“Breast reconstruction is a highly individualized process tailored to the needs of each patient”.
Selection of any particular technique depends on the oncological surgery (i.e., mastectomy, lumpectomy) and treatment (radiotherapy, chemotherapy) the patient has received, the condition of the remaining tissue, and the shape and size of the contralateral breast (if present).
The reconstruction process involves more that one plastic surgery procedure in order to restore volume, correct scarring, and restore the nipple/areola.
This can be achieved by using the following techniques:
- Breast implant(s)
- Tissue expansion -Flap(s)
- Gel Breast Implant
Silicone gel implants
Silicone gel implants are indicated in the majority of mammary reconstructions (skin-sparing mastectomies or bilateral skin- sparing mastectomies), and to correct asymmetries in small breasts, minimal mammary ptosis, or following tissue expansion.
The Surgery
A gel breast implant is placed in a pocket behind the pectoralis muscle. The previous scar can be resected partially or entirely, depending on the case.
In general, the goal is to obtain a breast similar to the contralateral. In the case of bilateral skin-sparing mastectomies, equal cohesive gel implants are placed to achieve the desired volume.
Types of Implants
Cohesive gel implants used include those with different surfaces (smooth, textured), composition (polyurethane), cohesiveness, profiles, and sizes. We use the main brands of implants as Mentor, or Eurosilicone implants.
These gel implants are selected together with the patient in order to satisfy her specific needs, with consideration for her particular medical situation and physical anatomy.
Anesthesia used
Neuroleptoanesthesia (deep sedation) or general, plus local anesthesia to ensure a painless recovery after surgery.
Length of procedure
2 hours.
Hospitalization
This plastic surgery requires a short stay of fewer than 6 hours.
Post-operative Care
- Antibiotics
- Physical activity is restricted depending on recuperative progress
- No sunbathing for 3 to 4 weeks post-op
- A surgical is worn for the first 6 weeks post-op
- Sports and other straining activities can be resumed one month following surgery
Post-operative Treatment
Sutures are removed 12 to 15 days post-op.
Expanders
Expanders are used to gradually stretch the skin in order to create increased tissue volume similar to that of the contralateral breast.
The Procedure
The expander (an empty synthetic pouch) is placed in a pocket behind the pectoralis muscle through an existing scar.
Over a short period of time, a saline solution is pumped into the expander in order to achieve the desired volume.
The expander can be permanent or can be replaced in a subsequent surgery with a permanent gel silicone implant.
Types of Expanders
Expanders have different surfaces (smooth, textured), cohesiveness, profiles, and sizes. The Patient together with Dr. Bukret choose which expander is used to facilitate the best match to the contralateral breast.
Anesthesia used
Neuroleptoanesthesia (deep sedation) or general, plus local anesthesia.
Length of procedure
1 to 2 hours.
Hospitalization
This plastic surgery requires a short stay of fewer than 12 hours.
Post-operative Care
- Antibiotics and analgesics
- Physical activity restricted depending on recovery progress
- No sunbathing for 6 weeks following surgery
- Sports activities can be resumed after 6 to 8 weeks post-op
Post-operative Treatment
Sutures are removed after 12 to 15 days post-op. Recuperation and progress are monitored closely following surgery. The time involved in this process depends on the surgical method performed and the evolution of recovery itself.
Flaps
A flap is a portion of tissue (autologous skin and sometimes muscle) that is transferred from the donor patient´s area (usually the back or lower abdomen) and attached to the thoracic wall.
This technique is employed when a significant amount of tissue is needed to achieve the volume required to create a new breast similar to the contralateral breast.
The Surgery
The flap is removed from different donor areas leaving a scar. The habitual donor areas are the thorax (lateral flap) the back (dorsal flap) or the abdomen (TRAM flap, DIEP flap).
In certain cases, an implant is utilized with the flap to add the required volume to the new breast.
Drainage tubes are placed both in the reconstructed and donor area. These are left sitting for 48 or 72 hs.
Length of procedure
2 to 6 hours, depending on the technique utilized.
Anesthesia used
Neuroleptoanesthesia (deep sedation) or general, plus local anesthesia to avoid pain after surgery.
Hospitalization
This plastic surgery requires a short stay of fewer than 48 hours.
Post-operative Care
- Antibiotics
- Activities are restricted depending on the recovery rate
- Sutures are removed 15 days post-op
- Sports and other straining activities can be resumed 6 to 8 weeks after plastic surgery
- Habitual activities can be resumed 6 to 8 weeks post-op
Close monitoring of recovery is essential. The time involved in this process depends on the surgical method performed and the evolution of recovery itself.
Post-operative Treatment
Sutures are removed 12 to 15 days post-op. Recovery and progress are monitored closely following surgery. The time involved in this process depends on the surgical method performed and the evolution of recovery itself.