DURATION OF PROCEDURE: depending on the used technique(from 1 to 3 hours)
TYPE OF ANESTHESIA: General
WHAT IS A BREAST RECONSTRUCTION?
The procedure of breast reconstruction is aimed to restore the symmetry of proportions and shape with the breast not operated. The mastectomy involves important mutilation and alteration of the body profile that causes not only aesthetic problems but also psychological nature problems, such as to significantly impair the normal life of patients. Currently, when to perform a mastectomy, reconstruction is now considered an integral part of cancer treatment.
As demonstrated by international studies, the reconstruction does not negatively impact on the development and course of the disease, nor with the execution of any adjuvant therapy (chemotherapy, radiotherapy, hormone therapy). The reconstruction of the nipple-areola complex requires an additional time which is usually performed on an outpatient basis to completion of the process.
WHAT ARE THE BREAST RECONSTRUCTION TECHNIQUES?
Three are essentially the reconstructive mode possible: the first one provides for the use of breast implants, the second uses autologous tissues of the patient and the third, combined, that to the autologous tissues of the patient will follow the insertion of the prosthetic device. The choice of the technique to be used is usually agreed with the surgeon on the basis of the demolitive surgery, any adjuvant therapies, the local and general condition of the patient. All reconstructive methods can provide unsatisfactory results for symmetry, volume or scarring. All breast reconstruction procedures can not be considered definitive because the possibility of revision surgery should be considered to obtain the best morpho-functional result and aesthetically compatible with a pre-existing medical condition.
The Breast Reconstructive Plastic Surgery is a procedure that has the purpose of returning to the patient the mammary volume and shape. It has been scientifically proven that the procedure of “breast reconstruction” has no negative influence on the progress of the underlying disease. Conversely, if performed correctly and with a good result it could eventually have a positive weight on psychological balance, immune system and thus on the patient’s quality of life.
BREAST RECONSTRUCTION WITH PROSTHETIC MATERIAL
It is the surgery of breast reconstruction internationally most widely used.
They are currently marketed prostheses and expanders of different shape and type that are selected on the basis of the individual clinical case.
The surgery is most often done in two stages and in general anaesthesia.
The first time (which can be performed simultaneously when demolitive procedure), consists in the preparation of a pocket underneath the pectoralis major muscle tissue where it will be housed an expander, ie a temporary prosthesis equipped with a valve device to allow its filling with saline solution.
The expander is a kind of balloon that is inflated on an outpatient basis, and on a weekly basis for about 1-2 months, which performs the function to expand the overlying tissue until it reaches the desired volume with the aim of creating a suitable pocket to accommodate the new prosthesis.
Subsequently, in a second surgical time, usually, after about 3-4 months from the end of the expansion necessary to allow an adaptation of the expanded tissue, the expander will be replaced with a permanent prosthesis.
During this second operation, if necessary, it will make a correction even on the contralateral breast to improve symmetry.
In selected cases and with a special prosthesis, the prosthesis can be positioned above the major pectoralis muscle (pre-pect technique) and then without interrupting the muscle fibres leaving the full functionality of the muscle.
PRE-OPERATIVE PHASE: WHAT TO DO BEFORE SURGERY?
Before the procedure a thorough medical examination will be performed. It will be required laboratory tests, electrocardiogram and chest X-ray, to minimize the possible occurrence of complications related to pre-existing conditions not obvious clinically. It is important to also perform breast ultrasound or a mammogram (depending on the age of the patient) of the contralateral breast.
It is better to suspend cigarette smoking at least 7 days before. It’s also suggested the suspension of drugs capable of altering the coagulability of blood such as aspirin and anti-inflammatory drugs. Whatever therapy is practised, has to be reported and discussed with the surgeon.
POST-OPERATIVE TREATMENT: WHAT TO DO AFTER THE SURGERY?
After surgery, you will absolutely need bed rest until the following day but you will be allowed to drink and eating very lightly.
They will also be given antibiotics and analgesics. They can be placed drains that will be removed after a few days. The stitches will be removed in the next 10-15 days.
It is recommended a rest period of about two weeks, after which it will be allowed to resume normal activities such as walking, driving, socializing with others so it will not be possible to resume sports activities within a month.
Movements upper limbs: after the first day the patient will gradually begin to move their upper limbs in all directions avoiding only for the first month to extend, comprehensively, laterally and at the top the affected limb.
Avoid physical effort also involving excessive contraction of the major pectoralis muscle.
The painful symptoms, always present in the initial phase, improves with exercise.
BREAST RECONSTRUCTION WITH AUTOLOGOUS TISSUE
The candidate patients to this type of surgery must have an excess of sufficient tissue for breast reconstruction in the pickup seat. The donor site most frequently used is represented by the skin, the subcutaneous tissue and a portion of the muscle tissue of the lower abdominal region, sometimes it can be used a portion of the skin, subcutaneous and muscle tissue in the thoracic region or the gluteal region. This type of procedure can also be performed with microsurgical techniques.
In case of the removal of the flap from the abdominal region, the patient will have a horizontal type abdominoplasty scar from one iliac spine to the other that can still be hidden under normal underwear. This type of reconstructive surgery may be indicated by the plastic surgeon when the breast reconstruction using expander and definitive prosthesis can not be achieved.
It is not recommended in patients who smoke, who suffer from metabolic diseases such as diabetes or with other general and/or local risk assessments. It is performed on an inpatient basis, under general anaesthesia and the hospital stay is usually 5-7 days long. The procedure takes on average 3 hours.
PRE-OPERATIVE PHASE: WHAT TO DO BEFORE SURGERY?
Before the surgery, a thorough medical examination will be performed. It will be required laboratory tests, electrocardiogram and chest X-ray, to minimize the possible occurrence of complications related to pre-existing conditions not obvious clinically. It is important to also perform breast ultrasound or a mammogram (depending on the age of the patient) of the contralateral breast. It may also be ordered an ultrasound of the abdominal wall. They also suggests the suspension of drugs capable of altering the coagulability of blood such as aspirin and anti-inflammatory drugs. Whatever therapy is practised, it still has to be reported and discussed with the surgeon.
POST-SURGERY: WHAT TO DO AFTER SURGERY?
After surgery, you will need to perform a medical therapy for a few days with antibiotics, painkillers and anti-thrombotic.
The resumption of a normal life is possible from two weeks later while the work activity can be resumed one month after surgery.
BREAST RECONSTRUCTION COMBINED
In some cases, the local and general condition of the patient may require the combined reconstruction methods, namely the use of autologous tissues (flaps) for the skin coverage and the insertion of the prosthesis to the desired volume.
These muscles and/or subcutaneous flaps are usually taken from the upper abdominal region, from the lateral wall of the thorax, from the back.