In our society breast cancer is a common illness which affects one in nine women.
Screening campaigns nowadays allow early detection of breast tumours. This also improves the chances of survival.
Treatment may consist in a tumorectomy (partial removal of the breast) either or not followed by radium (radiation) therapy or a mastectomy (removal of the entire breast).
Breast reconstruction can be performed if the patient so wishes.
In the case of immediate reconstruction, the breast is reconstructed at the time the breast is removed. This will only be done if the patient does, at first sight, not require any additional treatment.
If radio- or chemotherapy is required breast reconstruction will be carried out during a second operation at a later date.
Different types of breast reconstruction techniques :
1) Breast reconstruction by means of a breast prosthesis
2) Breast reconstruction by means of a latissimus dorsi flap
3) Breast reconstruction by means of the transverse rectus abdominis muscle (TRAM)
4) Surgical correction of the nontumorous breast
5) Reconstruction of the nipple and the areola
In general :
This technique is quite simple and consists in inserting a breast prosthesis under the large breast muscle. The volume of the prosthesis can be adjusted after the insertion if required.
This form of breast reconstruction is recommended for patients who have received additional or must still receive additional radiation.
In the case of an immediate reconstruction, a definitive prosthesis with definitive volume can be used.
Contrary to a reconstruction which takes place at a later date, a prosthesis is inserted of which the volume can be increased little by little during the weeks following the surgery.
This prosthesis may be replaced after a second operation by a prosthesis with a definitive volume.
Post-operative consultations :
3d day: removal of the drain
10th or 12th day: removal of the stitches
2nd to 8th week: adjustment of the volume of the prosthesis if required
3rd month: possible replacement of the prosthesis
6th or 12th month: final result
In general :
De latissimus dorsi is a flat muscle located in the back.
This muscle may be relocated with a skin paddle to the thoracal area which solves the problem of the lack of skin and gives a certain amount of volume. The volume itself of the reconstructed breast is usually obtained with the use of a breast prosthesis
The relocation of part of the muscle bears no influence on the functional recovery; patients can still perform the same actions after the operation as prior to the surgery.
This technique is recommended for patients who have previously undergone radiation therapy. The scar of this operation is located at the back but is invisible when wearing a bra.
This procedure is performed under general anaesthetic and 8 to 10 days hospitalization is required.
Work incapacity lasts 4 to 6 weeks
Postoperative consultations :
8th day : removal of the drains
1st, 2nd and 3rd month : follow-up of scarring and swelling
6th and 12th month : final result
In general :
This technique uses excess adipose tissue and skin from the lower stomach for breast reconstruction.
The main advantage of this procedure is that the volume of the tissue is often sufficient and that no further prosthesis is required.
This procedure cannot be performed on patients who have previously undergone abdominal surgery such as correction of the abdominal wall or aesthetic surgery abdominoplasty.
Surgery takes about 4H30, takes place under general anaesthetic and requires 8 days’ hospitalization.
A peridural catheter is systematically inserted to optimize post-operative pain control.
Work incapacity lasts for 4 to 6 weeks.
Postoperative consultations :
8th day: removal of drains
15th day removal of stitches
1st, 2nd and 3rd month: follow-up of scarring and swelling
6th and 12th month: final result
If a contra-lateral (at the other side) breast is too voluminous or droops, a breast reduction or lift may be required.
The latter procedure consists in repositioning the breast on the thorax while maintaining its volume (in the case of a lift there is no change in volume).
Postoperative consultations :
10th day: removal of stitches 6 weeks, 3rd, 6th and 12th months
These are the last 2 stages of breast reconstruction.
The nipple can be reconstructed by local plasty or by means of a graft of half of the other nipple.
Six weeks later the areola is tattooed on.
Both procedures take place in day surgery, take about half an hour and are performed under local anaesthetic.
No work incapacitation.