Breast cancer is the most common malignant tumor in women. It is estimated that 1/8 women will develop cancer in their lifetime.
Thanks to early diagnosis, breast cancer is a curable disease today. In early stages, surgery and complementary treatments achieve cures of the disease, without relapses over the years.
Once the patient is free of disease after applying combinations of different treatments (surgery, chemotherapy, radiotherapy, hormone therapy, etc.) it is time to reconstruct the breast (if the patient wants).
Breast reconstruction means for the woman to regain her femininity, her confidence, to feel alive and free of disease, without stigmata or marks; it often allows her to dress again without having to wear pads inside her bra… and the results, thanks to the progress of surgery are impressive. There are different techniques that are used alone or in combination with others, and whose results make breast reconstruction a very desirable process for women.
Procedures
- Lipofilling or breast fat grafting. It is used in lumpectomies or to improve small defects, it consists of filling with adipose tissue areas with volume reduction, retractions, sinks, hollows, etc. Fat also greatly improves the radiotherapy lesions that many breasts present after treatment.
- Expander implant and prosthesis. Reconstruction with prosthesis often has two stages: in the initial stage, the breast that has undergone a mastectomy has been left with little skin and tissue to support a prosthesis. Therefore, an expander (an empty water bag) is introduced, and it is progressively inflated with serum over several weeks and months, so that the skin is stretched and the scars are well consolidated. In a second stage, with the skin already expanded and well vascularized, the expander is replaced by a definitive prosthesis.
- Reconstruction with pedicled flaps (lattissimus dorsi). Occasionally, mastectomy resection and the use of radiotherapy greatly deteriorate the skin and ordinary prosthetic reconstruction is contraindicated. In these cases it is necessary to reconstruct the breast with healthy tissue, for example with the lattissimus dorsi flap, and place an expander underneath. The lattissimus dorsi will provide tissue in good condition ready to expand with guarantees.
- Reconstruction with microsurgical flaps (DIEP) – is the gold standard in breast reconstruction after mastectomy. It is performed with the fat and skin tissue from the patient’s abdomen, dissected together with an artery and a vein (the deep epigastric), which must be transferred to the breast, connecting this “flap” to an artery and a vein close to the breast (the mammary). This type of reconstruction functionally respects all the muscles of the abdomen, only fat and skin are removed; it also avoids the use of breast prostheses because they are usually bulky flaps. This is a complex procedure and requires microsurgical skills.
In conclusion, each woman’s reconstructive process is different. There are different types of oncologic resections, different types of breasts and multiple options for reconstruction. The reconstruction process has to be established and agreed with each patient according to the professional’s advice and the patient’s preferences.
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