Breast reconstruction is a section within the more complete treatment of breast cancer.
Depending on the case, the reconstruction can be done in the same surgical amputation, and in other cases it will be advisable to do it after a few months after completing radiotherapy.
Techniques to Reconstruct a Breast
There are different techniques to reconstruct a breast, using techniques that enable own tissues to recreate a more natural breast and will not change much over time or with changes in posture, or with weight changes. On the other hand, the use of tissue expanders and breast implants may decrease the possibility of complications in certain cases.
Typically, breast reconstruction is posed in 2 or 3 operations:
- Reconstruction of the affected breast with local flaps, regional or microsurgical. Or if local conditions allow the skin is performed reconstruction using temporary tissue expanders.
- In sagging breasts (ptosis) may be necessary to change the other breast to get a good symmetry (or symmetry mastopexy).
- Replacement of tissue expander for a permanent prosthesis.
- Reconstruction of the nipple-areola complex in the reconstructed breast.
In TRAM flap, the abdominal flap breast reconstruction, moving tissue from the abdomen to the upper chest area, to create a new breast. To avoid the weakness of the muscles of the abdomen may be necessary to place a mesh to give strength to the abdominal wall. It is very important to patient selection, as there are risks, such as necrosis or total loss of the flap.
Reconstruction with tissue expanders and breast implants can offer, in some cases, excellent results. A tissue expander is a prosthesis that once introduced can be completed progressively to cause expansion of the surrounding tissues and thus create space for a definitive prosthesis. There once inflated expanders can be left in place permanently.
A tissue expander needs good skin coverage with a certain thickness and elasticity, so that the quality of the fabrics is very important in these cases, a chest that has been irradiated with radiation therapy may be a contraindication to the use of tissue expanders. The extended latissimus dorsi flap, allows obtaining tissue from the back and removing the thoracic scar to create a new breast.
Depending on the amount of tissue and needs, it may be necessary to use breast implants to achieve the desired volume.
Complications of treatment of reconstructive mammoplasty are rare, although no surgical procedure is without risk. Potential risks include:
- Bleeding or hematoma.
- Partial or complete loss of the flap.
- Loss of skin sensation
- Fat Necrosis.
- Unsatisfactory results
- Infection, including in the surgical wound, lungs (pneumonia), bladder or kidney.
- Reactions to medications
- Additional surgery.
- Respiratory problems.
- Deep vein thrombosis / pulmonary embolism
The risks of breast reconstruction with implants are:
- The implant will break or leak present in 1 in 10 women in the first 10 years. If this happens, you will need more surgery.
- It can form a scar around the implant in the breast. If the scar becomes firm, the breast may feel hard and you may have pain or discomfort. This is called capsular contracture and need more surgery if this happens.
- Infection shortly after surgery, which would require removing the expander or implant.
- Breast implants may change slightly, which will cause a change in the shape of the breast.
- One breast may be bigger than the other (asymmetry of the breasts).
- There may be a loss of sensation around the nipple and areola, if this complex was not removed during mastectomy.