Breast reconstruction surgery seeks to return to the patient (who has undergone breast cancer surgery) the breast that she had before so that she feels whole again after overcoming her illness.
There are different options, they will be chosen depending on the type of surgery that the disease requires and the treatments that are carried out later on the patient.
- Fat tissue grafts: In the case of small breast tumors, a lumpectomy is performed, which consists of the removal of the tumor and surrounding healthy tissue, usually preserving skin and the nipple areola complex. In this case, the reconstruction technique of choice would be fatty tissue grafts.
- Expander prosthesis: If the tumor is large and invades the skin, a mastectomy is required, which consists of removing the entire mammary gland and sometimes the areola-nipple complex. Whether this complex is removed or preserved depends on if the tumor affects it or not. For this in the same surgery an analysis of the tissue that is just behind the nipple is made. If it comes out cancer-free, it can be preserved and, in that case, the breast would be completely emptied. When a large amount of skin is required to be removed, then an expander prosthesis is placed inside the breast, which will gradually expand with serum, to stretch the skin again and give the breast volume. Said prostheses can be pure expanders that are filled with serum, therefore, afterwards they require their replacement by a silicone prosthesis, or they can be mixed expander prostheses, which have an expandable chamber with serum, surrounded by another of silicone that gives it a more natural touch. In this case, this type of implant can be left permanently and do not need replacement later. The use of one type or another depends on the case.
- Silicone prostheses: These are the same silicone prostheses that are used in breast augmentation. They have a fixed volume and can be round or anatomical. They can be used in mastectomies that do not remove much skin, but simply empty the breast, therefore the excised volume of the gland can be replaced by the prosthesis, or when the skin has been expanded and stretched with an expander, it is replaced for this prosthesis that has a more natural touch.
- Latissimus dorsi flap: In cases of mastectomy and later radiotherapy, in which the skin in the area has been badly damaged, prostheses cannot be used in most cases, therefore it is necessary to take healthy tissue from the back. In this case, the latissimus dorsi muscle is used, which is grasped with a segment of skin and fat, this whole set of tissue is what is known as a “flap” and is what is carried to the breast area to give volume and provide healthy tissue. Once the tissue is in place, fatty tissue grafts can be placed to volumize the flap and shape it into a breast.
- Reconstruction of the areola-nipple complex: This is usually the final stage, once the breast has been reconstructed, a new areola and a nipple are made. There are several ways:
- Local flaps: using the own tissues of the area.
- Skin graft: a segment of skin is usually taken from the groin, which is placed as an areola on the reconstructed breast.
- 3D Tattoo: On healthy skin and at the same height as the areola and nipple of the other breast, a nipple areola complex is tattooed, reproducing every detail, including Montgomery’s tubercles and physiological shadows and cracks, which gives an image exact of an almost real areola and nipple. The advantage of this procedure is that it avoids new surgeries.
Breast reconstruction is indicated in all patients who have undergone breast cancer surgery. It brings a lot of quality of life to the patient and helps in her recovery process. To be a candidate, in addition to the wishes of the patient herself, she must be healthy from the point of view of cancer and be in good health to face the surgery.
The surgeries are usually performed under local anesthesia. Depending on the type of reconstruction technique, it can take from two to five hours. Each patient is different, and each case must be personalized. After surgery, the patient stays overnight and leaves the next morning. It is possible that you wear drains for a few days.
After surgery, usually the most tedious part is taking care of the drain that should not be torn off, as it prevents fluid from accumulating in the operated area. If it accumulates it could complicate the intervention. This drainage usually stays around three to seven days, depending on the case. The cures are usually done in consultation.
It takes from about two to four weeks for full recovery, depending on the type of surgery performed. Efforts cannot be made until after the first four weeks.
In the case of the placement of an expander, its filling begins after two weeks. This is done in consultation and what is done is the infiltration of the valve of the expander with a certain amount of serum.
Dr. Ospina has a long experience in breast reconstruction of more than 9 years, being part of the breast unit of Hospitals San Roque since 2016. He has been responsible for the breast reconstruction of all the patients of this center being a reference on the island of Gran Canaria in private centers.
This type of intervention must be performed in a hospital that meets all health requirements and has an intensive care unit. Cosmetic surgery is a very regulated surgery with fewer complications, but in case they appear, it is essential to have the support of a good hospital. Hence, low-cost surgeries try to save money on this and are performed in small clinics where these safety conditions are not covered.