BREAST RECONSTRUCTION SURGERY AFTER A MASTECTOMY.
What is breast reconstruction?
Breast reconstruction creates a new breast shape using surgery. It can be done at the same time as a mastectomy or some months or years later.
A total mastectomy is a surgery that removes the entire breast tissue. It is usually done to treat breast cancer. Also, you could have breast-conserving surgery (lumpectomy or partial mastectomy) where only a part of the breast is removed.
Breast reconstruction surgery intends to restore breast symmetry after your surgical cancer treatment. A new breast is created with similar characteristics to the other in shape and size. The main goal is to create a breast that looks as natural as possible.
Breast reconstruction not only restores a part of your body but also helps to recover psychological balance and femininity.
Recent studies show that reconstruction surgery is safe, without any side effects. Also, it doesn’t delay the treatment or the detection of tumor recurrence.
However, it requires a plastic surgeon with wide experience who is at the forefront of the most advanced techniques.
Medically reviewed by Dr Osama Bahsas Zaky
Written by Joaquín Pineda
Updated on July 19, 2021
How long should I wait to have breast reconstruction surgery?
According to the American Cancer Society, the breast reconstruction procedure can be done simultaneously as the mastectomy or any time afterward.
Traditionally, breast reconstruction was carried out months or years after the mastectomy. However, evidence of the benefits and the procedure’s safety make immediate breast reconstruction the most common option in recent years.
The advantages of immediate breast reconstruction (also called direct-to-implant reconstruction) in contrast to delayed reconstruction are:
- cost reduction.
- better aesthetic results.
- less psychological effects.
However, the diagnosis of breast cancer can be overwhelming. Thus, some women don’t feel up to deciding on the reconstructive process while coping with radiation treatment. In these cases, the best alternative is to do a delayed reconstruction to devote all the initial care to cancer treatment.
How can we get the two breasts to look symmetrical ?
Once the defect caused by the mastectomy has been addressed, the next challenge is to achieve symmetry between the two breasts. To do so, there are several options:
- breast reduction
- mastopexy (breast lift)
- breast enlargement
- a combination of these techniques.
The options should be discussed with the patient before starting the process. They can be carried out during the same surgical procedure or at a later time.
The final step is the reconstruction of the areola-nipple complex to improve the natural breast shape.
Usually, the areola and nipple reconstruction is done between 6 and 8 weeks after breast reconstruction. The most commonly used option to reconstruct the areola is tattooing. And the nipple may be reconstructed using local skin flaps.
Modern techniques have reduced the amount of scarring in breast reconstruction surgery. They usually fade over time but never go away completely. Also, the amount of scarring depends on the type of reconstruction.
How much breast reconstruction costs?
Breast reconstruction cost depends on many factors. Hence, we don’t offer approximate prices without meeting the patient as each patient is a different case.
However, we know that the economic factor is important when it comes to making a decision. Therefore, we offer the possibility for the patient to come to our facilities for a first free no-obligation visit.
The patient can consult with the breast surgeon regarding all their doubts and worries. We will offer the best solution and the best price for your reconstruction surgery.
BREAST RECONSTRUCTION SURGERY WITH AN EXPANDER AND IMPLANT
This technique usually involves at least two interventions.
In the first intervention, an implant with expansion capacity is placed under the muscle and skin to replace the breast that has been removed. This first surgical phase takes nearly two hours. Normally you will need two days of hospitalization.
The expander is gradually filled by adding saline solution for a few sessions (every 1 or 2 weeks) until the desired volume of breast skin expansion is achieved.
Then, after two to six months, plastic surgery is done to insert a standard breast implant and recreate the shape of the original breast. This surgery lasts an hour and a half. The patient needs to stay in the hospital for a day and to rest for a week.
After a few months, the patient can go ahead and have a third intervention under local anaesthetic to reconstruct the areola and the nipple.
ADVANTAGES AND LIMITATIONS
Breast reconstruction with an expander and implant is ideal for patients with small breasts.
Advantages to this technique:
- The expanded skin is sensitive and has the same color and texture as the previous breast skin.
- Surgery and recovery time are shorter.
- It is a relatively easy technique.
Disadvantages:
- The total time for reconstruction is longer.
- You will need a second surgery to change the expander for the implant.
- The result isn’t so natural since the aging of the treated breast is usually different from the other.
THE TRAM FLAP VS. DIEP FLAP
Generally speaking, tissue flap procedures use the patient’s tissue from the abdomen or back (and even the thighs or bottom) to create a mound to reconstruct the breast. It is an autologous reconstruction!
Taking abdominal tissue is called a TRAM (Transverse Rectus Abdominus Myocutaneous) flap. TRAM flap focuses on using tissue from your abdominal muscles, as well as some soft tissue.
On the other hand, the DIEP flap (Deep Inferior Epigastric Perforator) spares the abdominal muscle and only uses soft fat tissue and local blood vessels to create a new breast. At a basic level, both procedures achieve the same thing but differ in execution.
DIEP flap gives warm, soft, and supple reconstructed breasts that mimic natural breast tissue. Through this technique, it is possible to obtain a new breast that is very similar to the natural one.
BENEFITS AND LIMITATIONS OF THE TRAM FLAP AND DIEP FLAP
DIEP flap is considered the gold standard for breast reconstructive procedures. It is used in the most prestigious medical centers in the world. Conversely, TRAM surgery has an added risk of hernias and muscle weakness at the donor tissue.
Another added benefit is that the DIEP flap doesn’t interfere with the treatment or the subsequent control of breast cancer!
Besides, after the surgery, when the patient loses weight, the new breast will slim down too. If the patient puts on weight, the breast will also increase in volume. When the patient gets older, and the breasts sag, both breasts will do so in a symmetrical way.
Without a doubt, the DIEP flap is one of the best techniques that we have currently for breast reconstruction. It allows for a natural reconstruction using the patient’s own tissue. Besides, the donor zone is left as if we had done abdominal surgery (tummy tuck).
The biggest disadvantage is that DIEP flap surgery lasts 5 hours and requires a highly qualified team in microsurgery. Also, this surgery may not be suitable for certain patients. Some medical conditions might increase the risk of complications during and after surgery.
Despite being a long surgery, pain levels are moderate. A combination of general and epidural anaesthetic is used. After the operation, the patient must stay in the clinic for 4-5 days.
LATISSIMUS DORSI FLAP
Taking tissue from the back is called a latissimus dorsi flap. This technique is a very useful skin flap because it is near the reconstruction zone.
The Latissimus Dorsi flap is indicated in the case of:
- prior failure of breast reconstruction using implants or with another flap.
- obese or extremely thin patients in whom the DIEP flap is contraindicated.
- patients with very thin skin flaps to cover the breast implant after the mastectomy.
The main disadvantage of this technique is that it leaves a significant scar in the back area.
BREAST REDUCTION AND LUMPECTOMY
In patients with large breasts and a localized tumor, it is possible to do a breast reduction.
The tumor can be removed with wide margins, and the aesthetic result is similar to a conventional breast reduction.
The surgery must always be followed by radiotherapy. By reducing the other breast, as well as achieving symmetry, the risk of cancer is reduced. Recovery is similar to that of a standard breast reduction.
Do you want more information about breast reconstruction options?
The first visit is free and without obligation.
You can contact us on WhatsApp or Viber at +34 657 460 421.
If you wish, you can send us some photos to have an estimate quote. Photos will not be stored and will be treated with the utmost confidentiality. Please explain the results you wish to obtain.
