The physician will discuss with the patient what will occur during breast construction: during the mastectomy (immediate reconstruction) or subsequently (deferred reconstruction).
There are no absolute rules for determining the time to perform reconstruction. This varies from one patient to the other depending on several criteria, such as the effects of radiotherapy, spreading of the tumour and most of all, the desire of the patient herself to have this type of operation. Most patients wait approximately one year after an additional treatment of radiotherapy but some opt for immediate reconstruction.
The various types of breast reconstruction
Breast reconstruction can be performed using various surgical techniques:
- Reconstruction by prosthesis
- Reconstruction by a flap:
- Muscle and skin from the back
- Muscle and skin from the abdomen
- Cutaneous and fatty tissue from the abdomen
For each method, reconstruction of the areola and nipple is possible. The contralateral breast can be made symmetrical so that both breasts are very similar in shape and volume.
Reconstruction by prosthesis
This type of reconstruction may be considered if the skin and the large pectoral muscle are intact and substantial enough and if no radiotherapy has been administered. These tissues can in this case securely retain a prosthesis and give the breast a shapely contour.
The prosthesis will be placed behind the large pectoral muscle, taking up a portion of the mastectomy scar tissue. The prosthesis is an anatomical type of prosthesis (in the shape of a drop) made of silicone gel.
In some cases, the prosthesis is attached to a small valve placed under the skin of the chest. The concept of this type of reconstruction is based on the principle of tissue expansion, meaning the ability of skin and muscle to gradually expand. When the prosthesis is put in place, the portion in saline solution is empty. It will be gradually filled by weekly injections into the valve through the skin, under local anaesthesia. The injection is painless; the increase in volume will simply produce a sensation of tension for 24 hours after the injection.
The advantage: there are no additional incisions and duration of the operation and the hospital stay is shorter.
The disadvantage: the prosthesis does not change over time as the other breast does; its shape is set.
Reconstruction by a flap from the back
A flap containing the large dorsal muscle, and the skin and fat covering it, is ideal for reconstruction.
The skin taken up is in the shape of a spindle and will be used to reconstruct the underside of the breast. Volume will be obtained by muscle and fat. Sometimes it is necessary to put a prosthesis under the muscle to achieve the proper volume. On the back, the residual scar will usually be horizontally shaped, and hidden under the brassiere band.
Hospitalisation usually lasts a week. After the operation, the drains are left in place for several days. There is no cause for fear of disability in the use of the arm.
The disadvantages: the necessity of creating an additional scar on the back. A pouch of lymph fluid may also appear on the back. This pouch will be emptied by a simple puncture. One contraindication for this operation is periarthritis.
