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Cosmetic Surgery /


Breast reconstruction after breast removal due to breast cancer or other illnesses (mastectomy) is one of the current surgical procedures that is most gratifying for the patient. New techniques along with the evolution of medical materials allow the surgeon to create a breast which is very similar in shape, texture, and characteristics to a breast that has not been operated on.

Would you be a good candidate for breast reconstruction?

Most women who have undergone a mastectomy can consider themselves candidates for breast reconstruction, and in most cases it can be performed at the same time as removal of the breast. The optimal candidate has had the entire tumor removed during the mastectomy. The advantage of reconstructing the breast at the same time as the mastectomy is that the patient will wake up from the operation with a normal breast contour, avoiding the experience of seeing oneself with an amputated breast.
In some cases, however, the reconstruction must be postponed. Some women do not feel comfortable talking about breast reconstruction when they are still trying to digest their diagnostic of breast cancer; other women simply do not want more operations than those absolutely necessary to cure their disease.
At any rate, the most important thing is to have adequate and clear information about what you can expect from the surgeon. During the preoperative visit, the surgeon will explain the procedure in detail and the results that can realistically be expected. He will also show you photos of before and after the procedure.

  • Breast reconstruction surgery


    The medical team that will perform the mastectomy, the oncologist, and the plastic surgeon should coordinate with each other to develop a strategy that will produce the best possible results.
    The plastic surgeon is the specialist, with his training (specialized in Plastic, Reconstructive and Cosmetic Surgery) who has the specific technical and cosmetic resources to reconstruct breasts to their natural appearance. After evaluating the general state of the patient, we will inform her of the appropriate options for her age, level of health, physical and anatomical characteristics, and what she she can expect for the future. That is why there should always be at least one plastic surgeon in the multidisciplinary team that will perform breast reconstruction.

  • Breast reconstruction techniques


    There are different types of breast reconstruction procedures:

    Tissue expansion
    The cutaneous expansion technique is the most widely used technique and consists of expanding the skin in order to insert a prosthesis. After the mastectomy, the plastic surgeon will place a tissue expander under the skin and the pectoral muscle. Through a valve mechanism a saline solution serum will be introduced once a week for several weeks, until the expander is full. Once the skin has stretched enough, the expander is removed and substituted with a silicon breast prosthesis.
    There are certain types of expanders that are designed to be used as permanent implants. The procedure is performed under general anesthesia, normally with a 24-hour hospital stay. The nipple and areola are reconstructed afterwords under local anesthesia and on an out patient basis. The prostheses used for this type of breast reconstruction contain medical silicone. No relationship between breast cancer and the use of breast prostheses has been demonstrated. Their use has been approved by every country in Europe.
    Technique using the patient's own body tissue
    There is also a technique that uses the patient's own tissue which consists of moving or transplanting tissues from other areas of the body, such as the abdomen, the back, or the buttocks. In some cases these tissues continue to be united to their original location, conserving their vascularisation, and they are transferred towards the breast through a tunnel that runs under the skin. In other cases they are completely separated from their original location and are transplanted into the breast through a connection to the blood vessels in this area. This technique is more complex and leaves a scar, and the recovery period is longer. However, the cosmetic results are more natural. This technique is also performed under general anesthesia, with a 3-day hospital stay.
    Combined techniques
    We are currently very successfully performing a technique that consists of combining the best of the two previously mentioned techniques. It consists of combining the placement of a prosthesis with an injection of the patient's own fat in order to achieve more natural contours both visually and to the touch. This technique is especially indicated for patients who have undergone radiotherapy or who do not have very elastic skin, because the injection of fat is beneficial for the skin and for scarring. In these cases we advise an initial session to extract the fat to be used via liposuction, with the resulting improvement of the body's contour in cases where it is appropriate. The fat is then treated to purify it and then injected under the skin of the thorax, around and inside the scar from the mastectomy. Once the elasticity and thickness of the skin are improved, the expander is implanted. Fat injection can be used again in the final stage of reconstruction to improve the contours and symmetry of both breasts, for this reason we feel that this combined technique achieves cosmetic results very similar to those of achieved with micro-surgical reconstruction, without their complexity and drawbacks.
    Techniques for immediate reconstruction
    Any of the three techniques can be used for immediate reconstruction (the mastectomy and breast reconstruction performed during the same operation.) The tissue expansion technique implies a second procedure to place the definitive implant, but in the case of immediate reconstruction, the prosthesis can be introduced directly without having to go through the whole expansion process. This can be achieved thanks to the implantation of a special sheet that will protect the prosthesis, making expansion of the skin for several weeks unnecessary. In this way, the patient who goes into surgery with difficulty of a mastectomy, will come out with her breast completely reconstructed, all at the same time.

  • Results


    The results of breast reconstruction are definitive and allow the patient to live a normal life. In some cases, the reconstructed breast can look more hard and seem rounder than the other breast. The contour may not be exactly the same as before the mastectomy, and there may be some differences in symmetry with the breast that was not operated on. However, these differences will only be visible to the patient and will not be perceptible to others.
    For most patients, breast reconstruction implies a complete improvement in their appearance, allowing them to see there bodies as complete, while also providing psychological balance. It should be clear that breast reconstruction has no effect on the recurrence of breast cancer, it does not interfere with chemotherapy or radiation therapy treatments, even if the illness reoccurs.
    It does not interfere in subsequent studies that may be necessary in follow up examinations.
    You should know that currently there are no existing contraindications because all of the specialists in charge of evaluating this type of tests know perfectly well the normal changes that occur after the placement of a prosthesis.