Plastic Surgery | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao

Breast reconstruction

Plastic Surgery - Breast reconstruction - Breast reconstruction

Breast reconstruction

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The reconstruction of the breast after its extirpation due to breast cancer or another disease (mastectomy) is one of the most gratifying plastic surgery procedures for the patient.  The development of new medical techniques and materials enables the plastic surgeon to create a breast similar in shape, texture and characteristics to the unoperated breast.

To this effect, a breast reconstruction has as its objective:

• Recreate a breast of natural appearance including, if the patient so wishes, areola and nipple.
• Eliminate the need to wear a prosthesis, thereby enabling the patient to wear items of clothing that she would not be able to do without such a reconstruction (swimwear, clothes with low cleavage, etc.).
• Fill the hollow and the deformity remaining in the thorax, restore body image, improve quality of life and provide satisfaction to the patient.

THE IDEAL CANDIDATE

Almost all women who have undergone a mastectomy can, from a medical point of view, be considered as candidates for a breast reconstruction. In the majority of cases, the first opportunity to perform the reconstruction is at the same time as the mastectomy.
When the breast is reconstructed at the same time as the mastectomy is performed (technique called immediate reconstruction), the patient awakens from the intervention with an adequate breast contour, avoiding the experience of seeing their amputated breast; the psychological benefit of this technique is clear.

In some cases, however, the reconstruction can or should be postponed (technique called deferred reconstruction).  Some women do not feel comfortable talking about a reconstruction while they try to adapt to their diagnosis of breast cancer; other women simply do not want any more procedures than strictly necessary to cure the disease.  On other occasions, the use of more complex reconstruction techniques make it advisable to delay the reconstruction in order to not extend the intervention excessively.  If there are associated medical problems, such as obesity or hypertension, this may also delay the reconstruction.

On the other hand, immediate reconstruction requires a close collaboration between the surgeon removing the breast and the plastic surgeon, as the presence of both is required when the patient is operated on.
 
In any case, the important thing is to have adequate and clear information about the reconstruction options prior to the procedure, in order to face the operation as positively as possible.
The breast reconstruction is an essential step towards normality.  Not only does it replace a lost organ, but it helps to recover femininity, one’s own image, psychological equilibrium and helps to attenuate the commotion involved in the fight against cancer.

RISKS OF BREAST RECONSTRUCTION

Practically all women who have undergone a mastectomy can undergo a breast reconstruction.  However, there may be certain risks which the patient must be made aware of prior to undergoing this operation.  These risks are those that pertain to any surgery, such as haematomas, pathological scars, anaesthetic problems…. There is always a minimal possibility.  Likewise, smokers must know that smoking can cause cicatrisation problems and incur a longer recovery time.

If the reconstruction involves the use of implants, there is a minimal possibility that they may become infected, normally during the first or second week after the procedure.  In some cases, it may be necessary to temporarily remove the implant, which can be inserted again at a later date. The most common problem relating to implants is capsular contracture, consisting in the formation by the organism of an internal cicatricial capsule around the implant which can give the reconstructed breast a harder consistency than normal; this is nothing more than the exaggerated physiological response of the organism which does not recognise the implant as its own. There are various methods to combat it, from breast massage through to surgical removal.

It should remain clear that the reconstruction does not affect the recurrence of the breast disease, nor does it interfere with the chemotherapy or radiotherapy treatment, regardless of whether the disease recurs.  Neither does it interfere with the subsequent studies that may be necessary on check-up dates.  If your breast has been reconstructed with implants and your surgeon recommends periodic mammograms for monitoring purposes, you should have them done in a radiological centre with experience in the use of radiological techniques for prostheses.

WHO PERFORMS IT? WHERE IS IT PERFORMED?

As soon as a woman is diagnosed with breast cancer, she must be informed about the possibilities for reconstruction. The surgeon performing the mastectomy, the oncologist and the plastic surgeon must coordinate with each other in order to develop a strategy which combines to produce the best possible result. The plastic surgeon is the specialist, the one who due to his or her training (specialist in Plastic, Reconstructive and Cosmetic Surgery) has the appropriate technical and cosmetic resources required to reconstruct a breast with a natural appearance. After evaluating the general state of health of the patient, we will inform her of the most appropriate options for her age, health, physical and anatomical characteristics and future expectations.

BREAST RECONSTRUCTION TECHNIQUES

There are diverse types of interventions for breast reconstructions:

Skin expansion techniques
It is the most widely used and consists in expanding the skin and, subsequently, inserting a prosthesis. The prostheses used in this type of reconstruction contain medical silicone, just like many other materials employed in the field of surgery (testicular prostheses, facial implants, etc.). No link has been proven between breast cancer and the use of breast prostheses; neither has a clear link been proven with autoimmune and rheumatologic diseases.  Its use has been approved in all European countries.

Techniques which employ the patient’s own tissue
Techniques which use the patient’s own tissue are employed to create a natural breast and consist in the mobilization or transplantation of tissue from other areas of the body such as the abdomen, back or buttocks (techniques called autologous or flaps).

Techniques for the implantation of the patient’s own fat and fillers
When the defect to be corrected is very small within the breast, techniques such as lipostructure (filler with autologous fat) or even using synthetic gels (NASHA gel, hyaluronic acid) can fill or reshape the affected breast.  This may also be the technique of choice in these cases.

RESULTS

The results obtained after a breast reconstruction are definitive and enable the patient to lead a completely normal life. In some cases the reconstructed breast may have a more firm appearance and seem rounder than the other breast. It may be that the contour is not exactly the same as prior to the mastectomy, and there may be some differences in symmetry with the unaffected breast. These differences, however, tend to only be perceived by the patient herself, and remain unnoticed by everyone else.

For the immense majority of patients who have undergone a mastectomy, the reconstruction of the breast represents an absolute improvement of image, also providing the psychological equilibrium which is often lost, seeing their bodies as whole again. This means that patients can quickly return to a full sexual and social life, forgetting about the disease which led to the reconstruction.