Breast reconstruction is a surgery that aims to restore a breast usually removed completely or partially after breast cancer. This is a very common but complex procedure that can be performed immediately at the same time as the mastectomy (breast removal) called immediate reconstruction or performed after the end of radiotherapy and chemotherapy called secondary reconstruction.
Decision is made by mutual agreement between the oncologist, the radiologist, the surgeon performing the mastectomy and the plastic surgeon who will rebuild the breast. Generally, the secondary reconstruction is the most practiced once all treatments are completed.
The basic principle of this reconstruction is to provide a new volume with silicone implants and provide skin with the surrounding skin at the back or belly initially, then draw the nipple and areola and then if necessary use a plastic surgery for symmetry of the breasts.
There are three possibilities:
- If the skin is of good quality and sufficient quantity, we just bring volume with silicone breast implants. Knowing that we can use the stretching capacity of the skin by a prosthetic skin expansion up until a few months before the final implants.
- If the skin is irradiated and insufficient, we must bring skin more often from the latissimus dorsi flap, which mobilizes an anatomical unit consisting of a spindle skin part of the skin of the back, the vessels stay connected which will nourish the tissues transferred associated with the latissimus dorsi muscle transferred to the breast, taking care to keep the artery and vein located in the axilla which ensures the vitality of these tissues. In terms of volume, sometimes we put silicone implants and sometimes we can do without when there is a small breast reconstruction, the flap may be sufficient.
- If it is a big breast reconstruction, the flap of the transverse rectus muscle of the abdomen (TRAM) is exceptionally used as the surgery mobilizes all the skin under the umbilicus and the sheath abdominal muscle requires the establishment of a synthetic plate to repair the abdominal defect.
The type of intervention will depend on several factors including: the patient’s quantity and quality of skin, radiotherapy history, the desired symmetry and volume, etc.
Who is it addressed to ?
This surgery is indicated for women who have had breast removal after cancer, to feel more comfortable in her body. In order to not have to wear an external breast prosthesis every day, and feel more desirable and above all to forget this experience that is often felt as a mutilation.
The type of intervention chosen by Dr. Guessous will depend on several criteria:
- treatments (chemotherapy and radiotherapy) and their impact on skin tissue
- the amount of the removed breast skin
- The amount of present subcutaneous tissue for breast reconstruction
- The size and shape of the existing breasts
- The patient’s expectations
- And most of all the patient’s general health, as she had a mastectomy.
You should know that the majority of patients ultimately require the use of a silicone breast implant to restore volume and a latissimus dorsi flap to ensure the skin and muscle coverage of good quality. This technique does not cause any discomfort to the part where the flap was taken.
Breast reconstruction is a surgery performed by Dr. Guessous that lasts two hours and is done under general anesthesia.
– Symmetry of both breasts: In some cases, we can associate a symmetrization with respect to the contralateral breast; this can be a lift, a reduction or augmentation.
– Drawing the areola and nipple: Most often the nipple and areola are made in a second surgery, it will be skin graft taken from the groin or just a tattoo of the areola. The nipple is restored either by grafting hemi nipple on the other breast or just a tattoo.
We can use this second surgery to make alterations and remodeling of the reconstructed breast: scars, lipofilling, and liposuction. It’s a simple process that requires no hospital stay. This step can only be conducted when the breast has taken a final position generally on the second month.
Breast reconstruction is not a very painful surgery, but the first night some pain can be felt but prescribed medication will ease the discomfort.
Dressings are changed on the 4th day and finally removed on the 10th day, sutures are absorbable and do not need to be removed. The patient should wear a suitable bra during the months following the surgery.
Wearing a compressive back belt is expected in the case of latissimus dorsi flap. The lymph flow at the sampling area of the latissimus dorsi are virtually constant and must be punctured regularly until liquid dehydrating during a month or two.
In case of TRAM, a contention outfit should be worn.
The month following surgery, sports and rough movements should be avoided.
Result of the reconstructed breast is not immediately visible; it will take several months to get the final result. Even after several small alterations
Length of stay
According to the technique chosen by Dr. Mohamed Guessous, hospital stay varies from 2 to 3 days. It is necessary to rest and avoid efforts during the first few days.