The reconstruction of the breast after its loss (complete or partial mastectomy), usually due to oncological surgical treatment, is another part of the healing process, allowing the restoration of integrity prior to the disease.
Among its objectives is considered as essential, obtaining a new breast of natural appearance, similar to the opposite, including if possible the nipple-areola complex. When the loss is double, the forms obtained must be in line with the constitution or size of the affected woman. In consequence the need for external prosthesis filling, improving the chances in clothing or clothing is removed. The undoubted benefit in restitution of body image transcends any sphere of existence, both personal and relationship.
Who may be candidates, and which is the right time?
The prognosis of the original disease and the state of health are the first conditions. The ideal circumstance entails the radical or curative surgical treatment of tumor disease, which may involve mastectomy including limited excision, and reconstitution of the breast at the same operative time we call immediate reconstruction. In these women there is no experience of amputated breast. This option necessarily implies the simultaneous collaboration of the oncological surgeon and the plastic surgeon, therefore only possible under proper and anticipated planning. When the above is delayed, whether due to the prognosis of the tumor disease, previous health condition, risk factors such as obesity or cardiovascular disease among others, the reconstruction is called deferred.
Systematic breast reconstruction
Once the diagnosis of cancerous disease has been established and the extent of the extirpation determined in addition to the complementary therapy , it is important as an integral part of the multidisciplinary treatment among different specialists, to know in advance the possibilities of repair that are offered. Breast units are made up of specialists in diagnostic means, such as nuclear medicine, radiodiagnosis and pathological anatomy ; and also oncology therapists, radiation therapists and oncological surgeons. The reparative process is the responsibility of the plastic surgeon that brings together its scientific and technical knowledge, in addition to the harmonic sense, the ability to restore the affected organ.
Ways to perform breast reconstruction
1. Expansion techniques that basically promote the distension of skin and soft parts, by implanting a reservoir that is gradually filled with saline through a valve, over several weeks. Once the sufficient projection is obtained, it is replaced in a second time by a definitive prosthesis. This technique can be started at the time of mastectomy, or later. There are also expander prostheses that can remain without requiring replacement.
2. Techniques that use own or autologous tissues, here we move tissues from a donor part to the location of the new breast, be attached to some of its original insertions such as the back (large dorsal or latissimus ), or the abdomen (abdominal rectum or TRAM), of those that retain their blood supply. Or free when they remain unrelated to the donor area and need to be reconnected to the recipient vessels of the chest or armpit with microsurgery; The latter can come from various parts of the body, with abdomen and buttocks being habitual.
They are technically more complex procedures than expansion, but they provide more natural and lasting results. Some expander and implant prostheses may also be necessary.
3. The opposite or healthy breast can be provided, or quite the opposite by excess or default, including varying degrees of descent or ptosis . To obtain a necessary similarity between both breasts, it may be necessary to correct this imbalance by remodeling it while creating the new breast removed.
4. In general, the recovery of the areola-nipple complex is established once the definitive form and projection are obtained, techniques that are usually performed under local anesthesia on an outpatient basis or coinciding with the second definitive time. All techniques have their advantages and disadvantages therefore their indications in each specific case.