Dr. Carmen Iglesias, specialist in Plastic, Aesthetic and Reconstructive Surgery, explains what allows women to recover their body image, femininity and psychological balance.
Breast cancer is the most common tumor in women in our environment. Its treatment often involves partial or complete removal of the affected breast. Hence the reconstruction of the breast is essential to restore its appearance and, at the same time, as Dr. Carmen Iglesias, plastic surgeon at Nuestra Señora del Rosario Hospital, states, “to help the woman recover her body image, femininity, psychological balance and, once the process is over, to end the stage of the fight against cancer”.
Reconstruction after breast cancer, a totally personalized process.
Like each of the processes in breast cancer, breast reconstruction is also something individualized, personalized, in which the woman can almost always choose between several techniques. “Breast reconstruction is a process that involves at least two interventions, and the path to follow must be chosen jointly by the woman and her plastic surgeon,” indicates Dr. Iglesias.
When the tumor can be removed while maintaining part of the breast, plastic surgeons collaborate with oncologists to achieve an adequate breast shape. This procedure is known as oncoplastic surgery. If the breast must be completely removed, the best time for reconstruction is at the same surgery as the excision. “In this way we achieve the best aesthetic results and the alteration of body image is minimized. But sometimes it is not possible, due to the nature of the tumor or the woman’s decision, and we must perform the reconstruction at a later stage,” the surgeon adds.
Maintaining femininity and body image, the goal of breast reconstruction
The reconstructive objective is to preserve femininity and body image, so the two breasts must be symmetrical or very similar. “Sometimes surgeries should not only be performed on the diseased breast, but also on the healthy one, to ‘reposition’ it (mastopexy), augment it (augmentation mammoplasty) or reduce it (reduction mammoplasty),” Dr. Iglesias assures.
The many reconstructive techniques are divided into two: those that use implants and those that use the woman’s own tissue.
The tissue expander is an implant with the capacity to dilate the skin and to be able to place a breast prosthesis in a second intervention. Both surgeries are performed under general anesthesia and must be separated between three and six months, depending on the time needed to achieve adequate breast volume.
Sometimes the reconstruction with prosthesis can be performed directly, in a single surgery.
Autologous breast reconstruction, using the patient’s own fat.
Breast reconstruction using the patient’s own tissues (autologous reconstruction) has many possible techniques depending on the location of the greatest amount of fat: one can choose between procedures that take tissue from the abdomen (DIEP), the gluteal region (SGAP or IGAP) or the inner thighs (PAP). “In all cases, this excess fat and skin is used to take it to the thorax, where it is attached to an artery and a vein so that the fat is vascularized (still alive). This involves the use of highly specialized microsurgical techniques,” explains Dr. Iglesias, who adds that the most frequently used tissue is the abdominal, since the color of the skin, its texture and the characteristics of this fat are the most similar to those of the breast. With this technique no muscle is injured and it is an aesthetic benefit for the abdomen, because its result is that of an aesthetic abdominal lipectomy (abdominoplasty).
“With this technique, the reconstruction is durable and harmonious with the other breast. When the woman gets thinner or fatter, the reconstructed breast will look like the healthy one. Over the years, both will sag in a similar way. It is, therefore, an integral reconstruction of the body image,” concludes Dr. Iglesias.