Breast reconstruction
Breast reconstruction is a surgical procedure performed to restore the shape, volume, and appearance of the breasts after a mastectomy, lumpectomy, or other traumatic interventions. It plays an essential role not only from an aesthetic point of view but also emotionally, contributing to the restoration of self-image and the psychological balance of the patient.
Reconstruction can be done either immediately after the removal of the breast or later, depending on the health status and the oncological treatment plan. Several techniques are available, from breast implants to the use of own tissues (autologous), each adapted to individual needs and desires. The choice of the appropriate method is made together with the surgeon, considering both the desired aesthetic result and long-term medical safety.
What does breast reconstruction surgery involve?
For patients undergoing treatment for breast cancer, a positive attitude is very important and helps to support the treatment. In many European countries, breast reconstruction is included in the treatment plan for breast cancer.
At this moment, there are a multitude of possibilities for breast reconstruction. Unfortunately, few patients know about these available reconstruction methods, and some patients do not know that breast reconstruction can be performed. In Europe, approximately 10% of patients undergo a form of breast reconstruction after mastectomy.
The timing of breast reconstruction depends on several factors: the patient’s decision, physical condition, and certain medical necessities.
Reconstruction can be primary/immediate (directly after mastectomy or breast removal) or secondary/delayed (depends on the adjuvant therapy of the breast removal surgery, performed at a distance from chemo or radiotherapy). It is important for the patient to understand that the reconstruction surgery is not singular and there may be several stages to achieve a good aesthetic result.
Surgical techniques used for breast reconstruction
In general, breast volume can be reconstructed in two ways: one option is reconstruction with synthetic materials, silicone implants, or implants filled with saline; the second option is the use of own tissue (pedicled musculocutaneous flaps or free flaps). In the case of using synthetic implants, we are talking about reconstruction with a prosthesis, and in the second case, we are talking about autologous reconstruction.
01. Autologous breast reconstruction
In this type of reconstruction, the surgeon uses the patient’s own tissue (flap) harvested from another region of the body. In general, there are two types of flaps used for breast reconstruction: a pedicled flap, in which the tissue remains connected and receives blood vessels from its original location, and a free flap, in which the tissue is completely removed and reconnected to new blood vessels in the breast area through microsurgery techniques.
Currently, microsurgery and free flaps are used extensively in the autologous method of breast reconstruction. The tissues used for breast reconstruction are: the gracilis flap harvested from the inner thigh, the DIEP flap harvested from the lower abdomen, or flaps harvested from the gluteus muscle (buttocks).
Pedicled flaps remain attached to the donor site; the most frequently used are: the latissimus dorsi flap (latissimus muscle flap and skin from the back) or the transverse rectus abdominis muscle flap (the flap uses muscle from the abdomen and the underlying skin).
Autologous reconstruction can often be combined with implants, especially if the desired volume is greater than can be achieved only through autologous tissue. Together with the synthetic implant, a dermal substitute can also be used in the lower part of the breast to help support the implant.
A reconstruction method that is gaining ground is fat transfer. It should be noted that the volume that can be reconstructed by this method is smaller than by placing an implant, and it is usually a method that requires several stages to achieve the desired volume. Fat transfer is mainly used for small defects.
02. Reconstruction with synthetic prostheses
Reconstruction with a prosthesis can be performed both immediately and at a distance. Immediate reconstruction is possible if the biology of the tumor allows it. The need for radiotherapy excludes immediate reconstruction because the prosthesis can cause increased complications.
Reconstruction at a distance from the initial mastectomy operation requires several stages. First, the skin must be expanded, and for this, an expander is used in which saline is gradually introduced as the skin stretches. The expander is replaced with a permanent prosthesis, and if necessary, the contralateral breast is lifted to have a shape similar to the reconstructed one.
There are multiple shapes of breast implants so that it is possible to have a natural result at the end of the reconstruction. The advantage of reconstruction with an implant compared to the autologous one is the shorter operating time and less stress because the operations are shorter and the possible complications are fewer.
03. Reconstruction of the nipple-areola complex
In some cases, the breast removal operation will also sacrifice the areola with the nipple. These structures, so characteristic of the breast, can be reconstructed through a multitude of procedures that use autologous tissue. Usually, the areola is reconstructed by micropigmentation, which is a form of tattoo. Nipple and areola reconstruction is performed under local anesthesia.
What is the price of breast lift surgery?
€3800
Mastopexy without implant
€5,500
Mastopexy with implant
The costs mentioned are estimates, and they may vary depending on the surgical technique chosen, the complexity of the case, as well as any additional procedures or investigations required.
A detailed final cost can only be established after a medical consultation, in which the patient’s clinical situation will be assessed and the individualized therapeutic plan will be established. These costs include: the surgeon’s and anesthesiologist’s fees, the period of hospitalization, all the medicines and materials needed during the surgery and during hospitalization. For a personalized estimate, we recommend scheduling a consultation.