What is the principle of a breast reconstruction treatment?
A breast cancer patient has undergone a breast ablation, or a mammectomy.
The plastic surgeon’s role is to intervene afterward to restore mammary morphology and to reconstruct the breast.
Important advances have been made in this area and different techniques exist today to obtain a satisfactory result.
Choosing the most appropriate technique depends on the particularities of each case and will be explained by the surgeon directly.
The reconstruction can be conducted shortly after the mammectomy, usually within the year.
The goal of this surgical procedure is to reconstruct the missing breast volume and to make it symmetrical to the other one.
What are the best conditions for breast reconstruction?
This kind of surgery would only be considered after reaching an agreement with the patient’s gynecological surgeon and the cancer specialist.
Various techniques exist for various degrees of skin elasticity where the mammectomy was performed.
If the skin surface is supple, ample, and of good quality, the insertion of a breast prosthesis will suffice to restore a satisfactory bust line.
If, on the other hand, the skin is stretched thin and less elastic, it would be recommended to first add excess skin tissue to the breast that will be used later in the reconstruction.
What should be expected during the initial consultation?
The initial consultation is very important because it allows the patient’s motivations to be understood and the objectives to be clarified.
A medical history is taken, including allergies and prescription medications.
A gynecological and obstetrical history is also taken.*
A clinical exam is conducted to quantify the mammectomy by taking measurements and to determine the skin quality in order to determine the surgical technique to be used.
The non-operated breast is also examined, particularly to determine if there is any associated breast hypertrophy or ptosis.
The consultation finishes with a photo session, useful for technical analysis and for the evaluation of the post – operative results.
What is the preparation process for the surgery?
A consultation with an anesthesiologist is planned before the surgery, which includes a full medical exam and prescriptions for any complementary examinations necessary.
This consultation is used to discuss different types of anesthesiology and to take all safety precautions necessary.
The anesthesiologist will inform the patient of all the measures to take before the surgery concerning eating, drinking, smoking, and taking medications.
A mammogram or an ultrasound are conducted depending on the history and age, mammary gland quality, and to detect possible related cysts that will be removed at the same time.
What takes place during the surgery?
What type of anesthesia is used?
General anesthesia is recommended for this type of surgery. This practice is used regularly at the clinic, and meets maximum safety criteria.
How long does the surgery last?
The surgery takes between one to two hours to correct any associated hypertrophy or ptosis.
Will there be visible scarring?
This surgical procedure causes scarring around the reconstructed breast.
Generally, the mammectomy scar is used.
This scar will diminish because the reconstructed areola will cover part of it.
As for the opposite breast, it will be treated according to breast plastic surgery requirements for hypoplasia, hypertrophy, or ptosis.
The scars will be carefully treated and monitored to maximize the potential of each patient.
What takes place during the surgery?
The incisions are drawn on the patient’s body in an upright position before the surgery and precise measurements are taken.
The surgery is conducted under general anesthesia, and the technique used depends on the surface layers of the skin.
If the skin surface layers are supple, ample, and of good quality, a simple breast prosthesis will suffice to restore a sufficient bust line.
If on the other hand, the skin is less elastic and over-stretched, a skin graft may be recommended for which three possible techniques exist:
- graft a strip of skin and muscle from the back
- graft a strip of skin and muscle from the stomach
- distend the ribcage skin using a newer and simpler tissue culture expansion technique, preferred if no contraindications.
When the grafted skin is obtained by the first technique, a second operation to restore the breast volume by inserting an implant is conducted.
If necessary, the volume and shape of the other breast is made symmetrical.
The areola and nipple will also be reconstructed using various techniques.
What kind of bandage is used?
A bra-shaped compression garment is created.
This contoured bandage is worn the first day.
Depending on the case and according to the surgery and skin type, a subsequent support type will be recommended.
How long is the hospital stay?
The hospital stay is generally three days long.
What are the predictable post-surgical effects?
Generally, there is little pain, and analgesics are prescribed systematically.
The sutures are usually absorbable and the swelling diminishes within two to three weeks.
Some precautions are advised, such as avoiding physical exertion or athletic activities for two weeks.
What are the possible complications of a breast reconstruction treatment?
As with all surgical procedures, breast reconstruction can have general complications such as bruising, infections, or those related to anesthesia.
Other complications, specific to this surgical procedure related, especially skin quality, may arise.
If the skin is supple and has not been subjected to any particular treatment, the complications are usually extremely rare.
On the other hand, if the skin is over-stretched, especially if it has been treated by radiotherapy, scarring problems such as infection, or skin necrosis may occur.
If the complications are relatively insignificant, they can be treated by normal care.
If, on the other had, skin necrosis is significant, the reconstruction may have to be interrupted until the skin is revitalized, and continued at a later time.
Skin treated by radiotherapy is harder to repair.
As for reconstructing the areola, this is usually done by grafting skin from the other side or by dermo-pigmentation techniques.
The scar’s evolution should be monitored and the post-surgical instructions followed to reduce the risk of hypertrophic or cheloid scarring.
Reconstructed breast enlargement often includes the insertion of a breast implant.
This prosthesis is usually filled with salt solution and, like any implant, may be “rejected” by the body with the possibility of a “shell” forming.
This shell can be treated with regular massages that may soften its consistency.
The prosthesis may become deflated which would require another surgery.
What precautions should be taken after a breast reconstruction treatment?
Regular checkups are made with the plastic surgeon and with the gynecologist and cancer specialist to monitor the initial illness.
The other breast is also carefully monitored.
Scarring is monitored and is the object of attentive and personalized care.
It is recommended to avoid exposing the scars to the sun for one year.
How long do the results of a breast ptosis treatment last?
Breast reconstruction treatment allows for the restoration of the bust line and breast morphology.
More often, an augmentation is assured by the insertion of an implant; the complications are those associated with a breast implant.
As a result, a “shell” may appear, or the salt solution prosthesis may deflate.
Excluding these complications, which would require medical and surgical treatment, the results of this surgery are long-lasting and its quality remains dependent on regular medical checkups.
In conclusion, a breast reconstruction surgery has physical and psychological benefits and the results obtained aesthetically satisfying. These explanations are simplified as each case is individual and each technique should be thoroughly and carefully explained to the patient.