Breast reconstruction, breast cancer

Women that had malign breast disease and who undertook the surgery of breast removal can undergo its reconstruction. Regaining the chest symmetry and the shape integrity can therefore help to get the womanhood feeling again and also to moderate a depression.

The loss or deformation of breast caused by the treatment of malign tumour touches the woman in two areas. Beside the fear of further destiny, treatment and state of health, women suffer from the fear from how will their life change after a loss of such a big womanhood symbol.

Its proof is also that during the first information about the character of the disease and the planned treatment at the office, a big percent of women react in more positive way, when they find out together with the information of the necessity of breast removal about the possibility of its reconstruction.

The care of women with malign tumour is inter-branched and the breast reconstruction is part of the plastic surgery. The decision whether and when to perform the surgery depends on the oncologist, psychologist and sometimes even the geneticist.

The timing of the surgery

One of the possible options is so-called immediate reconstruction. It is the case when during one anaesthesia the surgeon removes the tumour with a part or with the whole breast and he/she then immediately fills the formed defect. Most often this procedure is applied in so-called prophylactic surgeries. Those are procedures in which potentially dangerous tissues are removed. In such breasts most often subcutaneous mastectomy is performed. In this procedure only the mammary gland is removed and the skin and areola with the nipple retains. The reconstruction is then usually performed with the usage of silicone implants.

Another possibility is so-called delayed reconstruction. It is a situation when the reconstruction procedure is performed after the termination of all examination concerning the recognition of the state and character of the breast tumour, thus in weeks to months. Those are cases, when it is not necessary to follow the surgical procedure with oncological treatment and it is performed rarely.

Breast reconstruction is most often undertaken after the end of oncological treatment and the negative examination aimed for possible secondary spread of tumour. It is usually performed after more than one year after the primary procedure.

The procedure of breast reconstruction

In principal there are 3 options of breast reconstruction. Always it involves gaining of the tissue volume in the place of missing breast.

  • The usage of own material (transfer of the skin, sub-dermis and possibly the muscle to the place of missing breast)
  • The usage of synthetic material (silicone implant, implant filled with saline or implant combining silicone content with saline)
  • The combination of own material with the implant (when the transfer of the skin and sub-dermis from the near area of missing breast and the following filling with the implant)

The use of own material

Most often used is so-called TRAM flap. It is a tissue that is transplanted from the woman’s lower abdomen. The major part consists of subcutaneous fat covered with skin. The result is an arcuate scar in the lower abdomen, the same as in cosmetic abdominoplasties.

It is possible to transfer this tissue to the area of the missing breast in several ways:

  • With the application of one of the muscles that forms the abdominal wall. It is the oldest method used for breast reconstruction. It brings the need to solve the formed defect of abdominal wall to prevent the creation of hernia. That is why this part of the body is often covered with small net as in solving bigger hernia.

It is possible to perform this procedure in all clinics of plastic surgery where the breast reconstruction is performed.

  • Another option is to separate totally this tissue from the vessels and to transplant it to the desired area as a so-called free flap; it is necessary to reconnect the vessels of the flap to the blood supply.

In this case the suturing of the vessels is made under the microscope. That is the reason why such surgeries can be performed just at the plastic clinics where microsurgical procedures are made.

The advantage of this procedure is that the defect in the abdominal muscles is not big or with the usage of DIEP flap no defect is created.

The disadvantage is in principal longer process of the surgery and more strenuous care after the surgery.

For transplantation of needed volume of the tissue it is possible to use also other parts, although they are applied much less.

The advantages of the usage of own material:

  • It is not a foreign material
  • The psychological moment
  • Lesser risk in the irradiated terrain
  • The correction of the second breast is not always needed
  • Final cosmetic look of the donor place

The disadvantages of the own material:

  • Longer surgical procedure
  • The possibility of defect creation in the donor place
  • More strenuous care after the surgery

The use of synthetic material

In very small breasts it is possible to perform breast reconstruction directly by inserting an implant to the area.

In bigger breasts it is possible to insert a special type of implant to the reconstructed place, so-called expander that is gradually after the surgery filled through skin by injection to the desired size. During that the skin above the expander is “stretched”. Like this we achieve to get enough tissue with which we can subsequently cover the implant of needed size. After that we can either leave the existing filled implant or we can change it with silicone filled implant.

Last option in this group is the breast reconstruction with the usage of so-called Becker implant. In principle it is an implant with two cells. One is filled with silicone and the other one is added to its desired size with saline. We can therefore call it expander-implant.

The combination of own and synthetic materials

During this procedure the excess of skin coverage, which is needed to cover the inserted implant, is transferred from the skin of near area. Most often so-called thoracodorsal flap is applied, when the skin from the surrounding side is transferred to the area of newly reconstructed breast.

Another, shorter time used method, is the transplantation of the skin from the adjacent area of abdomen. The advantage of this method is that no other scar is created during the surgery because the procedure is performed from the scar after the breast ablation.

The advantages of the use of synthetic material:

  • Shorter surgical procedure
  • Less strenuous care after the surgery
  • Suitable for small breasts and skinny women
  • No functional defect of abdominal wall is created

The disadvantages of synthetic material:

  • The psychological moment in the usage of foreign material
  • Problematic application in irradiated terrain
  • The complications during the healing of the implant (the capsular contracture)
  • The need to correct the other side in bigger breasts

Another phase of the breast reconstruction

Each breast reconstruction is a procedure that consists of several gradual surgeries.

In interval of several months a new nipple and areola is reconstructed. This topic has been already described in another article. At the same time, an additional change of size and shape of the other breast might be made.

And even after the reconstruction of the new breast with areola and nipple it is possible, especially in case of the reconstruction with implant, to expect several surgeries necessary for the correction of the final result.

The care of the patients with reconstructed breast is long-lasting and minimally the follow-up of the treated patient is for the whole life. In spite that, the breast reconstruction brings higher self-confidence and according to what they say, it improves significantly the quality of their private life and very often even the professional life.