Breast reconstruction
definition
Breast reconstruction involves plastic reconstruction of a breast. Various methods can be used for this. Breast reconstruction can be carried out using your own tissue or artificial implants. Which procedure is suitable for a patient depends on her physical situation.
indication
Breast reconstruction is particularly useful for patients with breast cancer and removal (Mastectomy) of the diseased breast. Often, for cosmetic and psychological reasons, the patient wishes to restore the original shape of the breast, including the nipple. Reconstruction of one or both breasts can also be carried out after congenital malformations. More and more often, the breasts are also removed as a precaution, for example if there is a family predisposition. The breasts are then reconstructed using implants or your own body tissue.
Figure female breast
- Nipple -
Papilla mammaria - Areola -
Areola mammae - Milk duct -
Lactiferous duct - Lobule of the mammary gland -
Lobuli glandulae mammariae - Adipose tissue -
Corpus adiposum mammae - Ribs - Costas
- Pectoralis major -
Pectoralis major muscle - Anterior saw muscle -
M. serratus anterior - Outer weird
Abdominal muscles -
Obliquus muscle
externus abdominis - Chest wall - thorax
- Skin - Cutis
You can find an overview of all Dr-Gumpert images at: medical illustrations
Time of operation
Breast reconstruction can be performed in the same operation as the breast removal, or it can be performed at a later date. Which approach makes the most sense depends on a number of factors. On the one hand, the right time depends on the type of cancer and the associated therapy. Immediate breast build-up can usually only be carried out if the cancer treatment has also ended with the breast decrease. If the mastectomy is followed by chemotherapy or radiation to treat the cancer, you should wait six months before the surgery can be planned due to the wound healing. Since above all psychological aspects are involved in this decision, this time can also be bridged with an implant. Many patients feel more comfortable returning to normal as soon as possible. A reconstruction with autologous tissue can then always be carried out.
Preparations
The operation should be done by a gynecologist and a plastic surgeon. A good and planned collaboration also achieves an optimal result. Often times, the plastic surgeon is involved in treating the patient from the time the breast cancer is diagnosed. In this way, the doctor gets to know the patient and her wishes and concerns on the one hand, and can on the other hand The patient builds trust in her treating physician. In addition, the patient should be informed early enough about the planned procedure, both about the removal of the breast and the possibility of reconstruction. Together with the treating doctors, the right method for the patient is sought.
In addition to a thorough physical examination, there is a comprehensive informative discussion. This should contain the various methods of reconstruction, as well as the respective advantages and disadvantages and which complications and risks can arise. Furthermore, the patient is informed about the behavior before the operation. Ten days before the procedure, the patient should no longer take any blood-thinning medication and should also refrain from nicotine and alcohol. At the same time, the patient has the doctor about regular medication and present allergies or to inform other diseases. There should be enough time after the conversation so that the patient has the opportunity to think about everything again and to clarify open questions in a possible further appointment. For many patients, a accompanying psychological care very helpful be. Here she can share possible fears and worries, but also be professionally prepared for upcoming situations.
Reconstruction with implants
After Breast decrease can the breast means Implants to be rebuilt. The goal is to have a Breast shape as natural as possible to accomplish. The procedure is a common method that very often uses silicone implants. If enough skin remains after a tumor has been removed, the implant can be placed either directly under the skin or under the pectoral muscle. If a lot of tissue and skin was removed due to a tumor, the existing skin initially stretched to then insert an implant underneath. Doctors use one for this expander, which is filled with more and more fluid over several weeks and thus prepares the existing tissue for the procedure. There is also the option of a Expander prosthesis use, which is also increasingly filled with liquid and then as a breast replacement remains there. So becomes a second operation unnecessary.
There are different approaches to this method and different cutting techniques, which should be discussed with the patient in advance and a course of action agreed. The advantages of this method are the simple technology and the lower effort. In contrast to using your own tissue, arise with this method no more wounds and scars accordingly. In addition, the patient will less pain exposed and can expect faster wound healing. A disadvantage and at the same time one of the most common complications is the risk of one Capsular contracture. Since the implant is a foreign body acts for the body, it can also react to it. A thin layer of connective tissue can gradually form around the implant. This eventually hardens more and more and can ultimately lead to severe pain. The chest then feels harder than usual and can also lose its shape as a result. If the capsular contracture is very pronounced, it is very likely that a corrective surgery be performed. This can be more difficult as more tissue has to be removed.
Reconstruction with own tissue
Another way to rebuild the breast is to remove the skin and fat and Muscle tissue to reconstruct. There are different techniques here too. At a pedicled flap graft the tissue to be transplanted together with the supplying blood vessels is transplanted into the breast. The doctor can also continue to do so first remove the tissue completely, shape the breast out of it and then connect the vessels in the breast under the microscope so that the Blood supply is secured. This procedure usually creates very natural breast shapes and achieves a very satisfactory result for many patients. The quality of the skin depends on the location and the surface of the skin itself. A distinction is made between different types of reconstruction from the patient's own tissue.
