Breast cancer is a treatable disease in most case, which often requires surgery to achieve complete removal with procedures that range from lumpectomy, partial mastectomy to complete mastectomy including or sparing the nipple-areola complex depending on each case.
It is possible and it is each woman’s right to have her breast reconstructed to return to a full life with the joy of her femininity without suffering the stigmata of a breast amputation.
Depending on the defect and clinical condition, if patient has received chemotherapy and/or radiotherapy there are different solutions that suite to each case.
Which are the available options for breast reconstruction?
Fat transfer is an ideal technique to restore small volume loss and as refining technique after breast has been reconstructed. It is also highly recommended in irradiated areas to reduce pain and improve elasticity. Its low invasivity permits to be easily repeated more than one time until the desired result is reached.
Latissimus dorsi flap
Latissimus dorsi is a fan shaped flap of the back of the thorax that can be easily rotated to the chest.
Again, it is one of the oldest and yet most reliable ways to reconstruct a breast.
Latissimus dorsi can be used as first choice when irradiated breast needs to be reconstructed or as back-up plan when other reconstruction plans have failed or had an unsatisfying result.
Expander/implant based reconstruction is the most known and common reconstruction technique, for sure. It requires two operations; the first to place the expander, consequently it is inflated in the consultation room every 10-15 days until desired volume is obtained.
During the second operation the expander is substituted for a silicone or polyurethane implant to reach the final result. The first procedure is performed in one hour and requires one night of hospital staying; the second one is performed in one, one and a half hours and is performed as outpatient procedure.
The advantage of this technique is high control in final shape of the breast; the disadvantage is a two-step procedure and the nearly absolute contraindication in irradiated breast.
Abdominal flap (DIEP) and free microsurgical reconstruction
Microsurgery is the highest level of surgical art and technical difficulty in breast reconstruction; not all plastic surgeons offer it.
The basic concept is to avoid to use synthetic material like silicone to restore the breast shape using a part of the own patient’s body; it can be described as a transplant using the same person tissues. Like heart or kidney transplant, the skin and fat transferred by the surgeon survive thanks to the connections of tiny arteries and veins (anastomosis) manually made by the surgeon under microscope magnification to restore blood circulation.
Soft tissues can be harvested by various part of the body. Nevertheless, the abdominal flap, named DIEP flap, is the most popular option to rebuild a breast because a woman often has enough volume in her abdomen to match the breast size, as a pleasant side effect, the abdomen will be flat and nicely shaped after surgery, which is usually appreciated.
In the long term, the patient can enjoy the advantages of having the breast restored in a single stage, has not to worry about implant maintenance (for example broken implant replacement) and can expect both breasts to age symmetrically.
In case of radiotherapy or delayed reconstruction with lack of tissue to build a new breast, abdominal flap finds its best indication against expander/implant reconstruction.
What happens to the other breast?
Often, reconstructed breast does not reach perfect simmetry with the other breast, in this case simetrization surgery mey be indicated.
According to the situation, breast lift, reduction or augmentation may be required.
Simetrization is achieved by breast molding surgery with or without implant, sometimes only fat graft is enough to reach a satisfatory aesthetic result.
How can I have my nipple and areola reconstructed?
When the reconstruction process is over, we wait up to three months the breast to settle in its new position.
After that, we can do perform nipple reconstrucion under local anesthesi using a little portion fo the skin of the same breast or grafting a portion of the other nipple in those cases when the patient a big nipple.
The areola can be reconstructed either with a skin graft or a tattoo.