Breast Reconstruction
Overview of Breast Reconstruction
Breast reconstruction is currently part of the treatment of breast cancer. It can be immediate at the same time as mastectomy or most often secondary, six months after the end of radiotherapy treatment.
It should ideally be performed by plastic surgeons familiar with surgical oncology especially breast, and all medical oncological treatments.
Breast reconstruction should be discussed at the first consultation with an oncologist and should be suggested to all patients.
Breast reconstruction allows the reconstruction of the missing breast, a symmetrical contralateral side and the reconstruction of the areola and nipple.
In most cases, two interventions are needed with a period of three months between the operations.
Before Breast Reconstruction No radiotherapy. Mastectomy scar visible
After Breast Reconstruction Anatomical silicone gel implant. Result after 1 month. Resumption of the existing scar.
After Breast Reconstruction Final result. Reconstruction of the areola and nipple and right breast reduction . Outcome after 3 months.
The different techniques of breast reconstruction :
Mammary plasties of symmetrization and areola and nipple reconstruction
Three months after the reconstruction of the breast operated by one of the three techniques previously described, the reconstruction of the mammonium areolar plate can be carried out at the same time, if necessary, with the mammary plasty of contro-lateral breast symmetrization.
Breast plasty symmetrization uses all the usual techniques of breast plasty reduction and ptosis.
The reconstruction of the areola is ideally carried out by a graft of skin taken from the inner surface of the thigh giving a natural and pigmented appearance. The nipple is rebuilt by a local torch that can be tattooed secondarily or by a transplant of the opposite nipple.
Pre-operative mammograms of the contro-lateral breast are performed systematically and removed glandular tissues are systematically addressed in anatomopathology.
Before breast reconstruction
History of radiation therapy
After breast reconstruction
Silicone gel prostheses
Breast reconstruction after
Reconstruction of the areola and nipple by total skin graft and nipple graft of the opposite breast.
Breast reconstruction: interest of lipofilling
Currently, in some limited cases, grease can be injected under the mastectomy scar (lipofilling), to improve the suppleness of the skin and the thoracic wall, allowing to rebuild the breast with a prosthesis and avoid a large back torch.
This method develops in breast reconstruction with very encouraging results.
Before breast reconstruction
Scar has been retracted.
Lack of flexibility for a prosthesis despite small breast volume.
After breast reconstruction by lipofilling 250 grs of fat under the left mastectomy scar.
Result at 3 months. Great improvement in skin flexibility.
After breast reconstruction
Result at 1 year with prosthetic and reconstruction of areola and nipple.
A second lipofilling time is planned internally.
Conclusion
While conservative treatments have increased significantly over the past 10 years, indications of mastectomy are still common.
Reconstructions after mastectomy are better and better codified.
Prosthetic reconstructions, accounting for 80% of breast reconstructions, are currently producing excellent results thanks to the wide choice of prostheses available on the market. The musculocutaneous-cutaneous tatters, made in 20% of the cases, are reserved for the case which cannot benefit from a prosthesis.