Every year the cases of breast cancer are increasing in the world.
This is why many women must undergo treatments such as mastectomy, which result in changes in physical appearance such as weight loss or gain, scars, and even loss of the breast. The latter brings with it various physical and psychological problems, which is why specialists recommend undergoing breast reconstruction surgery so that the patient can regain her quality of life and can feel comfortable with her body and appearance.
The breast reconstruction operation is part of the breast surgery together with the Mastopexy, Gynecomastia, Breast Augmentation, and Breast Reduction operations.
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What is breast reconstruction?
Dr. Eduardo Simón explains that the main objective of breast reconstruction is to restore the shape, symmetry, and size of the breast after a mastectomy, quadrantectomy, or lumpectomy.
After these surgeries can even be to remove benign tumors or of infectious origin, the breast can be left with sequelae such as the complete removal of the breast, subsidence, scars, and non-symmetrical or natural shapes.
For this, several plastic surgery surgical techniques can be used, among which are:
- Fat grafts
- Reconstruction based on implants and tissue expanders
- Using tissue flaps from the patient herself
In addition, Dr. Eduardo Simón mentions that a breast reconstruction surgery can be performed at the same time as cancer surgery, which is known as immediate reconstruction, or it can be performed after treatment and radiotherapy have been completed, which is known as a lazy rebuild.
Likewise, the specialist mentions that the techniques to be used in each case will depend on innumerable factors such as the type of incision made, the weight, the size of the contralateral breast, and the expectations of the patient.
How do I know if I am a candidate for surgery?
Breast reconstruction surgery is indicated for patients who have undergone the removal of a breast after a mastectomy, quadrantectomy, or lumpectomy, and with it, the presence of physical sequelae such as the absence of a breast, sinking, or scars in the chest area, among others aftermath.
It is also indicated for patients who did not develop one of the breasts or have some type of genetic malformation.
On the other hand, experts recommend that this surgery patient d even have a good state of general health. In patients with well-controlled previous pathologies such as diabetes, hypertension, etc., the above-mentioned techniques can be performed, however, the possibility of complications is somewhat higher. Special mention to smoking patients, whose healing is usually impaired, and the possibility of suffering complications in the healing or ischemia of the tissues, is much higher.
How to choose my plastic surgeon?
Specialists leading organization of certified plastic surgeons in the world, ISAPS, explains that l or more importantly, the surgeon is qualified by some entity is to be certified
This will assure the patient that he is an experienced plastic surgeon, with the appropriate technical capabilities, who will provide the patient with safe treatment, using the latest technological advances, which will translate into satisfactory results, very much in line with expectations.
On the other hand, specialists recommend the patient learn about the various centers and clinics where they perform the surgery, reading comments and reviews about the experiences of other patients, which will provide a much clearer picture of where and with whom to perform the surgery. operation.
Finally, explains that a good formula to choose the plastic surgeon who will perform the surgery is to choose two or three doctors who inspire confidence in the patient. After that, the person must go to visit them and tells you in detail what they need and what their expectations are with the intervention. As a second step, it is important to listen to surgeons, and understand what techniques they will use the risks associated with surgery, and post-operative care. Accordingly, you must choose who you felt most comfortable with, and who generated the most confidence and security for you to be in charge of the entire process.
What is the first visit with the plastic surgeon like?
For the first appointment with the surgeon we have chosen to be in charge of our breast reconstruction case, recommends simple but useful steps so that this first appointment is the most beneficial for both sides.
In the first instance, the patient must keep a complete and as detailed clinical history as possible, in addition to the list of all the medications (both natural and not) that she consumes daily so that the doctor can analyze her situation in detail. medical.
On the other hand, the specialist advises being accompanied, since as it is the first consultation, there is a lot of information to retain and memorize, so the help of another person will always be quite useful. Likewise, it is very good to keep a notebook and take notes of the techniques that will be used or the key points of the conversation to review later.
In addition, the surgeon will evaluate the patient and suggest the best treatment based on the diagnosis, and medical history, among other factors such as weight, breast size, etc.
On the other hand, advises going prepared with all your score doubts and expressing freely. Hopefully, during the first appointment, the expectations that are had with the operation, as well as deepen on an issue that is not yet clear.
How is breast reconstruction performed?
There are 4 types of techniques or procedures to perform breast reconstruction according to each case, among which are:
- Breast Reconstruction Using Flap Surgery: The Specialists, explain that this is one of the most complete procedures since the body’s tissues are used. This intervention can be performed at the same time as a mastectomy in an immediate reconstruction surgery or it can also be done later, in a late reconstruction. General anesthesia is used in all techniques. On the other hand, it is possible that with this intervention more surgeries will be needed to perform a reconstruction of the nipple or to leave the breast as natural and symmetrical as possible. With this technique, the surgeon performs a transfer of muscle, skin, blood vessels, and fat from some area of the body, depending on each case, towards the chest to rebuild the breast. Generally, two methods are used for this technique;
Likewise, there are various types of flap surgery. Among them are:
- Abdomen (TRAM flap): Here the surgeon removes tissues, skin, and muscle from the abdomen area. It can be by pedunculated flaps or free flaps. In the first, the surgeon removes the most important muscle in the abdomen, called the rectum. In the second, the surgeon only removes part of the muscle, which allows the patient to maintain strength in that area.
