A form of normal breast, a healthy breast is an important thing for the well-being of a woman, also contributes to increasing confidence in its own forces.
For patients undergoing treatment for a breast cancer a positive attitude is very important and constitutes an aid to support treatment. In very many European countries the reconstruction of the breast is included in the treatment plan for breast cancer.
At the moment there are a multitude of possibilities for breast reconstruction, unfortunately few patients know these methods of reconstruction available and some patients do not know that breast reconstruction can be performed. In Europe, about 10 of the patients undergo a way of reconstructing the breast after mastectomy.
The time when breast reconstruction can be made depends on several factors: the patient’s decision, physical condition and certain medical needs.
Reconstruction can be primary/immediate (directly after mastectomy or breast removal) or secondary/remote (depending on the adjuvant therapy of the breast removal operation, it is carried out at the distance of chemo or radiotherapy). It is important that the patient understand that the reconstruction operation is not single and can be more steps until a good aesthetic result is achieved.
Surgical techniques used for breast reconstruction
In general, the volume of the breast can be rebuilt in two ways: an option is the reconstruction by synthetic materials, silicone implants or implants filled with physiological serum, the second option is the use of literally tissue (muscle-cutaneous flap and free flap). In case of use of synthetic plants we are talking about reconstruction with prosthesis and in the second case we are talking autologose reconstruction.
Autologome Breast reconstruction
In this type of reconstruction the surgeon uses the tissue of the patient harvested from another region of the body. In general there are two types of flap used for the reconstruction of the breast: the pedicular flap in which the tissue remains connected and receives blood vessels from its original dwelling and free flap case in which the tissue is completely removed and is reconnected to the vessels of New blood from the breast area through microsurgery techniques.
At this time microsurgery and free flap are used extensively in autologoic way of breast reconstruction. The tissues used in the reconstruction of the breast are: the gracilis flap harvested from the internal face of the thigh, the Diep flap harvested from the subombilical abdomen, or the flap harvested from the level m. Gluteus (buttocks).
The pediculated flap remains attached to the donor site, the most commonly used are: the latissimus dorsi flap (the Latissim muscle flap and the skin on the back or the transverse muscle flap rectus abdominis (the flap of the muscles of the abdomen and underlying skin).
Autologous reconstruction can often be combined with implant, especially if the desired volume is higher than can only be achieved through autologous tissue. Together with the synthetic implant you can also use a lower-part derm substitute of the breast to help support the implant.
One way that the reconstruction that wins the land is the transfer of the autologoous fat. It should be noted that the volume that can be rebuilt by this method is smaller than by placing an implant and usually is a method that requires several steps to achieve the desired volume. Fat transfer is mainly used for small defects.
Reconstruction by Synthetic prostheses
Prosthesis reconstruction can be carried out both immediately and remotely. Immediate reconstruction is possible if tumor biology allows it. The need for radiotherapy excludes immediate reconstruction because the prosthesis can cause increased complications.
The remote reconstruction of the initial mastectomy operation requires several stages. First, the skin should be expanded, and for this, an expander is used in which a gradual saline is inserted as the skin stretches. The exper shall be replaced by a permanent prosthesis and if necessary, the contralateral breast shall be lifted so as to have a shape similar to that rebuilt.
There are multiple forms of breast implants so we may have a natural result at the end of Reconstruction. The advantage of reconstruction with the Autologose-comparative implant is the operator time and lower stress because the operations are shorter and the possible complications lower.
Reconstruction of the nipple-areola complex
In some cases the operation of removal of the breast will sacrifice and areola with the nipple. These structures so characteristic of the breast can be reconstructed through a multitude of procedures that use autologous tissue. Usually areola is reconstructed by micropigmentation which is a form of tattoo. Reconstruction of the nipple and areola is carried out in local anesthesia.