Beauty with care
What is Breast reconstruction?
Breast reconstruction is a surgical procedure that aims to recreate breasts after a mastectomy or lumpectomy. Reconstruction may require multiple surgeries, and there are several techniques available, such as using silicone or saline breast implants, or utilizing a flap of tissue from another part of the body, such as the lower belly. Breast reconstruction can be performed immediately after breast cancer surgery or months or years later, and it may involve reconstructing both breasts or just one breast to match the other. However, the decision to undergo breast reconstruction is a personal one, and not everyone chooses to have it done.
To be a candidate for breast reconstruction, you need to be able to cope well with your diagnosis and treatment, not have any additional medical conditions that may impair healing, and have a positive outlook and realistic goals for restoring your breast and body image. While breast reconstruction can rebuild your breast, the results may vary, and the reconstructed breast may not have the same sensation or feel as the original breast. Visible incision lines will also always be present on the breast, whether from reconstruction or mastectomy, and some surgical techniques may leave incision lines at the donor site, usually located in less exposed areas of the body such as the back, abdomen, or buttocks.
In some cases of breast cancer, a mastectomy is necessary to prevent the disease from affecting other organs, which may require removing one or both affected breasts. Different techniques are available for post-mastectomy breast reconstruction, some of which are relatively simple, and others that are more complex. Breast reconstruction can be performed during mastectomy surgery or at a later time.
Breast reconstruction with expander
Breast reconstruction with expander
This technique can only be used if the surgeon performing the mastectomy was able to save all the skin covering the breast. This breast reconstruction can be performed during the mastectomy surgery or at a later time.
The post-mastectomy breast reconstruction technique involves inserting a temporary inflatable breast implant under the pectoral muscle in the breast region. The implant is gradually filled with saline solution on an outpatient basis to make the skin and/or muscle expand. This means that, after a few months and thanks to the elastic properties of the skin, the tissues are expanded enough to remove the expander and replace it with a final breast implant. However, there are expanders that do not require removal.
As the expander is being inflated, the patient can undergo the radiotherapy or chemotherapy treatments prescribed by the doctor without any impact on the breast reconstruction or on the disease.
Later on, the nipple and areola can be reconstructed if necessary. The end result is a breast that is very similar to the other, allowing the woman to recover her body identity and forget the injuries caused by the disease.
After breast reconstruction surgery with an expander, the patient can return to everyday life within three to five weeks.
Flap breast reconstruction
Flap breast reconstruction involves using tissue from the area near the breast, known as “flaps.” This technique is more complex than the first as it requires microsurgery to mobilize the skin, fat, muscle, and vascular structure from another part of the body, such as the back or abdomen. Consequently, the recovery period is longer.
Candidates for this breast reconstruction technique include mastectomized patients who do not consider breast implants, either due to personal choice or medical advice, particularly in cases where the patient has undergone or will undergo radiotherapy treatment.
Among the different options available, the preferred technique currently is DIEAP. In this surgery, skin and fat, along with an artery and vein for irrigation, are removed from the abdomen and then transplanted into the breast area of the same patient for reconstruction. The skin, fat, and vessels are removed without damaging the muscles of the abdominal wall, thus avoiding hernias, eventrations, bulges, and weakness of the abdominal wall. Additionally, this technique is less painful than traditional techniques.
The advantage of DIEAP flap breast reconstruction is that it allows complete reconstruction using the patient’s tissue. The skin tissue and fat behave more naturally, both physically and biologically.
Flap breast reconstruction
While surgical breast reconstruction is possible, reconstruction of the areola can be performed surgically or using a dermal-pigmentation technique.
The surgical technique for areola reconstruction consists of reconstructing an areola with the same shape and size as the other areola. A skin graft is performed in the inguinal or labia minora area to reconstruct the texture and pigmentation of the areola. Local flaps are normally used for the nipple. This is an outpatient procedure that can be performed under local anesthesia. The results are definitive, although there might be certain depigmentation of the areolar graft over time.
The dermo-pigmentation technique consists of injecting mineral pigments into the surface of the skin using microneedles. The skill and expertise of the therapist will create an appearance that is the same as the patient’s original areola. Dermo-pigmentation provides a very realistic reproduction, although without any texture. Because the pigments are located very near the surface of the skin, they progressively lose shape and the procedure must be repeated every 3-5 years.
In both cases, the results are extremely satisfactory and almost reproduce a real areola. The combination of both procedures is commonplace for optimum results.
What to expect?
During your visit with the surgeon prior to the procedure, the surgeon will collect your health history and order some tests (such as blood tests and X-rays) to determine if you are fit for surgery. The surgeon will also perform a detailed examination of your breasts and, with your permission, take some photos to plan your surgery and for future comparisons. You may need to have a baseline mammogram before surgery. Inform your doctor about any medications you are taking, and you may be asked to discontinue certain medications such as aspirin, ibuprofen, and some herbal supplements that could increase the risk of bleeding. Tell your doctor if you have any drug allergies. The surgeon will provide instructions related to food and drink intake before surgery, and you should arrange for someone to drive you home after the procedure.
To achieve maximum symmetry between the breasts, the surgeon will make a detailed and precise drawing on the patient’s breast during the final preoperative examination. The drawing is an important orientation factor for the surgeon during the surgery and is a significant step towards the final success of the operation.
Frequently asked questions
Not at all. Breast reconstruction has no impact on the progression of the disease. Although many women may fear further surgery in the area, several studies have shown that there is no relationship between the disease’s progression and the different post-mastectomy breast reconstruction techniques.
Ideally, it would be best to plan breast reconstruction surgery at the same time as the mastectomy because the tissues are of better quality than after they have healed. However, the results when performed during a later surgery are also extremely good.
Yes, it is possible, but you will need to undergo another surgery. It is more advisable to have the surgery at the same time as the mastectomy, especially for psychological reasons.
Yes, if your doctor recommends it. It is important to find an imaging center that specializes in this type of examination on women who have undergone breast reconstruction surgery and inform them of this circumstance before undergoing a mammogram.
We advise our patients to improve the appearance of the other breast to ensure an attractive, balanced end result. In some cases, the patient decides to remove glandular tissue from the healthy breast to prevent cancer from appearing in that breast.