breast reconstruction

Breast Reconstruction – Synonyms & Principle

synonyms:
breast reconstruction, breast augmentation, breast reconstruction

principle:
Breast reconstruction (usually after breast cancer) using autologous fat, breast implants and/or flap surgery (from the back, abdomen, etc.)

is often combined with…

• Often different methods are combined with each other – e.g. first autologous fat, then implant – or free flap and then autologous fat – etc.
  
• the reconstruction of lower abdominal tissue corresponds to a tummy tuck

efficiency

the breast will never be the same as before reconstruction, but in some cases the reconstructed result is superior in overall impression and shape to the initial situation

duration of surgery

depending on the method between 1 hour and several hours

repetition of the treatment

Several operations are necessary to achieve complete reconstruction, usually at intervals of around 3 months. On average, a period of around 1 year should be taken into account - from volume reconstruction to adjustment of the opposite side to nipple reconstruction and final tattooing of the areola.

Application in which body region

Breast

Tissue usually comes from the abdominal area

decision-making aids

Essentially, these are fundamental decisionsthat constitute breast reconstruction.

Should I have breast reconstruction do it at all? – Sometimes it is better not to do something at all.

Good advice highlights all the advantages and disadvantages of an operation – and thus helps you make the right decision.

Initial situation:

The initial situation is always different – and influences the reasonable possibilities of recovery

• Can the nipple be left standing?
• How much skin can/should remain?
• Has/is radiation been administered?
• What is the exact histological finding of the tumor?
• Previous abdominal surgery? – can a flap from the lower abdomen be riskier or even impossible?
• How much fatty tissue would be available for autologous fat to be suctioned?
• What is the patient's desired size?
• etc.

no treatment: For some patients, the option of a scar plus a bra insert is the best one for them.

But of course there are also very good possibilities for restoring/improving volume, shape, symmetry, etc.

Which material should be used to reconstruct the volume? – This step usually concerns part 1 of the reconstruction. Each method has its advantages and disadvantages. Since there are usually several options, the decision is always an individual one. The individual methods are often combined with one another:

• autologous fat is a possibility - but with limitations (for some types of tumors, autologous fat is not recommended, with autologous fat a maximum of 1/2 cup increase in size can be achieved per treatment - and that is the ideal case, better emphasis is possible with autologous fat in the upper half of the breast - but the lower half of the breast would be more ideal)
• breast implant (with or without reinforcement with artificial tissue) is also possible. However, an implant is always a foreign body and can cause problems such as capsular fibrosis and the resulting subsequent operations. Furthermore, in some cases the necessary covering with soft tissue and skin is missing.
• skin+muscle from the back – almost always a breast implant is necessary – with all possible disadvantages as above
• free (that is, vessels are severed and sewn back together under the microscope) skin+fat abdominal flap (usually DIEP flap) – normally no implant is necessary here. The method is the most demanding and complex surgically – and requires a well-trained, experienced surgical team.
• expander to slowly stretch the tissue is also an option.
• There are many other possibilities, but they are usually used less frequently

Reconstruction immediately – or in a second step?

Here the decision is always individual and depends on:

• Tumor type and extent – and effort of removal
• final histology (and this always takes a few days)
• Method and Effort of Reconstruction
• patient's wishes

Therefore, a thorough, comprehensive analysis is important

alignment of the second side

Usually, the adjustment of the opposite side takes place 3 months after the volume build-up on the affected side - the volume must first "settle" and take on its final form.

Theoretically, however, it is possible to bring the other side into line with the reconstruction. However, this is usually not advisable.

prophylactic removal of the mammary gland

After a thorough oncological examination and if there is a high probability of developing breast cancer, a prophylactic mastectomy (=removal of the mammary gland) may be advisable. Usually with immediate restoration of volume (in the form of a breast implant (or expander), possibly with the patient's own fat or with the help of a flap).

What should you have heard/read before breast reconstruction?

Several steps are necessary. On average, one year is always planned from the first operation to the final touches in the form of tattooing the areola. Good coordination between the oncological surgeon (who removes the tumor) and the plastic surgeon (who carries out the reconstruction) is a good idea.

Prejudices

everything is possible

facts

A reconstruction is always a compromise. Nevertheless, sometimes the reconstruction is an overall improvement compared to the oncological and reconstructive surgeries.

common possible side effects/complications

• capsular fibrosis (with implant)
• infection
• postoperative bleeding
• Asymmetry (always present on two sides to a certain extent)
• scars
• Death of the flap tissue (in flap surgery)
• wound healing disorder
• Abdominal wall hernias (in flaps from the lower abdomen)

details Information on possible complications can be found in the information documents

In summary, good preparation (information, explanation, preliminary examinations, coordination of surgeons, analysis, etc.), appropriate time intervals between the individual steps, experience of the surgeons and materials used (e.g. breast implants) are important factors for the success of breast reconstruction.

You should avoid…

• implants that are too large
• time stress between the individual steps
• decisions without appropriate information

anesthesia

Breast reconstructions are almost exclusively performed under general anesthesia.

The corrective surgery is also usually performed under general anesthesia.

Nipple reconstruction can usually be performed under local anesthesia

the operation

Deadlines must be met in Austria (surgical information and anesthesia information) – this means that there is a waiting period of at least 3-4 weeks from the decision to undergo breast enlargement, but often longer.

THINKING POSITIVELY – helps. It not only prolongs life, but is also always a good first step towards any treatment or operation.

Do not take any blood-thinning medication until 10 days before surgery (if necessary – discuss changing medication with your family doctor or internist)

no smoking for at least 2 weeks before and 2 weeks after a procedure – especially in the case of free tissue transfer (flap from the lower abdomen) and autologous fat

the operation

Rest for 3 weeks in the sense of:

• do not lift more than 5-6kg
• nothing jerky
• don't work headfirst

with autologous fat: no pressure on the transplanted areas for 3 months

no nicotine!

our preferred technique/recommendation

• individual analysis and individual concept – honest and comprehensive advice is very important here!

Cost

are individual – depending on insurance, effort, etc.

The final total price will be determined during the second consultation (=consent) depending on the individual effort/planned operation time, combinations, desired clinic/room category and other factors

reasonable budget

A final cost estimate is only possible and meaningful after a detailed on-site inspection and clarification of individual wishes.

downtime

In general, 2-3 weeks of rest be taken into account – this means specifically:

• lifting no more than 5-6 kg
• no jerky movements
• do not perform any activities overhead

Important to know…

• There are several possibilities – the decision for the appropriate method will always be individual.

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breast reconstruction