suffer from extreme obesity, who have a record of serious diseases or who smoke are not good candidates for this procedure. In order to minimize the possibility of a post-operatory complication, there are many controls and restrictions.

There is another reconstructive procedure which is done with autologous tissue. This process uses the latissimus dorsi muscle.

In most cases, this technique requires an implant to provide volume to the breast, since the flaps aren’t very thick.

Depending on how the new breast must be covered, the surgeon will design the “skin pocket”. The amount of latissimus dorsi transported may vary, according to the situation, in order to completely cover the implant when this muscle is attached to the pectoralis.

The procedure may leave a depression on the donor site and a visible scar, which should be hidden by the bra.

All these techniques must be completed with the reconstruction of the areola and nipple. Usually, the intervention is quite simple, and is done with local anesthesia only.

Sometimes, in order to make both breasts symmetrical, it may be necessary to operate the contralateral breast, either to augment it, reduce it or lift it. Symmetry is always the main reason to perform a breast reconstruction.