INTRODUCTION:
The breasts have an enormous importance in the woman from the point of view anatomical, functional, aesthetic, emotional, psychological and sexual.
Her loss produces a real catastrophe in the body image and modifies essentially the affective, social and sexual life of the patient. Breast cancer attacks a woman’s self-confidence and her very life.
Today, women with breast cancer have more and better options for treatment, preservation and reconstruction of the breast.
The different surgical procedures have advantages and disadvantages. To make the final decision will depend on the clinical history, our team of plastic surgeons and you.
WHAT’S A MASTECTOMY?
It’s a surgical operation to remove a woman’s breast for breast cancer or significant risk factors for breast cancer.
BREAST’S ANATOMY
The breast is a mound of glandular, fatty and fibrous tissue located over the pectoralis muscles of the chest wall and attached to these muscles by Cooper’s ligaments. The breast itself has no muscle tissue.
The glands have the capacity for milk production, blood vessels, milk ducts to transfer the milk from the glands to the nipples and sensory nerves that give feeling to the breast. Most breast cancer begins in the lining of the ducts and sometimes the milk glands.
TIMING OF BREAST RECONSTRUCTION
- INMEDIATE RECONSTRUCTION: reconstructive surgery performed at the same time as the mastectomy. It has positive psychological benefits for women. It offers major advantages for obtaining an optimal result.
- DELAYED RECONSTRUCTION: reconstructive surgery performed from a few days to years after the mastectomy. It allows the breast tissues time to heal, she can plan the timing, more time to plan the surgery to achieve breast symmetry. The patient has time to recover from adjunctive therapy. But as risks she may experience depression from mastectomy, she may never “get around” to having reconstruction, additional cost of two surgeries.
SURGICAL OPTIONS FOR BREAST RECONSTRUCTION
Breasts can be reconstructed using implants or expanders and the tissue remaining after the mastectomy or with flaps of muscle or muscle and skin oftained from the abdomen, back, hips or buttocks and then transferred to the chest wall.
The choice of reconstructive method depends on the amount and quality of the tissue remaining after the mastectomy, our team plastic surgeon’s experience and your preferences and expectations.
RECONSTRUCTION WITH AVAILABLE TISSUE:
The implant or expander is the simplest method of breast reconstruction. New scars are not created. A second operation will be required to reconstruct the nipple-areola and if necessary to make appropiate adjustments in implant size, shape and position or to release the capsular contracture.
Basically, there are,
- IMPLANTS with fixed-volume
- EXPANDERS: implants in wich the volume can be changed after they are implanted
Implant reconstruction is indicated for the woman who has available and healthy tissue after mastectomy, her chest muscles are preserved. Benefits: symmetric appearance, suitable for bilateral reconstruction.
Expander recosntruction is indicated for the woman who desire a simpler reconstructive approach, but the taut skin in the area of the mastectomy is streched and expanded. Benefits: usually without additional breast scars, patient can help make the final determination of the volume and size; suitable for bilateral reconstruction. Drawbacks: it’s time intensive.
FLAP RECOSNTRUCTION:
The two most common sources of tissue for breast reconstruction with the patient’s own tissue are the lower abdominal wall and the back.
- Reconstruction with the Lower Abdominal (TRAM) flap: this technique allows to restore a woman’s breast with her own tissues without the need for a silicone breast implant, and at the same time give her a slimmer abdomen. It’s indicated for the woman who prefers a breast reconstruction without a breast implant and she will accept the prospect of having a “tummy tuck”. But TRAM FLAP blood supply is precarious in the overweight woman, the hypertensive woman, if she has had radiation therapy, certain types of abdominal scars and the woman who is a cigarette smoker. When the woman’s abdominal wall is very thin or she doesn’t want scars in this region. It isn’t indicated for the women with medical problems such as diabetes mellitus or heart disease, or who have had liposuction across their upper abdomen.
- Reconstruction with the Latissimus Dorsi (Back) flap: is selected when additional tissue is needed to reconstruct mastectomy defects. It’s indicated when the patient does not want a TRAM flap or a TRAM flap would pose too much risk. Benefits: it permits the formation of a more naturally shaped, fuller, larger breast. The healthy skin added is often thicker than the thin expanded skin. It’s indicated for patients who have skin grafts or irradiated skin. Drawbacks: when a large amount of skin and fat are removed from the back, the resulting scar can be unattractive. This procedure adds an implant or expander because the skin and the muscle are thin
CONCLUSIONS:
BREAST RECONSTRUCTION MEANS,
- To reconstruct a good cutaneous coverage.
- To achieve a suitable volume and shape.
- Creating a nipple-areola.
- To achieve symmetry making the necessary adjustments in the opposite breast.
BREAST RECONSTRUCTION IS A HUMAN RIGHT AND A NEED TO RECONSTRUCT THE LOST ANATOMY AND TO CONTRIBUTE TO AND FEEL GOOD IN A RELATIONSHIP.
THE BREAST ARE AN ESSENTIAL PART OF THE FEMININITY.
