Breast reconstruction
What is breast reconstruction?
Breast reconstruction is a highly sophisticated process of replacing a lost organ – breast, with an entire team of experts involved, starting from breast surgeon, plastic surgeon, oncologist, radiologist and psychologist, with each being an unavoidable segment in solving the more and more present problem of breast cancer.
When?
Considering general and oncological condition of the patient, the above mentioned team of experts forms a consultation body which after the completed diagnostics, decides on further treatment and also the breast reconstruction, so there are primary and delayed breast reconstruction.
Primary breast reconstruction is ablation i.e. mastectomy and reconstruction in the same surgical process while delayed breast reconstruction is related to patients with completed ablative surgery and completed radio or chemotherapy. Primary breast reconstruction is limited mostly to early stages of the disease as well as tumours of certain localizations.
How?
It is possible to reconstruct the breast with implants and tissue expanders, by combination of implants and its own tissue or just with tissue.
Each mentioned method has its good and bad sides so by summing up the general condition of the patient, oncological finding as well as the local finding of the opposite breast the most adequate choice of the surgical procedure for breast reconstruction is reached.
Tissue expanders and implants are mostly limited to patients with small opposite breasts as well as to those with advanced stages of the disease or with poor general condition because the procedure itself is quick and short and the morbidity rate minimal.
Breast reconstruction with its own tissue is the best and most used breast reconstruction method but requires an extremely educated and experienced plastic and reconstructive surgeon who is skilled at micro surgical technique and esthetic surgery with the purpose of subsequent synchronization of asymmetry of the opposite breast.
The most common of those methods is the TRAM flap reconstruction i.e. with lower stomach skin and the muscle of the front abdominal wall. It is possible to perform breast reconstruction without the use of the abdominal muscle but then it is necessary to know the microsurgical technique. In those cases the best esthetic results are obtained.
With the use of anatomic implants of various sizes and shapes (Mentor) and with adequate tissue cover of the implant provided by the back muscle, possibilities of breast reconstruction and functionally esthetic results reach amazing boundaries. That is specifically related to the cases of primary reconstruction where the “skin sparing technique” is used which leaves the skin cover of the breast and is in line with the oncological principles because the local recidive is the result of tumour biology and the stage of the disease and not inadequate skin excision.
What happens to the nipple?
Six months up to a year after the breast reconstruction there is a nipple reconstruction, with tissue again, partly with local and partly with free skin transplant taken from the groin region and during that procedure, the opposite breast is also corrected with the purpose of achieving the full symmetry of both breasts.
That is why the plastic surgeon who performs the breast reconstruction must not only be skillful in all breast reconstruction techniques including microsurgery, but must also know all the lifting, augmentation or reduction techniques of the opposite breast, with the purpose of achieving a quality functional and esthetic result.
