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BREAST RECONSTRUCTION AFTER BREAST TUMOR OR PREVENTIVE SURGERY

 

Unfortunately, many women are affected by breast cancer every year and the basis of treatment is surgery. The breast tumor is removed with a piece of the breast or with the entire affected breast, so-called mastectomy. The surgical treatment is often, but not always, supplemented with radiation therapy, chemotherapy and anti-hormonal drugs.

For most women who have their breasts removed, it is experienced as very difficult and many describe that they have lost a bit of their femininity. At the same time, they experience a number of purely practical concerns. This can range from the loose breast prosthesis in the bra falling out during a swim, to difficulty holding up a dress and feeling confident in intimate situations.

There are several methods of reconstructing a breast, see below. Depending on when in the process the reconstruction is done, they are divided into direct reconstruction and late/secondary reconstruction. In the former, the breast is reconstructed during the same operation as the breast is removed, and in the latter, a mastectomy is performed first and some time later one or more additional operations are performed where the breast is reconstructed.

Primary reconstruction is superior to late reconstructions, both emotionally for the affected woman and in terms of appearance. However, sometimes direct reconstruction cannot be performed due to a particularly aggressive breast tumor. The basic attitude is now that the nipple and areola can always be saved in a direct reconstruction, but there are exceptions if the tumor is too close or in the areola.

Women who have a hereditary high risk of developing breast cancer sometimes choose to have their breasts removed as a preventative measure, known as prophylactic mastectomy. This usually involves direct reconstruction of the breast. The risk of developing breast cancer after a prophylactic mastectomy is lower than that of women in general.

We at Elite Clinic has a long and very solid knowledge of this type of surgery and especially the superior direct reconstructions. Dr. Richard Lewin has been responsible for breast reconstructions after breast cancer, prophylactic direct reconstructions and breast deformities at Sahlgrenska University Hospital for many years. Dr. Carolina Borén has operated on women affected by breast cancer at both Sahlgrenska Hospital and Gävle Hospital for several years.

Depending on whether there is breast cancer or whether it is a preventive surgery, different surgical methods are used. Even if the breast has already been removed due to cancer, there are different surgical methods to choose from when we reconstruct the breast, an important dividing line for choosing a method is whether the previous treatment included radiation.

DIRECT RECONSTRUCTION

  • Prophylactic (preventive) mastectomy with direct reconstruction. The breast is replaced with a silicone implant or in some cases an expander prosthesis. The areola is preserved and the prosthesis is supported with a so-called dermal sling (a sling of the dermis). If the conditions do not allow the use of the dermis, a synthetic mesh (e.g. TigR) can be used instead.
  • If a breast tumor is to be removed and direct reconstruction is to be performed, in addition to the method above, there may sometimes be a reason to add your own tissue to the breast. An alternative may then be to use the back muscle Latissimus dorsi. With the method "short scar LD" parts of the muscle can be used without leaving any scar on the back.

SECONDARY RECONSTRUCTION

If the breast has already been removed due to a breast tumor, we can perform a so-called secondary breast reconstruction where we recreate the breast. An important factor in choosing the surgical method is whether the area has been treated with radiation. Radiation therapy is good for fighting breast cancer and reducing the risk of recurrence, but it makes some reconstruction methods more difficult.

NOT RADIATED

When reconstructing non-irradiated tissue, in principle the same methods as for direct reconstruction can be used. However, the tissue is often tight and may need to be stretched, expanded, before a silicone implant is inserted.

  • The expander method, in a first operation, an expander prosthesis is placed under the pectoral muscle. This is gradually filled with saline to slowly stretch the muscle and skin. After a few months, the expander can be replaced with a permanent silicone implant in a second operation.
  • Silicone implants, if a smaller implant is desired and the tissue allows, the permanent implant can be inserted directly, without expansion.
  • Killambå, a method where the tissue on the side of the breast is used to provide a little extra skin and subcutaneous fat to the breast. A silicone prosthesis is used in addition.

RADIATION TREATED

If the chest is irradiated, there is a basic principle of adding healthy, unirradiated tissue. Either alone or in combination with a silicone prosthesis. In Sweden, the most common methods are:

  • The latissimus dorsi method, back muscle and skin from the back are moved forward to the chest. Leaves a scar on the back that can often be hidden under a bra.
  • DIEP flap (Deep Inferior Epigastric Perforator) a portion of the stomach skin and fat is used to reconstruct the breast. An advanced operation that requires microsurgery. This method is not performed on Elite Clinic at the moment.

Once the volume and shape of the breast have been recreated, reconstruction of the nipple and areola remains. 

To achieve a good cosmetic result, corrections or additional minor surgeries may sometimes be needed. Common is fat transplantation, “lipofilling”, for better shape and softness of the breast, but fat injections can also affect tight scars.

THE SECOND BREAST

To achieve better symmetry between the reconstructed breast and the healthy remaining breast, we often perform some form of corrective surgery on the non-reconstructed breast. Usually it is a breast lift or a breast reduction, but a combination of lift and silicone implant placement is also common.

Having cancer in one breast sometimes creates such strong anxiety in the woman that she chooses to remove the breast on the other side as well. In such cases, a combination operation can be performed, with a secondary reconstruction on one breast and a prophylactic mastectomy with direct reconstruction on the other side.

Because all women are unique and have different conditions for recreating a breast that is to be removed or has been removed, precise planning can only be done after consultation with us at Elite ClinicWelcome to us!

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