Breast reconstruction is the term used to describe plastic reconstruction of the breast, which is very commonly performed due to breast cancer.
What is breast reconstruction?
Breast cancer is one of the most common cancers in women. In the course of therapy, the diseased breast must very often be removed, which is also one of the main reasons for a subsequent breast reconstruction or breast reconstruction. With the help of implants or autologous tissue, the female breast can be restored in this way.
Function, effect and goals
Breast reconstruction is the term used to describe plastic reconstruction of the breast, which is very often performed due to breast cancer. Various methods are available to reconstruct a female breast. Which procedure is chosen depends on a variety of factors. These include:
- The quality of the remaining tissue
- The health status of the patient
- Shape and size of the breast
- Wishes of the person concerned
Basically, a distinction is made between breast reconstruction using autologous tissue or with an implant. Here saline- or silicone-filled implants are available, although these have recently been significantly improved by the use of pre-treated animal dermis, so that an often very costly reconstruction with the help of autologous tissue can be avoided. Implants are placed under or on top of the pectoral muscle. If the patient has a sufficiently large skin mantle, the doctor inserts the implant directly. However, if the skin is too tight after the operation, it is first stretched with an expander. For this purpose, a plastic bag is inserted under the skin, which is filled with saline solution with the help of an injection needle. After a few months, the skin is stretched and the implant can be inserted. Breast reconstruction with an implant is a relatively simple and short operation and causes little pain. In a breast reconstruction with the body’s own tissue, muscle or fat tissue is first removed from the abdomen, back or buttocks, and this form of surgery requires a great deal of experience. Here, the surgeon detaches muscle tissue from the abdomen or back and moves it to the chest wall, where he or she sculpts a new breast. In tissue grafting, on the other hand, the tissue is completely detached from the body and reconnected with the blood vessels. A method that is used very often is the so-called TRAM (Transverse Rectus Abdomis Muscle) flap method, where fat or muscle tissue from the lower abdomen is used. Another technique is breast reconstruction using autologous tissue from the large muscle of the back (latissimus dorsi muscle). In addition, autologous fat from the abdomen or thigh is also used for breast reconstruction. A method for breast reconstruction without muscle is the so-called DIEP flap transplantation (Deep Inferior Epigastric Perforator). For this, fatty tissue is taken from the abdominal wall and after preparation, the doctor injects the fat with the help of cannulas. Afterwards, follow-up treatment is usually required to complete the aesthetic shape. Reconstruction can be performed either at the same time as the tumor surgery (primary reconstruction) or at another time (secondary reconstruction). In this case, any necessary therapies (for example, radiotherapy, chemotherapy, hormone therapy) must be completed. Since the built-up breast can often change after reconstruction, the surgeon does not reconstruct the nipples until several months later. In this way, it can be ensured that the reconstructed breast is also completely healed. A nipple is imitated either with the help of a skin graft or a local flapplasty. For the areola, skin is used that is more pigmented and often comes from the inner thigh. This procedure is relatively short and can also be performed under local anesthesia. After breast reconstruction, physical stress such as carrying or lifting should be avoided. It is also advisable to wear a special bra as well as massage the breast.
Risks, side effects and dangers
Implants with silicone gel are normally not harmful to health. However, since a risk can never be completely excluded, it is necessary to have the built-up breast constantly checked.An implant is also a foreign body for the body, so sometimes hardening occurs, which can compress the implant. This causes pain and can lead to deformation of the breast. In this case, a new operation is necessary, during which the old implant is removed and replaced with a new one. However, the risk of silicone leaking no longer exists with modern implants. Today, silicone gels are no longer liquid, but very similar to breast tissue. In addition, they are very stable and also have a long shelf life. However, they do not last a lifetime, but must be replaced after a few years. Breast reconstruction with the patient’s own tissue is more stressful and more time-consuming than inserting an implant. The operation takes longer and the risk of bleeding or complications also increases. In addition, patients must also expect scars. Depending on the technique chosen, there may be restrictions in movement or circulatory problems. The recovery period after a reconstruction with autologous tissue is longer than for a breast reconstruction with an implant. However, the autologous tissue is not rejected by the body, so that no capsular fibrosis occurs. In addition, there is no need to replace the implant. Breast reconstruction with autologous fat (without muscle and skin) is a method that is not yet fully developed and is therefore rarely used.