In some cases, in order to prevent breast cancer from spreading to other organs, some parts of the breast or the entire breast has to be surgically removed (mastectomy). Immediately after the mastectomy is performed, or a while later (depending on the patient), the surgeon can perform a reconstructive surgery of the breast. This particular decision has to be made after consulting a breast surgeon, an oncologist and a plastic surgeon.
Breast reconstruction is very important for patients that have suffered from cancer, as it helps them regain their self-confidence.
Reconstruction operation can be done by implants (saline or silicone implant) or by using parts of the patient’s own tissue (moved sections of skin, fat, muscle).
Saline implants offer more flexibility, as over time, the size of the breasts can be adjusted. The implant is done in three phases: first a tissue expander has to be introduced between the skin and the muscle. It is left there until the skin and muscle are slowly strecthed to make room for the implant. The expander is a special saline implant that contains a valve which allows further insertion of saline, thus adjusting periodically the size of the breasts until the end result is obtained. Finally, the expander is removed and the implant (saline or silicone) is inserted.
If the patient has to undergo radiation therapy after the mastectomy is performed, it is recommended that the implant surgery is performed before the radiation therapy begins, as the skin is affected.
Acellular dermal matrix
This is a technique that uses the skin that remains after the removal of the breast or donated human tissue. The advantages are that it is a single-step procedure, and the tissue is well-integrated. Still, it is a procedure that is avaliable depending on the type of mastectomy that was performed.
Choosing between saline or silicone implants
Both options have good and bad aspects. The silicone implant is more similar to a natural breast, but is less flexible than a saline implant. Both kinds of implants are likely to rupture, but in the case of the saline implant, the patient can immediately notice if this happens. Both implant options can lead to health complications or unpleasant manifestations (infections, pain, contraction of the tissue around the implant), and both will need to be replaced after a while.
Natural grafts surgery
Breasts can be reconstructed by using skin and muscle taken from different parts of the patient’s body; this is a more complex procedure, but the end result will look and feel more like a natural breast.
Several muscle flaps can be used in breast reconstruction:
- the latissimus dorsi muscle (a large muscle in the back prelevated together with a skin portion and fatty tissue),
- transverse rectus abdominis myocutaneous (TRAM), which uses tissue set from the lower abdomen,
- deep inferior epigastric perforator (DIEP) flap breast reconstruction uses skin and fat tissue from the tummy, just like the TRAM procedure, but does not affect the muscle, which makes the recovery easier.
- Superior gluteal artery perforator (S-GAP) flap is a breast reconstruction method that uses tissues from the upper buttock. It is a better option for women who have more fat tissue in that area than in the abdominal area.
In the final phase of breast reconstruction, the nipple and the areola are recreated. This procedure helps build a more natural feel and look and it can help estompate scars. The nipple can be recreated from the skin of the reconstructed breast or it can be `spared` during the mastectomy. The areola can be reconstructed by tatooing the area around the nipple or by taking a skin graph from the groin area, as it is similarly pigmented.
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