Breast reconstruction following tumour operations
Consultation in deciding to opt or not for breast reconstruction following an operation on a tumour is cardinal.
The patient should be advised by a plastic surgeon proficient and can offer all methods of reconstruction (including microsurgical reconstruction techniques such as TRAM and DIEP).
Photographs should also be produced in order to develop conceptions of what may be realised.
Reconstruction using implants
One possibility is the use of foreign tissue, like silicone implants, to restructure the breast. Adequate amounts of skin are required to form a naturally appearing breast. This skin is obtained by stretching during the reconstructive process, and thus a skin-expander is used. This is a silicone balloon with a valve that is filled with a saline solution and stretches the skin gradually in small steps. The expander may either be applied straight after the tumour operation or at a later stage.
Once the skin has been stretched adequately, it must rest for some 3 months so that it does not shrivel back to its original position.
A further operation is then performed where the implant, smaller than the stretching, is inserted, It is here that the natural contour of the breast is formed.
Advantages: The individual operations are short and take no longer than an hour.
Disadvantages: The reconstructed breast is always firmer and, over time, tends to sit higher than the healthy breast as the artificial tissue does not recreate its normal posture. Thus the patient often requests a correction in this regard.
This procedure is well suited to patients who have other ailments or do not wish to undergo the long operation needed for tissue creation.
Reconstruction with own tissue
The most significant advance in plastic reconstructive surgery has been achieved in this area. More sophisticated operations are available now where we previously relied on back muscles and later abdominal muscle and fatty tissue for the restoration of breast tissue.
Our most common operation is breast restructuring with the fatty tissue from the abdomen. This surgical procedure utilises the excess skin and subcutaneous fatty tissue that many women have. Removal of this excess proves to be a positive side-effect of this operation. Today it is only necessary to remove a small TRAM flap or the supplying tissue itself (DIEP). The refinement of surgical technique minimises the negative effect on the abdominal wall.
However, this procedure takes a while (up to 6 hours) and may therefore only be offered to otherwise healthy women.
Advantages: The reconstructed breast resembles normal breast tissue and undergoes the natural process of tissue change. There is no sensation of a foreign body and this method provides for the most natural reconstruction of the breast.
Simultaneous abdominoplasty (tummy tuck)
Disadvantages: Long operation (up to 6 hours) and scar at the donor site. Abdominal wall weakness at the donor site, in rare cases.
Mammary reconstruction is only performed once the final contour of the breast has been achieved, i.e. some 6 months after breast reconstruction. The operation occurs under local anaesthetic on an out-patient basis. Reconstruction either requires the tip of the opposite nipple or a small flap of the reconstructed breast. The areola is either pigmented by a skin graft or tattooing.
The opposite breast
No exact symmetry may always be achieved, particularly with breast reconstruction using implants. Therefore the patient may request that the opposite breast is enhanced, mostly by lifting.
This operation is referred to as a streamlining convergence and is usually covered by health insurance.