Breast Augmentations — Reconstructive
Breast reconstruction after mastectomy has evolved over the past century to be an important element in the therapy for individuals with breast cancer. It involves using autologous tissue or prosthetic material to develop a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple.
The goals for individuals undergoing reconstruction are to correct the anatomic defect and to bring back form and breast proportion.
How Breast Reconstruction Is Conducted?
Typically, a mastectomy normally removes a variable amount of breast skin surrounding the nipple. The quantity of skin removed depends on tumour size and also the location of the biopsy scar. When significant breast skin has been excised with the mastectomy, a natural appearing form cannot be achieved without the use of tissue expanders, which slowly expand the remaining breast skin. Additionally, the skin circulation and its healing ability might be somewhat compromised by the mastectomy. In combination, these aspects prevent the quick placement of a permanent breast implants Cardiff at the time of mastectomy in most individuals. Thus, the implant reconstruction turns into a staged process, which includes the first usage of tissue expansion.
Breast Reconstruction Techniques
The most common approaches applied by cosmetic surgeon in reconstructing breasts are:
Tissue Expander – Breast Implants
Based on whether one is coping with an immediate or a delayed reconstruction, the tissue expander is either placed at the time of the mastectomy or during a subsequent procedure. A tissue expander is like an inflatable breast implant that is inserted into a pocket under the skin and muscle of the chest.
The expander is usually placed in its collapsed form at the time of mastectomy and then beginning about 2 weeks after surgery, fluid is introduced into the tissue expander to slowly inflate it The pectoral muscles might be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. Six to twelve weeks are then permitted for the skin to stabilize and loosen around the expander. The patient is then brought back to the operating room to eliminate the tissue expander and place a permanent breast implant.
Flap reconstruction
The second most common procedure uses tissue from other parts of the patient’s body, such as the back, buttocks, thigh or abdomen. Reconstruction with the latissimus dorsi myocutaneous flap produces a breast with ptosis and projection while keeping the natural consistency and feel of normal tissue. It reinstates the anterior chest wall with healthy tissue, particularly of benefit in patients who previously have undergone irradiation. The latissimus muscle flap is a workhorse flap for salvage of failed expander-implant reconstructions.
Indications for Implant Reconstructions
Most people who choose to have their breast reconstructed should be presented with a choice of either an implant reconstruction or a reconstruction with their own living tissue. However, generally, patients with smaller, minimally ptotic breasts who have gone through a total mastectomy are the best prospects for an implant reconstruction. Also, some individuals may not have the excess tissue needed for certain reconstructive breast procedures. For instance, a very thin woman may not have sufficient excess abdominal tissue for a TRAM flap procedure.
Contraindications for Implant Reconstructions
Patients who don’t have enough soft tissue or skin after their mastectomy may not be candidates for tissue expander-implant reconstructions, as it may be impossible to cover the tissue expander. For instance, patients after a radical mastectomy might be left with very thin skin flaps and an absent pectoralis major muscle. Usually this requires the addition of tissue from elsewhere in your body to rebuild the defect. Thus, these individuals are not ideal prospects for tissue expander-implant reconstructions. Generally, any patients who have gone through extensive skin excisions with tight closures and thin flaps are might be better treated with flap reconstructions. Patients who have had or are scheduled to have chest wall radiation are not good candidates for tissue expander-implant reconstructions. It is also hard to make a large, slightly ptotic (i.e. droopy) breast with reconstruction using implants only.
Possible Risks/Complications Associated With Breast Implants
The most frequent complication is leakage or rupture of the breast implant. This occurs in approximately 10% of cases over the first 10 years. When this happens, the implant should be taken out and changed.
The second most typical complication is encapsulation or “capsule formation”. Scarring forms externally of all artificial implants when placed in the body (See Figure 10). Usually, this does not pose a problem. However, in a minority of cases, too much scar tissue forms. The scar tissue may cause discomfort and pain and may make the implant feel hard to the touch. When this happens, surgery might be necessary to split up or take away the scar tissue. It may also be necessary to remove or replace the implant. Capsules can form at any time from a couple of weeks to many years after the implants are put.
It is also likely that the implant might shift in accordance with the breast tissue sometime following the surgery. This may require further surgery to fix the positioning of the implant.
Lastly, “wrinkling” or “rippling” in the shape of the final reconstructed breast may occur. This is particularly common with saline filled implants.
Predicted Time To Recover
Recovery from implant-based reconstruction is generally quicker than with flap-based reconstructions, but both take at least three to six weeks of recovery and both require follow-up surgeries in order to create a new areola and nipple. All recipients of these operations should refrain from strenuous sports, overhead lifting, and sexual practice during the recovery period.
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