The cancer treatment of breast consists in surgical removal of the tumor, often including removal of sentinel ganglion with following radiotherapy or chemotherapy. During the tumor removal also a part of mammary gland is removed at the same time and often even the whole breast, which represents usually big handicap for a woman. Although within the plastic surgery it is possible to reconstruct a part or even the whole breast together with breast areola so that it resembles maximally the look of the real breast.
The breast reconstruction must be at first recommended by the oncologist, who will decide in what time period after the tumor removal it is possible to perform the breast reconstruction.
In breast reconstruction we can use either artificial implant or own tissue.
The choice of the method depends on the local finding and on the general patient’s condition.
In case there has remained a part of breast’s skin after the breast removal or if the breast was removed just partially, we can simply insert a silicon implant, mostly under the breast muscle. If the whole breast was removed and there is not enough skin, a skin graft from a surrounding area is used. We form a skin flap and transfer it to the place where we want to form a breast. In such formed skin fold we then insert an implant. It is possible to transfer the skin flap from the outer part of the chest (thoracodorsal flap) or from the place under the breast (skin advancement). These skin flaps are suitable for reconstruction of small breasts, when the inserted implant does not exert big pressure on the created skin fold.
If we want to reconstruct bigger breast it is more suitable to use own patient’s tissue instead of an implant, it is a tissue from the further place with its excess and better possibilities to form it to a natural shape. Own tissue has also another advantage compared to an implant, there is no risk of capsular contraction and there is no need to change it like in case of an implant. For breast reconstruction with own tissue a skin with subcutaneous tissue is removed from the abdominal area under the navel.
The whole tissue is transplanted to the place on the chest where we plan to reconstruct a new breast, and there it is formed into desired shape. This tissue needs to have its own vascular supply to survive, through which blood flows to the transplanted tissue and the flap is therefore healed into the new place. The abdominal tissue might be supplied by vessels passing rectus abdominis muscle that lies under the transferring tissue.
The flap is rotated to the chest with the part of the rectus abdominis muscle and the vessels that are attached to the tissue are not disconnected so it guarantees its survival. The disadvantage of this method might be the defect of the part of the rectus abdominis muscle and following weakening of the abdominal wall.
More favorable, although technically more intensive is the method of free transport of tissue with the help of microsurgical technique. A tissue is removed with the part of the rectus abdominis muscle and the vascular pedicle of the flap is disconnected. The whole tissue is transferred to the chest where the disconnected vessels are connected on the receiving vessels under the ribs, and the blood between them can start to flow. For such vessel connection special suturing is used that is not visible with the naked eye, and this part of the surgery is therefore performed under the microscope and with the usage of special instruments.
The technique of the free tissue transplantation is technically and time wise more consuming and it represents bigger exercise for the patient compared to the breast reconstruction with silicon implant.
The patient has to be therefore in a good health state to avoid more serious complications during and after the surgery.
After the surgery the patient stays at intensive care unit for several days and then is placed to the standard unit. Calm mode is recommended for about one month and then slowly the physical exercise is allowed.
After some time also the adjustment of the second breast is often made so that both breasts would look the same. Also reconstruction of the nipple with the help of small skin folds is performed from the local material on the reconstructed breast. For more real colour of the breast areola we can use colour tattoo.
The solution of breast disease with its following reconstruction needs the cooperation of the mammography specialist, oncologist and plastic surgeon. Plastic surgeon should choose according to the specialist’s recommendation the most suitable method of breast reconstruction regarding the best result of the surgery and also the minimum risks for the patient.
The breast reconstruction after their removal is covered by the health insurance company.