- Abdomen (DIEP flap): With this procedure, only skin and fat are extracted from the abdomen, thus the patient retains the greatest strength capacity in that area, which is a great advantage. Today it is the best possible reconstruction technique.
- Abdomen (SIEA flap): This technique uses the skin of the superficial inferior epigastric artery (SIEA). The same abdominal tissue is used, but with the advantage that this skin does not depend on such deep blood vessels. It is possible to perform it in a few cases, and it depends on the individual anatomy of each patient.
- Back (latissimus dorsi flap): In this technique, the surgeon takes skin and muscles from the upper back and is recommended for patients with small to medium breasts.
- Buttocks (gluteal flap): Part of the gluteal tissue is taken to reconstruct the breast and is recommended for women who do not have enough tissue in the back or abdomen area.
- Inner thigh (TUG): Fat and muscle are transferred from the lower gluteal area to the inner thigh. It is a fairly new technique and is recommended for patients with medium to small breasts. It allows the reconstruction of the nipple in the same intervention
- Breast implants: When using this technique, the surgeon makes breast implants, which are made of silicone to mold the breasts and leave them as asymmetrical and natural as possible. This procedure can also be performed at the time the mastectomy is performed, but the surgeon will be the one to decide when the reconstruction can proceed. It is important to note that this technique requires several operations. On the other hand, if the patient requires radiotherapy after the mastectomy, this intervention is not recommended.
- Reconstruction with breast implants and expanders: After the mastectomy, the surgeon inserts a temporary prosthesis, called an expander, and a saline solution under the skin and the pectoral muscle. This, during several weeks, to prepare the skin and leave enough space in which the surgeon will insert the definitive silicone prosthesis,
- Fat grafting: It is a very common technique used in combination with the others, however, it is usually insufficient to rebuild a breast by itself. It consists of improving the shape of the breast and giving it volume through fat grafts, which visibly improves the elasticity and appearance of the breast. It is common to need several interventions, especially if the breast to be reconstructed is of moderate or large size and/or the defect to be corrected has a large volume.
When a patient undergoes a breast reconstruction, she usually also requires a nipple reconstruction, so that it is as natural and harmonious as possible. This is how the surgeon reconstructs the nipple and may include a tattoo to define the dark area that surrounds the nipple or areola.
How to prepare for breast reconstruction surgery?
Specialists recommend not taking aspirin or any medication with (Acetyl Salicylic Acid) for two weeks before and after surgery. Remember that you should not smoke or drink alcohol, as it delays the healing process.
On the other hand, it is important to wear comfortable and loose clothing on the day of the operation and for discharge from the clinic. Avoid shaving or waxing the day before or the day of the surgery as it is better to do it at least 3 days before.
What are the main advantages of breast reconstruction surgery?
Among the main benefits we can highlight:
- The patient recovers her quality of life
- Increased self-esteem and confidence
- Natural and very satisfactory results
- Long-lasting results
What are the main complications and risks of breast reconstruction?
Like any surgery, it can present complications of various types such as:
- Possible infection: If you notice that you have a discharge of pus, fever, or change in color and redness in the area of the operation, you should immediately consult with your surgeon and he will most likely prescribe antibiotics.
- Excessive blood loss: You should also consult with your surgeon if you notice a great loss of blood in the area of the operation.
- Implant problems: A very common problem is capsular contracture. This is when the scar around the implant tightens. Usually, in these cases, the surgeon changes the implant for a new one.
- Flap problem: The main complication that can occur in these cases is the loss of strength in the area where the flap was removed. There is also a risk of clotting from the various blood vessels involved and which were transferred.
- Death of tissue (necrosis) due to interruption of the blood supply.
- Hernia or weakness in the abdominal wall, from where the flap was removed.
What are the results of breast reconstruction?
For=- specialists, the main expected results are:
- Visibly improves body image
- Improved self-esteem
- Provides better symmetry of the breasts so they look natural and look alike
- Helps mitigate physical memories of illness
- Most of the results are long-term
- Is there any risk if I have a second breast reconstruction after two years due to disagreement with the results? , explains that depending on the particular case of each patient, it is essential to attend the consultation of a specialist who will assess why the deformity. If the prosthesis was displaced in the case of an implant or if the technique to be used must be modified.
- If I had a mastectomy, is breast reconstruction necessary? It is highly recommended for patients who have undergone a mastectomy to undergo breast reconstruction, as it will have a very positive effect on a physical and psychological level,
- How long should I wait after chemotherapy and/or radiation therapy to rebuild my breasts? The experts mention that it is recommended to wait 3 months from the end of chemotherapy, and 6 months from radiotherapy.
- Are all patients a candidate for surgery? No. There are patients who due to health problems will not be able to undergo surgery or there are some who will not obtain the results they want,
- When will I be able to go back to work? It will depend on each case, but usually a week after discharge,
- Can I expect my breasts to look 100% symmetrical? , they explain that they will never stay the same, nor will they retain the old appearance, but you can expect a natural result under a bathing suit or clothing.