Plastic surgery is performed to restore the shape, appearance and size of the breast affected by the cancer.
The female breast has a very strong representation for women, due to the direct relationship with femininity, self-esteem, sexuality and motherhood. Mastectomy surgery aims to remove all or part of the breast affected by cancer, which can have a negative impact on female self-esteem and affect the woman emotionally.
Breast reconstruction restores women’s self-esteem
Breast reconstruction procedure becomes the best option for women to regain self-confidence. the surgery of breast reconstruction will return the shape, appearance and size of the breasts. However, this surgery depends a lot on the type of resection that the mastologist performed. In some cases, immediate reconstruction is possible, ie in the same surgery, so that the patient does not suffer the trauma of being without the breast.
When can the procedure be performed?
There are cases where the patient has to undergo additional procedures, such as radiotherapy, so the reconstruction surgery can be stopped a second time, after the completion of these additional treatments. This is defined by the mastologist together with the plastic surgeon and the oncologist, depending on the type of tumor, the size of the lesion and the clinical condition of the patient.
Necessary procedures
Generally, breast reconstruction is completed after a few surgical times, in general, three procedures, the first longer, followed by two smaller procedures. The goal of the surgery is to make the breast symmetrical, looking for a result as similar as possible.
How is breast reconstruction performed?
Reconstruction is directly dependent on primary surgery to remove the tumor. In cases where much of the skin and fat has been preserved in the mastectomy, the plastic surgeon can perform a simpler procedure, using only a silicone prosthesis for reconstruction, achieving a satisfactory result.
In women where the removal was a little more aggressive, but the tissue still remains (skin and fat) in smaller quantities, the surgeon can use the positioning of the expander to gain space, that is, to extend the skin and, subsequently, replace it with a breast implant. The expander will be inflated weekly with saline solution until it reaches the size of the other breast and then, later, the expander can be replaced by the breast implant.
Reconstruction in the most aggressive cases
In more aggressive cases, in which it was necessary to remove more tissue and the areola, the nipple and, in some cases, the pectoral muscle, it is necessary to use tissues from other parts of the body to cover the defect created by the resection of the breast cancer. So, we have two most used options: use the skin, fat and muscles of the abdominal region located below the navel (TRAM), or use the muscles, fat and skin of the dorsal region (BIG BACK).
Use of the rectus abdominis muscle
In the TRAM technique, reconstruction is performed with the rectus abdominis muscle, in which the skin and fat, together with the abdominal muscles, are brought into the mammary region. In these cases, breast implant placement is usually not necessary. Natural breast volume can be achieved with these tissues from the lower abdomen region. The scar on the abdomen is similar to that of a tummy tuck.
Technique with fat and muscles of the dorsal region
In the latissimus dorsi technique, the skin, fat and muscle of the dorsal region are used to cover the defect in the resected breast. In these cases, it is necessary to use a breast implant to obtain the volume of a healthy breast.
Last stages of the reconstruction
In cases where resection of the nipple and areola is necessary, the second surgery will be performed, which consists in the reconstruction of the papillary areola complex (nipple and areola). The nipple is reconstructed with local flaps and the areola is reconstructed with grafted skin from the groin area (darker skin, similar to the areola).
One of the last stages of breast reconstruction is called ‘symmetrization of the breast boobs‘, in which a breast augmentation with prosthesis placement, or a reduction, is performed to try to make the breast as symmetrical as possible.
by dr. Arysio Peixoto
Member of the Brazilian Society of Plastic Surgery
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Source: Terra
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