Breast cancer affects women in two ways. First, they have to deal with being seriously ill with breast cancer. Second, treatment for breast cancer may involve amputation of the breast or both breasts. For many women, the loss of their breast is associated with the perceived loss of their femininity. They feel less attractive and suffer from inferiority complexes. However, thanks to medical advances, it is now possible in many cases to operate in this way for breast cancer without reducing the chances of survival.
Implants as an alternative
If breast-conserving surgery is not possible, plastic surgery offers options for surgically reconstructing the breast using implants or the patient’s own tissue. Patients should find out whether or not such reconstruction is an option for them before undergoing surgery. This is because breast reconstruction after breast cancer is not a must for every woman. Some consciously decide against any form of surgical reconstruction because they do not want to define femininity solely by their breasts. For other women, reconstruction provides psychological relief and help in coping with the disease. In addition to individual preferences, factors such as health suitability and tolerance of implants must always be taken into account. It is therefore advisable to clarify with your doctor before treatment for breast cancer whether and how the breast should be reconstructed. Above all, the surgical technique and possible risks and complications of the procedure should be part of the discussion.
Breast prostheses or breast implants
In an optical reconstruction of the breast, a distinction is made between external breast prosthesis or breast implants. An external breast prosthesis is worn in a bra. These are cotton or silicone inserts that completely fill the bra cup and are carried in medical supply stores. Their weight and mobility resemble natural breast tissue. Silicone also adapts very well to the skin and the remaining breast, so that from the outside it is not visible that it is a prosthesis. Such a breast prosthesis is suitable for the period shortly after surgery and is very well tolerated by most patients. In warm weather, unpleasant sweating under the prosthesis may become a problem. However, this can be remedied with suitable underwear and special skin care. In addition, a large bust size can lead to tension and back pain if the weight of the prosthesis and the breast do not match. However, readjustment of the prosthesis at a specialized store usually alleviates these problems.
Surgical reconstruction of the breast
There are three options for surgical reconstruction of the breast: Breast reconstruction using artificial breast implants is one option. Other options are breast reconstruction using the patient’s own tissue or a combined procedure using breast implants and the patient’s own tissue.
Breast reconstruction thanks to breast implants
The preparation for a later breast reconstruction is already made during the mastectomy. In this procedure, an inflatable cushion is inserted under the large breast muscles Saline can be injected into this so-called expander via a small valve located in the armpit. The cushion expands, thus widening the skin. The procedure is repeated at one-week intervals until the desired breast volume is achieved. To ensure that the skin does not lose its stretched state, it is advisable to wait about six months before replacing the implant. Then, in a second operation, the saline-filled cushion is removed and a final implant is inserted. The nipple is also restored during the procedure.
Advantages of breast implants
This form of breast reconstruction is usually the least stressful of all surgical forms. Although it takes about nine months from mastectomy to reconstruction, this form of surgery often produces good cosmetic results. It is particularly suitable for women with small and medium breasts in which the pectoral muscle is still intact. The patient should not be sensitive to foreign materials implanted in the breast. It should also be assumed that no further radiation will be administered. If this is subsequently the case, the cosmetic result may deteriorate.In rare cases, a kind of connective tissue capsule (capsular fibrosis) can form around the implant, so that it must be removed or replaced. The implant should be replaced after about 15 years. These follow-up surgeries must be considered when deciding on breast reconstruction.
Breast reconstruction with body-own tissue
This form of surgical breast reconstruction is much more complex and usually riskier than breast reconstruction with artificial implant. In this procedure, the patient’s own skin, muscle and fat tissue from the abdomen, buttocks or back is used to recreate a breast. The skin-muscle flap is detached from the corresponding body part in such a way that the supplying blood vessels are still connected to it. It is then placed under the armpit through a skin tunnel onto the upper part of the body and sutured in place. In this way, the new breast continues to receive blood supply. The loss of the tissue and muscle flap at the corresponding location usually does not mean any restrictions in mobility for the women. The loss of skin is also not a problem from a cosmetic point of view. The procedure also has the advantage that no foreign body is inserted. There is therefore no risk of sensitivity to the new tissue. In particular, women who still receive radiation after surgery can have their breasts reconstructed in this way.
Risks associated with breast reconstruction
However, they must be in good general health, as the operation takes a relatively long time (three to four hours), postoperative bleeding and infection can occur, and sometimes a second operation to reconstruct the nipple takes place if desired. Also, in rare cases, tissue flaps may have poor blood supply and need to be removed in a second surgery. Another risk exists if the tissue was taken from the abdomen. The stability of the abdominal wall can thus be affected in rare cases, sometimes resulting in abdominal wall hernias. Therefore, this option is not suitable for women who have already had abdominal surgery or abdominal wall hernias. Overweight, diabetic and smoking women are also advised against this operation, as well as patients with vascular diseases. Which breast reconstruction option is most appropriate and the risks involved should be determined in a personal consultation with a physician.