Suffering a breast cancer is one of the hardest situations that a woman can suffer and, even more so, if she finally has to undergo a mastectomy in which the breast is removed. But nowadays surgery has advanced to provide techniques that allow the reconstruction of the breast in a natural way, very similar in shape, texture and characteristics to the non-operated breast. I have my own specific unit for breast reconstruction in which we apply the latest techniques, which I will explain below.
Cutaneous expansion technique:
The technique of skin expansion is the most used and is based on expanding the skin to subsequently place a prosthesis. After the mastectomy, we place an expander under the skin and the chest muscle. Through a valve mechanism, we introduce a saline solution once a week for several weeks until the expander is filled. When the skin has sufficiently given way, the expander is removed and we replace it with a silicone breast prosthesis. And there are some expanders that are designed to remain as permanent implants. This procedure is performed under general anesthesia, with a hospital stay of usually 24 hours. As for the nipple and areola, they are reconstructed later, under local anesthesia and on an outpatient basis. It is important to bear in mind that the prostheses used in this type of breast reconstruction contain medical silicone, and to emphasize that no relationship has been demonstrated between breast cancer and the use of breast prostheses. It should also be noted that its use is approved in all European countries.
Technique that uses the patient’s own tissue:
This technique is based on the mobilization or transplantation of tissues from other areas of the body such as the abdomen, back or buttocks. In some cases, these tissues remain attached to their original site, preserving their vascularization, and are transferred to the breast through a tunnel that runs under the skin. In other cases, they are completely separated from their original site and transplanted into the breast by connecting to the blood vessels. This is the most complex technique, it leaves more scarring and the recovery period is longer, but the aesthetic result is much more natural. For this intervention, general anesthesia is used and a three-day hospital stay is required. ç
Mixed Techniques:
We are currently performing with great success a technique that manages to combine the best of the two previous ones, that is, that combines the placement of a prosthesis with the injection of the patient’s own fat to achieve more natural contours both to the eye and to the touch. This technique is especially indicated in patients who have undergone radiotherapy or who have a poorly elastic skin, since the injection of fat produces a very beneficial effect on the skin and the scar thanks to its high content of stem cells. In these cases we perform a first session to extract the fat by liposuction, with the consequent improvement of the body contour in appropriate cases and, in that same intervention, the fat is treated to purify it and injected under the skin of the chest, around and inside the scar of the previous mastectomy. Subsequently, once the elasticity and thickness of the skin has improved, we perform the implantation of the expander. The fat injection can be used again in the final phase of the reconstruction to improve the contours or to symmetrize the breasts. This combined technique achieves aesthetic results very close to the more complex microsurgical reconstructions and lacks many of their drawbacks.
Any of these three techniques can be used for immediate reconstruction, that is to say that the mastectomy and breast reconstruction are performed in the same surgical act. However, the skin expansion technique will imply a second surgery for the placement of the definitive implant, although an immediate reconstruction can be performed with the placement of the prosthesis directly without going through the whole expansion process. This can be achieved thanks to the implantation of a special film that protects the prosthesis without the need to expand the skin for weeks. In this way, the patient who enters the operating room with the trance of undergoing a mastectomy, leaves the same with her breast completely reconstructed in a single time.
In any case, the choice of one of the three techniques will depend on the patient. Personally, I always advise the best option according to the case and always in order to obtain the expected results.
The results
We must also remember that the results of a breast reconstruction are definitive and allow to make an absolutely normal life, even the reconstructed breast may have a firmer appearance and look 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 non-reconstructed breast. However, these differences are usually only visible to the patient and are not perceived by others.
Finally, it is important to note that breast reconstruction has no effect on the recurrence of breast disease, nor does it interfere with chemotherapy or radiotherapy treatment, even if the disease recurs. It also does not interfere with subsequent tests that may be required at relevant checkups.