Breast reconstruction aims to:
● Recreate a natural-looking chest, including the areola and the nipple.
● Eliminate the need to wear external filling prostheses making it possible to wear clothing that would not be possible without reconstruction as swimsuits
● Restore body image and improve the patient’s quality of life. A breast reconstruction is final and will allow you to make an absolutely normal life.
For the majority of women with breast cancer, the reconstruction of the same improves the image, which facilitates greater emotional stability, allows to face the disease in a more positive way and lead a normal social and sexual life.
When
Depending on each individual case, the reconstruction will be done immediately or deferred, it means after all the necessary treatments such as chemotherapy and / or radiotherapy and the recovery of the patient.
How
There are multiple therapeutic options for breast reconstruction, depending on each case and need of the patient
Lipotransfer in case of quadrantectomies or simple lumpectomy
With the Water Jet (WAL) system, a minimally invasive liposuction is performed, which achieves the volume of fat necessary to reconstruct the lost breast volume, this fat is transplanted by means of the vibratory expansion system (EVL) which results in a autologous reconstruction
Flap reconstruction, which is the transfer of a piece of tissue from the patient to form the new breast. This is the standard treatment in patients with mastectomy and radiotherapy treatment.
Free flaps: DIEP, TMG, SGAP, ALT
DIEP flap: It is the autologous reconstruction with more benefits for patients. Skin and subcutaneous tissue of the lower abdomen are taken along with the artery and vein that nourishes this tissue. This tissue takes the breast to rebuild, connecting the artery and veins to local arteries and veins. This reconstruction results in the most natural reconstructed breast possible, both to the touch and to the shape. The second benefit of this surgery is the result in the abdomen. It is a abdomen and a scar equal to a tummy tuck, a surgery that is performed very aesthetically to recover a flat abdomen, the scar is very low, at the same height as a cesarean.
TMG flap: Another option for autologous reconstruction in patients with low abdominal fat or previous large abdominal surgeries. In the inner thigh a muscle with subcutaneous tissue and skin is removed, along with its artery and vein to reconstruct a small or moderate-sized breast.
SGAP
ALT
Pedicle flaps:
Wide dorsal, TRAM
Wide dorsal flap: This flap uses an area of skin and a muscle in the back that, because it is thin, requires a prosthesis and / or lipotransfer to be added to increase the volume
TRAM flap: It is a reconstruction that takes the skin of the abdomen attached to an artery that is in the rectus abdominis muscle and is taken to the area that was empty by the mastectomy, similar to DIEP, but without micro-connection of arteries and veins
Immediate reconstruction with silicone gel prostheses associated with the use of biological mesh and lipotransfer
In special cases, in which the entire breast or a large breast size is removed but without radiotherapy treatment, a reconstruction with a silicone cohesive gel implant can be performed, in these cases a biological mesh is usually used to give more stability to the reconstructed chest To reduce the palpability of the implant and improve the result, the reconstruction of the breast is combined with lipotransference.
Placement of tissue expanders and in a second surgical time change to definitive prostheses associated with lipotransference with symmetry of the contralateral chest if required. In patients with radiotherapy in most cases a reconstruction with prostheses is not recommended, but with own tissue such as free or pedicle flaps.
Reconstruction with an expander / prosthesis: A tissue expander is a bag that has a valve through which the remaining tissue after the mastectomy is stretched and gradually inflated during the following weeks
In a second procedure this expander is changed and a silicone gel prosthesis is placed, in this same procedure a breast surgery is performed on the other side looking for maximum symmetry if required
Areola / Nipple complex reconstruction
The reconstruction of the Areola and the Nipple will be carried out from six months after the reconstruction of the breast. In local anesthesia (with sedation if the patient wishes) the nipple and areola are reconstructed with a small local plasty.
