Breast Reconstruction

The issue of breast reconstruction after oncologic ablation is still a subject of intense discussion and dispute. In the developed countries breast reconstruction after cancer surgery is mandatory and the costs are covered by the health insurance. In our country this surgery is done on request and brings rather large costs for the patient.

Modern oncological resection of the breast is not as radical as it was 10 years ago so the area will not remain mutilated, uncorrectable.

The timing of breast reconstruction is chosen depending on the stage of the cancer, if possible at the same time with the oncological resection. Thus are minimized the social and psychological implications that may occur due to the lack of a segment so noble for woman.

Usually these interventions are done by complex teams with more then one specialist. Besides the oncologist surgeon who performs the ablation, a plastic surgeon it is required to achieve the reconstruction and a pathologist to determine the stage of the disease. If the stage of the cancer is more advanced and requires tissue irradiation then the reconstruction will be delayed.

Most common methods in breast reconstruction imply the use of:
silicone breast implants with a previous use of tissue expanders pedicled flaps: latissimus dorsi muscle, the rectus abdominal transverse muscle or TRAM (rectus abdominis muscle) transferred free flaps: latissimus dorsi, the TRAM, the glutes, the gracillis. Often techniques are combined to achieve more natural results. If the excision is minimal, the introduction of an implant is a relatively easy fix. In the case of a total excision, a large soft tissue and skin defect is generated and commonly used is the Latissimus Dorsi musculocutaneous flap pedicle.

In addition to the methods of reconstruction of the breast volume and silhouette, areola and nipple reconstruction methods may be taken into account. For the areola reconstruction the most used method is the medical tattoo. Another option is a free skin graft, with the full thickness of the skin harvested from a region where there is a constitutional darker tone (perineal region).

At the same time, the tissue expanders will be inserted and will be filled gradually, over the course of several weeks. This will form a cavity large enough to insert a permanent prosthesis. Later the areola and nipple will be rebuilt.

Pairing this technique with liposculpture and microlipofiling can be beneficial for the patient. Thus the edges will be less noticeable to the touch.

What is mentioned above is ideal therapeutic plan for breast cancer. Even if it was not possible to synchronize the operation of excision of the tumor with the breast reconstruction, that does not mean it can not be done later. Reconstruction in breast cancer is possible anytime after the disposal, even if many years have passed, provided that the disease is kept under control.

Frequently Asked Questions

How many surgeries are needed for breast reconstruction?
Usually after the first stage of the oncology ablation surgery, under the same anesthesia, and if the stage of the cancer allows it, breast reconstruction can be done, thus sparing reoperation. The patient has a net benefit for the combination of the two operations, suffering no psychicall trauma from the breast ablation.

Two to three months later then the ablation the patient will require another surgery in which the tissue expander will be removed and replaced with a permanent prosthesis. At this time a shape correction of the breasts can be achieved by a contralateral correction, if needed, and also the areola and nipple reconstruction can be done.
What are the possible complications of breast reconstruction surgery?

Immediate postoperative complications that can occur are:

hematoma, bleeding, which is why often a drain suction at this level will be maintained for a longer period of time (7-10 days) seroma in 50 % of cases
infections wound dehiscence skin and soft tissue necrosis Remote complications:

unsightly appearance pathological scarring lack of symmetry in the contralateral breast Is the evolution of breast cancer influenced by the breast reconstruction surgery?

Breast reconstruction does not seem to influence in any way the evolution of the cancer . If the condition is evolved, after irradiation the reconstruction can be tryed. In the case of irradiation, tissue becomes very brittle and difficult to handle during the surgery.

Where will the breast reconstruction postoperative scars be placed?

In the case of a classical reconstruction of the Latissimus Dorsi musculocutaneous flap on the front of the chest, there will ba a circular scar horizontally under the new breast. On the posterior thorax, where the flap was harvested from, there will be a linear scar, oblique lateral and cranial, 20-25 cm in length, sometimes even more, resulting from direct suturing the site.

What are the contraindications of the breast reconstruction surgery?
noncompliant patients advanced stages of cancer disease associated pathologies such as infections, wasting, diabetes, severe illness skin or blood diseases etc. Results depend largely on the type of injury, its severity and the time since its occurance.
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