What is breast reconstruction?
In some cases, due to breast cancer, the breast is amputated (mastectomy). After this procedure, many women want to conceal the absence of one or both breasts. In addition to breast prostheses, there is also a permanent solution for this: breast reconstruction.
In this plastic-reconstructive operation, the shape of the breast and the nipple are restored – either with implants or autologous tissue, for example autologous fat. If a unilaterally amputated breast is reconstructed, the remaining breast often has to undergo an adjusting operation – so that the final result is symmetrical.
How does breast reconstruction with autologous fat proceed?
After a mastectomy, it is possible to reconstruct the breast with autologous tissue or to aesthetically align the breasts again. One way to do this is with autologous fat tissue transplantation (EFT), also called lipofilling or autologous fat transfer.
Breast reconstruction with autologous tissue: other methods.
In addition to lipofilling, there are also breast reconstruction methods that use other autologous tissue. In breast reconstruction with muscle, a so-called TRAM flap is used (transverse rectus abdominalis flap). In this procedure, a skin-fat tissue flap is taken transversely (transvers) from the lower abdomen together with part of the straight abdominal muscle. It is transplanted into the chest area as either a “pedicled” or “free” flap.
- In a “pedicled” TRAM flap, the supplying vessels are not cut. They must be long enough to allow the skin-fat tissue-muscle flap to pivot up to the breast.
- In a “free” flap, the vessels are cut. So after it is grafted into the breast area, the flap must be microsurgically sutured with new blood vessels to ensure adequate tissue supply.
Breast reconstruction with autologous tissue: advantages and disadvantages
Breast reconstruction with autologous tissue usually looks natural and is more permanent than inserting breast implants. Later corrections are very rarely necessary. In addition, with this type of breast reconstruction there are no problems with radiation therapy.
On the other hand, breast reconstruction with autologous tissue is more complex and associated with more complications than the insertion of implants. Sometimes follow-up surgeries are necessary. In addition, tissue removal leaves larger scars on the affected part of the body.
Removal of a tissue flap with muscle (as in the TRAM flap) has the disadvantage that there may be movement restrictions, muscle weakness, and pain in the area of removal. This is not the case when removing a tissue flap without muscles (as with the DIEP flap).
In the case of breast reconstruction with autologous fat, it may happen that the body breaks down the fat again and a new procedure will be necessary at a later date.
Breast reconstruction with implants
As an alternative to reconstruction with autologous fat, some women have their breasts augmented with implants. For this purpose, physicians usually use plastic cushions with a silicone gel filling. There are also implants filled with a saline solution. Such implants are usually used only as a temporary solution. The implants are inserted under the skin, either above or below the pectoral muscle, as part of an operation.
Breast reconstruction with implants: Advantages and disadvantages
Breast reconstruction with implants is a relatively short, simple operation that carries few risks. Compared to breast reconstruction with autologous tissue, it usually causes less pain and there are no additional large scars (for example, on the abdomen or back due to the removal of autologous tissue). Wound healing is completed quite quickly.
In response to the silicone implants, the body surrounds them with connective tissue. Under certain circumstances, this leads to hardening, which in the worst case compresses the implant and causes pain and deformation of the breast. If such capsular fibrosis occurs, the implant is usually replaced.
Radiation therapy is sometimes problematic with breast implants.
What is the procedure for breast reconstruction after breast cancer?
In principle, it is possible to perform breast reconstruction at any time – either immediately in combination with breast amputation (primary reconstruction, one-stage procedure) or as a separate procedure at a later time (secondary reconstruction, two-stage procedure). Primary reconstruction (immediately after amputation) is less psychologically stressful for some women.
The surgery itself is performed under general anesthesia. How long the surgery lasts and how long the patient has to stay in the hospital varies from person to person and also depends on the surgical procedure. Sometimes follow-up surgeries are necessary, for example, to surgically adjust the other breast or to reconstruct the nipple.
Reconstruction of the nipple
Reconstruction of the nipple is done either with the patient’s own skin tissue, for example from the other nipple or the abdomen, or by means of tattooing in a specialized clinic or practice.
