Breast Reconstruction

The issue of the breast reconstruction following cancer ablation is still an intensively discussed and disputed topic. In the developed countries breast reconstruction after cancer is a mandatory surgery that the costs are supported by the health insurance funds. In our country this surgery is made upon request and involved pretty high costs for the patient.

Modern cancer breast resection is not as radical as it was 10 years ago, in such way that the area does not remain mutilated, incorrigible. The right time for mammary reconstruction is chosen depending on the status of the cancer disease, although if possible, it would be ideal at the same time with the cancer resection.

This way the social psychological implications that the lack of such noble segment might have with a women are minimized.

Usually these surgeries are performed by complex teams comprised by more than one specialist. Besides the cancer surgeon who makes the abscission, a plastic surgeon is required to make the reconstruction and a pathologist to establish the status of the disease. Should the cancer status be evolved and requiring tissue irradiation then the reconstruction will have a delayed action.

The most used practices to rebuild the breasts assume using:

silicone mammary implants with previous tissue expanders.
pedicle flaps: of Latissimus Dorsi (the broadest muscle of the back), of TRAM flaps (transvers rectus abdominal muscle).
free transferred flaps: of Latissimus dorsi, TRAM, gluteus, gracillis, etc) The practices are often combined to obtain results as natural as possible.

Where the excision is minim the insertion of an implant solves relatively easy the problem. In case the excision is total and leads to a big failure of soft parts and skin, the most frequently used is musculocutaneous flap, of pedicle Latissimus Dorsi. Besides volume reconstruction and breast silhouette practices there have to be considered also the reconstruction practices of the mammary areola and of the nipple. The most efficient practice of areola reconstruction is the medical tattoo.

Another option is the free skin graft containing the tegument sampled from a region where this is, constitutionally, darken(perineal region). In the same operative time with the ablation of the cancer, an expander is inserted. Hence a sufficiently big cavity will form to allow the introduction of the final prosthesis. Subsequently the nipple areola complex will also be reconstructed.

The association with the liposculpture and microlipofilling practices could be benefic. Hence the margins of the implants will be less perceptible upon touching.

The steps above mentioned represent the ideal in the therapeutic planning of a breast cancer. The missed timing of the tumor excision surgery with the mammary reconstruction does not mean that this cannot be done later. Breast reconstruction is possible anytime following cancer removal, even if many years have passed, provided that the disease is kept under control.

Frequently asked questions

How many surgeries are required for breast reconstruction?

Usually, following cancer ablation which is the first surgery stage, under the same general anesthesia, and if the cancer status allows it, the mammary reconstruction could also be performed, saving this way another surgery. The patient has a net benefit of the association of the two surgeries due to it will not suffer at all in psychical plan for a missing breast.

Subsequently, after 2 to 3 months another surgery will be required to remove the expander and to replace it with a final prosthesis. At the same moment a shape correction of the contralateral breast could be performed, if the case, as well as the areola and nipple reconstruction. Baker implants represent the newest method in breast reconstruction. This type of breast implants associates the benefits of an expander and a silicon gel implants, therefore it is no need for a second operation to change the expander with a final implant.

Which are the complications of the surgery?

Immediate post surgery complications that might occur include the following:

hematoma, massive bleeding, reason for which most of the times the suction drain which is left at this level will be kept for a longer period of time (7 to 10 days)
seroma in more than 50% of the cases
infections
wound cleft
tegument and soft parts necrosis

Remote complications:

visible unaesthetic appearance
pathological scarring
lack of symmetry with the contralateral breast

Is the cancer evolution affected by mammary reconstruction?

Mammary reconstruction seems to not affect in any way the evolution of the mammary cancer. In case the disease is evolved, following the irradiation a reconstruction might be attempted.

In case of tissue irradiation these become very brittle being hard to handle during the surgery act.

Where will the post surgery scars be placed?

In case of classical reconstruction with musculocutaneous flap of Latissimus Dorsi, on the anterior side of the thorax, at the level of the new breast a circular scar of oval shape will exist, arranged horizontally.

On the posterior thorax, in the flap sampling location, a line scar will exist, arranged laterally oblique and cranial, 20 to 25 cm long, sometimes even more, resulted from direct suture of the donor area failure.