Overview
Breast reconstruction is a reconstructive plastic surgery procedure designed to recreate a breast following a total or partial mastectomy, most often performed as part of breast cancer treatment.
This reconstruction can be performed:
- immediately (at the same time as the mastectomy)
- or at a later time (as a follow-up, after treatment)
The goal of breast reconstruction is to restore the breast’s volume, shape, and symmetry, while taking into account the medical considerations associated with cancer treatment.
In Paris, Dr. Alexandre Vairinho offers personalized care, working in coordination with the medical team involved in your care whenever necessary.
Explanation of the breast reconstruction technique
There are several breast reconstruction techniques available. The choice depends on many factors:
- your body type
- the quality of the fabrics
- treatments received (including radiation therapy)
- your surgical history
- your preferences
- the amount of available tissue
Breast reconstruction using a breast implant
Simple prosthetic reconstruction is the simplest method of breast reconstruction when the skin on the chest is of good quality.
A silicone gel implant is used to restore breast volume. In most cases, the implant is placed behind the pectoralis major muscle.
This technique should be reserved for patients with a small remaining contralateral breast and good-quality skin coverage if satisfactory aesthetic results are to be achieved. However, it may be suitable for patients who do not wish to undergo a major procedure.
Reconstruction using a tissue expander is another option for prosthetic reconstruction. It involves placing a temporary tissue expander, always behind the pectoralis major muscle.
This technique, which is used to stretch the skin, is temporary but will allow for the placement of permanent implants that are slightly larger than those used in the previous method.
This implant is equipped with a valve that allows it to be inflated gradually over several weeks, starting three weeks after the initial procedure, until the desired volume is achieved.
Once the desired volume has been achieved, the expansion prosthesis can be replaced with a permanent prosthesis.
Reconstruction of the areola-nipple complex is performed during the second surgery.
Breast reconstruction using lipofilling
Lipofilling (fat injection)—a technique that involves re-injecting fat harvested from the patient into another area of her body—can be used to complement implant or flap procedures. It helps improve the reconstruction in terms of aesthetics, overall appearance, and, most importantly, tactile sensation.
Lipofilling can be performed as a standalone procedure.
Fat is harvested from fat deposits (such as the upper thighs, abdomen, and thighs) in the same way as in cosmetic liposuction. The fat is then purified and reinjected into the breast to be reconstructed.
Nipple and areola reconstruction is performed separately and at a later stage than breast reconstruction, once the breast has taken on a stable shape.
The goal of this procedure is to restore a natural-looking breast that closely resembles the patient’s breast prior to the mastectomy.
The various techniques used can produce results that look more or less natural.
Intérêts :
- use of autologous tissue
- feels natural to the touch
- improved skin quality
Several sessions may be necessary, depending on the desired volume.
DIEP flap reconstruction
DIEP flap breast reconstruction is a microsurgical reconstruction technique that restores breast volume by using skin and fat from the abdomen.
Excess skin and fat from the abdomen are harvested while preserving the blood vessels that supply them, and then transferred to the breast to be reconstructed by reconnecting the vessels at the chest under a microscope.
This procedure offers two benefits: breast reconstruction and an abdominal lift, effectively performing a full abdominoplasty.
The breast is lifted and sometimes reduced to achieve a harmonious result. The nipple is reconstructed by shaping skin flaps at the highest point of the reconstructed breast. Sometimes a skin graft from the inner thigh or the areola of the remaining breast is used. These skin grafting techniques generally yield good results; however, sometimes the graft does not take, and the procedure must be repeated. Pigmentation can sometimes be improved through tattooing.
L’excès cutanéo-graisseux du ventre est prélevé en gardant les vaisseaux qui le vascularise pour ensuite être transféré au niveau du sein à reconstruire en rebranchant les vaisseaux au niveau du thorax sous microscope.
Cette intervention apporte deux bénéfices ; celui de la reconstruction mammaire et celui du lifting abdominal réalisant une véritable abdominoplastie.
