Breast Reconstructive Surgeries

Breast reconstruction is a set of surgeries that aims to restore the appearance of the breast after oncological surgeries. In cases of tumor resection, ie removal of only the tumor with a small amount of healthy tissue around it, an oncoplasty operation is usually sufficient. In cases where most of the breast needs to be removed (total mastectomy) the restoration needs to be done with larger surgeries such as tissue expanders and silicone implants or with cortical or free flaps.

In cases where after the operation the remaining breast will need to be irradiated, in several cases the quality and texture of the skin and the underlying breast are altered due to the effect of radiation. In these cases, a healthy fat transplant is especially beneficial.

In cases of unilateral oncological surgery, it is common to operate on the healthy breast to achieve symmetry and a better overall aesthetic result.

Finally, when it needs to be removed for oncological reasons, the nipple can be repaired with plastic surgery.

ONCOPLASTY

Oncoplasty is indicated in cases where the removal of the tumor was done with tumor resection, ie removal of only the tumor with a few millimeters of healthy breast around it. If the deficit that will be created is relatively small then the restoration can be done with special techniques that redistribute the remaining breast in such a way that the gap is covered smoothly and the breast acquires a normal appearance. Depending on the location of the tumor and the estimated size, there are several oncoplastic techniques

RECONSTRUCTION WITH TISSUE EXPANDERS AND SILICONE INSERTS

Reconstruction with tissue expanders and silicone implants is the simplest method of breast reconstruction after total mastectomy. If, in addition to the breast, a significant amount will need to be removed from the breast skin then a tissue dilator will need to be placed in the first stage. This is a special balloon that is placed under the skin and above the chest wall in the place where the mammary gland was before it was removed. A sufficient amount of saline is placed in it at the time of surgery and then in the doctor's office gradually (usually every 2 weeks) until the skin is stretched to the desired degree. Then a second operation is usually performed where the retainer is replaced by a permanent silicone insert. If the skin does not need to be removed during the oncology operation and there is enough skin then it is possible that the silicone implant can be placed directly from the first operation without the need to place the dilator first.

RECONSTRUCTION WITH MUSCLE SPARING

This technique involves reconstruction by transferring to the site of the mastectomy deficit another part of the body without it being cut off from the main vessels that supply it with techniques of preparation, rotation and advancement. The other part can come from the tissues of the abdomen (TRAM, muscle sparing TRAM) which usually provide a sufficient amount of tissue so that the need for a silicone implant is not needed or from the tissues of the back (flap wide back muscle) which provides satisfactory tumor only in cases of small breast reconstruction while for cases that require a larger tumor is usually combined with silicone implants.

RECONSTRUCTION WITH UNUSED TISSUES

This technique involves rehabilitation by transferring to the site of the mastectomy deficit another part of the body cut off from the main vessels that supply it and which will then be reunited with other vessels in the breast area by microsurgical techniques to regain their perfusion. . The most common donor area is the abdomen (DIEP free flap), while tissues from the thighs, buttocks and back can be used less frequently.

SELF-TRANSMISSION OF FATS FOR THE TREATMENT OF RADIATED BREAST

In cases where the oncology protocol requires the operated breast to be irradiated, it is common for the radiation to have a detrimental effect on the skin and the remaining breast. It is clinically expressed with the appearance of a harder breast and with changes in the quality of the skin with a characteristic darker appearance. Research has shown that fat self-transplantation has a beneficial effect on the quality and appearance of the skin while adding volume and healthy cells to the breast. Fat is usually taken from the abdomen, the sides of the pelvis and the inner thighs by simple liposuction and after proper treatment is placed in the breast. The operation is very simple, without complications or risks.

NIPLE RECONSTRUCTION AND IMPROVEMENT OPERATIONS

When the nipple needs to be removed for oncological reasons then restoration can be done with small flaps that use the remaining skin to reshape a new nipple. The new nipple is given permanent color with special tattoo techniques. Additionally, for even greater improvement of the appearance of the operated breast, gum correction, small liposuctions and fat self-transplantation can be done.

SYMMETRY SURGERIES IN HEALTHY BREAST

Usually with the completion of the reconstruction of the operated breast for aesthetic reasons it is necessary to perform symmetry surgery on the healthy breast as well. There are various options depending on the goals to be set such as breast augmentation with fat or silicone implants, simple erection, augmentation with erection and breast reduction with erection.