Mammology

Methods of Breast Reconstruction

Currently, there are many ways to reconstruct a breast. Probably the most important question that you should ask: "Is it worth to you to perform breast reconstruction?" For tens of thousands of patients who have had breast cancer, the answer was positive.

Currently, the breast reconstruction is very promising for many women undergone mastectomy. Having had a mastectomy women choose to conduct reconstructive surgeries for different reasons. Some consider themselves inferior; others do not feel like women in the full sense of the word. In some cases, it becomes difficult for women to wear breast prosthesis every day. In many cases, breast reconstruction greatly improves the women's wellbeing and allows them to start a new life.

Currently, there are new, simpler surgical techniques for breast reconstruction, which can reduce the duration of the surgery and, in most cases, ensure good results.

What is a Mastectomy?

Determination of the Timing of Breast Reconstruction

The breast reconstruction can be performed during mastectomy surgery. Such surgical operation is called immediate reconstruction. The second option would be to conduct the reconstruction of breast in a few weeks, months or even years after performing the mastectomy, which is called delayed reconstruction. Taking into account all the circumstances of a particular situation, you and your doctor may decide which technique is best for you.

Immediate Reconstruction

The advantage of immediate reconstruction is that the surgery is done simultaneously with performing a mastectomy. In such case, you have to face only one surgery and recovery period. So you can avoid unpleasant experiences associated with the absence of one or both breasts.

Using the Patient's own Tissue for Breast Reconstruction

Reconstruction Using Muscle Flap of Latissimus Dorsi

One method of breast reconstruction with the patient's own tissues is the reconstruction using muscle flap of latissimus dorsi. When using this technique the area of skin and muscle tissue from the back or from the underarm area is moved to the area of the breast and is used for its reconstruction. Since the skin and muscle tissue on the back is usually quite subtle, this technique is sometimes used in combination with a breast implant to give the breast additional volume and more natural form. 

Reconstruction Using TRAM flap

Another method of breast reconstruction with the patient's own tissues is the reconstruction using the TRAM flap. The use of this method requires only moving the fat and muscle tissue from the abdomen up to the area of the breast for breast reconstruction. In some cases, the tear-off flap may be connected to the abdomen; it is possible to preserve its blood supply in this procedure. If this is not possible, by using microsurgical techniques it is necessary to implant blood vessels in the area the flap is moved up (breast), thus ensuring blood supply to stomach.

Determination of the Timing of Breast Reconstruction

Delayed Reconstruction  
The advantage of the delayed reconstruction is the possibility to focus primarily on treatment of malignant tumors and to restore the body. When performing delayed reconstruction you have more time to explore all possible options and to make an informed decision. 
 
Breast Reconstruction Methods
There are several methods of breast reconstruction. You and your doctor choose the method most suitable for you; when choosing the surgery procedure you should take the following into account: 

• health and lifestyle; 
• body type; 
• breast size; 
• patient's personal preferences
• the size of untouched tissue and skin of the breast 
 
Breast reconstruction can be performed using the patient's own tissue, breast implants or with the combined use of tissue and breast implant. 
 
Discussing all possible options with your doctor, you can choose the most suitable method of surgery.  
 
Breast Reconstruction Using Implants  
 
During mastectomy the surgeon removes skin and breast tissue, leaving a smooth, dense layer of tissue that covers the chest wall. Before installing durable implant it is necessary to stretch the breast tissue in order to create cavities for placing the implant. This manipulation—tissue expansion typically occurs in one (single-stage) or in two stages.   

Two-stage Breast Reconstruction 
 
Breast reconstruction using implants is a commonly used technique. This surgery can be performed directly at the time of mastectomy or at a later stage (delayed reconstruction). 

Surgical Technique  

Temporary breast expander is implanted into the chest wall tissue. Within a few weeks the doctor gradually fills the expander with saline solution similar in composition with salt water. When the skin will stretch and gradually increase in size due to which the created space is filled with expander as it extends. Over time, the patient's body adapts to the enhanced implant similar to how a woman's body adjusts to the gradual increase in the abdomen during pregnancy. 

One-stage Breast Reconstruction

Surgical Technique

The adjustable implant is installed in chest-wall tissues during mastectomy, which is both breast implant and tissue expander. The implant is equipped with the small fill tube and injection dome, which is placed next to the implant. Within a few weeks or months, the dome is filled with saline through the hole (port), which stretches the implant and stimulates tissue growth. After reaching the required volume, a simple outpatient manipulation is carried out to remove the fill tube and port, and the implant remains in place. The recovery period is different in each case. Typically, within a few days after installing the breast implant painful feelings are possible. The maximum discomfort is noted during the first 24-72 hours after the surgery. Swelling and soreness of the breast is observed. Despite the fact that the recovery period in each case is individual, it is possible to perform mild physical exertion even after about a week. An important feature of the recovery period may be the need to wear special postoperative bra or compression underwear. Such clothing is designed to provide an enabling environment for restoration of the organism. The doctor may also give some special additional recommendations at the time of the recovery period. If you experience any complications after surgery for implant installation, you should seek immediate medical attention. 
 
The leading experts in breast reconstruction are Eugenia Ya. Ptukh and Kirill A. Prikhodko