Le sein normal est remonté et parfois réduit afin d’harmoniser le résultat. Le mamelon est reconstruit en modelant des lambeaux cutanés au point le plus élevé du sein reconstruit. Parfois on utilise une greffe de peau de la racine de la cuisse ou de l’aréole du sein restant. Ces techniques de greffe de peau donnent généralement de bons résultats, parfois la greffe ne prend pas et il faut la refaire. La pigmentation peut parfois être améliorée par tatouage.
Latissimus dorsi reconstruction
Breast reconstruction using a latissimus dorsi muscle flap is a more complex technique that involves harvesting the latissimus dorsi muscle from the back, along with the overlying skin, and transferring it to the area of the breast to be reconstructed.
This technique is used when there is not enough skin at the mastectomy site or when the skin is of poor quality. This allows for the use of higher-quality tissue (skin, muscle, fat) that has not undergone surgery or radiation therapy and, most importantly, will heal better.
The latissimus dorsi muscle is chosen because harvesting it results in minimal functional impairment.
This procedure is the most reliable and, above all, the most widely used in reconstructive surgery
If necessary, an implant can also be placed at the same time. The overlying muscle, fat, and skin—which are supplied with blood by the muscle—are harvested and used to cover the implant placed at the recipient site.
Overview of the procedure
The process of breast reconstruction begins with a specialized consultation to assess your medical condition and determine the most appropriate reconstruction strategy.
During this consultation, the following are performed:
- an analysis of your medical history and cancer treatment
- a detailed clinical examination of the breast area
- assessment of skin and tissue quality
- a discussion of the various reconstruction options
- the provision of complete medical information
- the development of a personalized rehabilitation plan
Depending on your situation, consultation with the oncology team may be necessary to coordinate your care. Medical imaging may also be performed as part of your follow-up care and surgical planning.
Before the procedure, a preoperative evaluation is ordered and a consultation with the anesthesiologist is scheduled.
Breast reconstruction is performed in a clinic or a specialized facility under general anesthesia. The duration of the procedure varies depending on the technique used, whether it involves implant-based reconstruction, fat grafting, or a flap procedure.
The length of your hospital stay depends on the procedure performed and your medical condition.
AVANT/APRÈS
Postoperative Care and Expected Results
Les suites opératoires varient en fonction de la technique de reconstruction employée. Dans les premiers jours suivant l’intervention, il est fréquent d’observer :
- edema
- bruises
- a feeling of tension
- temporary fatiguetemporary fatigue
Un soutien-gorge de maintien ou un pansement spécifique peut être prescrit afin de protéger la reconstruction et d’accompagner la cicatrisation.
Patients resume their normal activities gradually, at a pace tailored to each individual. Regular post-operative follow-up appointments are scheduled to monitor healing and track the progress of the results.
Breast reconstruction helps restore breast volume and the body’s natural contours following a mastectomy.
The objectives of the initiative include:
- recreate a natural-looking breast shape
- improve symmetry with the opposite breast
- enhance comfort in clothing
- support physical and personal recovery after illness
In many cases, breast reconstruction is performed in several stages and may include additional procedures such as symmetrization of the opposite breast, secondary fat grafting, or reconstruction of the areola.
The results gradually improve over the months following the procedure, as the tissues heal and the reconstruction takes its final shape.
FAQ
Frequently Asked Questions About Breast Reconstruction
No. Breast reconstruction is always a personal choice. It can be considered immediately or at a later time, or it may not be performed at all.
Breast reconstruction is often performed in several stages to achieve the best possible results. The exact number of stages depends on the technique chosen and your individual circumstances.
In the context of breast cancer reconstruction, coverage by Medicare is generally provided in accordance with current regulations.
The goal is to achieve the best possible symmetry, but perfect symmetry can never be guaranteed in breast surgery.
The resumption of activities depends on the technique used and your recovery. It is gradual and monitored during post-operative follow-up.
>> This page is intended to provide general information. Only a consultation with Dr. Vairinho will allow for an accurate assessment of your situation and the recommendation of an appropriate treatment plan. A personalized quote is provided only during a consultation.
