Breast reconstruction surgery is a fundamental part of the multidisciplinary treatment of cancer or other diseases of the breast. The objective of breast reconstruction is to improve the quality of life and self-esteem of these women.
Surgical treatment or removal of the breast tumor is performed by the mastology or oncological surgery team and immediate (or delayed) reconstruction by plastic surgeons according to the guidance of the multidisciplinary medical team (clinical oncologist, mastologist or oncological surgeon and plastic surgeon).
It is a complex treatment that, in most cases, requires more than one surgery to obtain the desired result. Almost always, the first surgery is the biggest and most important and the next ones are minor surgeries with the intention of refinement and improvement of the surgical result.
The 4 main surgeries performed for breast reconstruction after treatment for cancer or other breast diseases are silicone prosthesis, Temporary Silicone expander, muscle flaps (Large Dorsal Muscle and Rectus Abdominal Muscle (TRAM)) and fat graft. Every patient must be evaluated in a personalized way to decide on the most appropriate treatment for each case.
The Silicone implant is mainly indicated for small and medium breasts that had little mammary gland and little skin removed. It's not just "putting" silicone on the breasts, but treating the area where the breast cancer was removed, repositioning the breast tissues, remodeling the entire structure of the breast, seeking a more natural shape as possible and, oh yes, the silicone to help us.
The temporary silicone expander is widely used when the treatment of breast cancer requires the removal of a lot of breast tissue and skin or when the surgery was a little more aggressive. In these cases, we use the breast expander in the same place where, later, the silicone prosthesis will be removed and placed. In addition to this previous indication, another very frequent one is when the patient will need radiotherapy. In these cases, we prefer to place the temporary breast expander to protect the breast “store” during radiotherapy and, six months after the last radiotherapy session (when indicated), surgery will be performed to replace the temporary expander with the silicone prosthesis. This is why this type of reconstruction is called two-stage breast reconstruction or temporary expander reconstruction.
The Latissimus dorsi Muscle Flap is the most versatile breast reconstruction surgery and can be indicated for almost all patients. In the vast majority of cases, it is necessary to associate a silicone prosthesis to give volume to the breast, but in overweight or obese patients and excess tissue in the back, the silicone prosthesis may not be necessary. The resulting scar on the back is designed to be hidden by the bra or bikini.
In breast reconstruction surgery with the Rectus Abdominal Muscle Flap (TRAM) we remove a part of the abdominal muscle along with the skin of the abdomen to reconstruct the breast, usually with more natural results and without silicone prosthesis. It is a major surgery and used for selected cases.
The Fat Graft is very indicated in breast reconstruction surgeries to improve the appearance of the skin after radiotherapy and correction of defects after other types of reconstruction. Finally, fat grafting is almost always indicated at some point in breast reconstruction. It's an outpatient surgery, so you don't need to be hospitalized. Scars are minimal and return to activities occurs after a few days.
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