Chest build-up from the latissimus dorsi muscle
This procedure loosens part or all of the back muscle. A piece of skin remains, from which a natural breast shape can ultimately be built. The supplying blood vessels are not severed, but are transplanted with the tissue, thus the blood supply is guaranteed continuously. Often, however, there is also a additional use of an implant necessary. The removed back muscle is balanced by other muscle groups on the back, so that there are no restrictions there. One disadvantage is the additional scar on the back and that Risk of capsular contracture through the implant.
TRAM - Transverse Rectus abdominis muscle flap
This procedure is one of the most original methods of breast reconstruction and has always been further developed. From the straight abdominal muscle (Rectus abdominis muscle) transverse strips of skin and fatty tissue are removed and finally sewn into the breast region. In the meantime, it is also possible to save on muscle tissue. All that is needed is a small muscle spindle that contains the supplying blood vessels. This creates a prevents excessive impairment of the abdominal muscles. Furthermore, this procedure can also be carried out using a stalk. Accordingly, the tissue is detached, always remains connected to the body and is transferred under the skin to the breast region. A connection of the vessels is then not necessary and accordingly the effort is lower, but this method also offers the risks of circulatory disorders and wound healing disorders.
DIEP - Deep Inferior Epigastric Perforator Flap
With this method, which is now the Gold standard for reconstruction is made of its own tissue, it becomes straight Muscle not removedbut only split to loosen the blood vessels. This will be Abdominal wall weaknesses and fractures avoided. Furthermore, similar to the TRAM, skin and fat tissue is removed to build up the breast. This operation leaves a transverse scar on the lower abdomen and a circular one around the navel.
S- GAP / I- GAP - Superior / Inferior Gluteal Artery Perforator Flap
In these procedures, skin and fat tissue are removed from either the lower gluteal fold or from upper buttocks taken to build up the breast. This method has the advantage that it works for you second breast augmentation attempt can be used. It is particularly suitable for slim patients, as they sometimes do not have enough fatty tissue on their stomach. The size of the flap depends on the size of the breast to be reconstructed, so the size of the scar also varies. The resulting scar can, however, be covered very well by clothing and is less noticeable compared to the other procedures. There are, however, statements from patients who have had long discomfort while sitting.
TMG - Transverse Musculocutaneus Gracilis Flap
With this variant, the Inner thigh Part of the gracilis muscle, including skin and fat tissue, was taken. The removal of a muscle part does not affect mobility of the leg, but is very well compensated for by other muscle groups. For this method, enough material must be available to be able to remove it, but also to ensure a cosmetically attractive tightening of the tissue. This surgical technique is particularly popular when it is possible to preserve one's own breast skin, because the thigh skin is usually darker than on the breast. The remaining scar is not noticeable and it is also a very simple and time-limited operation.
Autologous fat transplant
This method is an option if enough own skin could be obtained after breast removal. Then the breast can be built up using fatty tissue that has previously been suctioned off from various suitable body regions. Often one has to Fat graft to be repeated, because the body partially breaks down the fat again and this can lead to a difference in size of the breasts.
Reconstruction of the nipple
After the breast has been reconstructed and healing is largely complete, it can be done in another operation also the nipple being constructed. Various methods can also be used for this. The skin and the corresponding tissue can be removed again and shaped into the nipple. This procedure can usually also be performed under local anesthesia. Another variant is the so-called "Nipple sharing". This is a method in which the healthy nipple, if it is large enough, is divided and a new one is formed from it. However, there is the dangerthat it becomes a Change in sensitivity of the healthy nipple. The areola is then used tattoo or transplant colored accordingly darker.
Complications
Every operation carries different risks and complications, including breast reconstruction. Possible complications include Infections, Wound healing disorders, Secondary bleeding, excessive scarring, Intolerances due to the implants and the need for follow-up operations. In addition, the reconstruction can also cause numbness, especially when the nipple is built up through nipple sharing. Accordingly, the patient must be informed that the breast is in size often very good and natural looking can be built, but the original chest sensation not achieved can be. Also well-known risks of thrombosis or embolism can occur.
After the reconstruction
During the operation, drains are placed in the wound, which are supposed to drain blood and wound secretions a few days after the operation. If they only convey very little wound fluid, they can be removed. As a rule, patients can Discharged from the hospital after a few days if the treatment is uncomplicated. The maximum stay in the hospital is most up to two weeks. After the procedure, the patient should rest and recover sufficiently. Depending on the job, a sick leave is still necessary. Furthermore, you should do sports that also require arm activity be paused for at least six weeks after the operation. During this time, the patients also wear certain bras or bodices that compress the breast and thus prevent scars from tearing. The cosmetically beautiful healing of the scars can also be favored by them initially protected from sun rays and with appropriate Scar ointments be creamed regularly.
Surgery cost
When breast cancer is present, the subsequent reconstruction of the breast is a Part of the treatment plan. Accordingly, the costs for the operation as well as for any subsequent interventions that may become necessary Covered by statutory and private health insurance companies. Congenital malformations and precautionary breast removal in the case of a family disposition can also be taken over. Before the operation, the patient can obtain sufficient information from her responsible health insurance company.
