Breast reconstruction is a set of surgical techniques which have the purpose of returning to a woman a volume and a shape of the breast as close as possible to those naturally present prior to surgery.
An important aspect of breast reconstruction is its realization “immediate”, that same intervention in which the general surgeons remove the breast tissue affected by cancer, or is “deferred”, that is, postponed to a later date.
And ‘universally it recognized that the immediate reconstruction is by far the best for the patient, for his psychological and moral well-being, since it reduces the sense of breast loss and does not force a woman to live for months with a body that hears and sees amputee. However, it is never too late to carry out a breast reconstruction.
There are several situations in which one works to perform a breast reconstruction: the doctors call it mastectomy “total” if the removal includes all of the diseased gland with skin that covers it, is called “nipple sparing” or adenectomiasottocutanea if you remove entire gland but it retains all the skin with the nipple, and finally “skin sparing” when in fact the intervention is removed throughout the gland and the nipple-areola complex, but it preserves part of the skin.
In these conditions we can talk about breast reconstruction itself.
There are also situations in which it is possible to remove the tumor, removing only one of the four quadrants of the breast, in this case one can speak instead of “quadrantectomy” and Oncoplastic reconstruction.
In the case of mastectomy it will obviously be necessary to replace, according to the removed parts, only the breast volume or even the skin covering.
Regarding the skin there are two possibilities: the cutaneous defect is reintegrated with the intake of fabric through the transfer of skin grafts from other parts of the body, or the use of the expansion of the chest skin remained after the removal of the mammary gland inserting an expander under the chest muscle that is inflated in the following weeks in the clinic.
For the reintegration of breast volume can be used instead or autologous tissue (flaps) or to breast implants.
there is no absolute best method of reconstruction of the other and then recommended in all cases: for each patient should be identified the most appropriate one.
Some techniques, such as the DIEP, the flap Gran Dorsal or TMG can replenish simultaneously both the skin covering is that the volume and then reconstruct “a sol-time” surgical breast.
Even when it was possible to save the skin and it only requires the volume replenishing you can always resort to the use of autologous tissues (only adipose DIEP flap without the skin) without the use of breast implants.
Sometimes, although there is availability of transfer of these flaps, they are not sufficient to restore the breast volume and you have to resort to the “mixed media” that use autologous tissue with implants (Lembo Grand Ridge with implants, Wise pattern + implants etc. ), the aim is to return the breast in a single contemporary surgical procedure to removal itself.
Sometimes instead to lack of necessary fabrics it is not possible to use the flaps or for the reinstatement of the volume and even for cutaneous reintegration, in these cases it will still be possible to reconstruct the breast, but must resort to the technique of the expanders and implants, which necessarily involves ” two stages “distant surgical together. In the first stage it is inserted an expander, a kind of silicone reservoir that by introducing the liquid week after week, expands the skin on the chest. The second phase intervenes months later, replacing the expander with the final prosthesis.
In cases where the doctors decide instead that it is possible to avoid total mastectomy, resorting to quadrantectomy just to remove the diseased part of the gland, it can “reconstruct” the remainder of the cup in an appropriate way to achieve a good cosmetic result, sometimes overlapping to an aesthetic surgery for breast reduction.
It is possible that for many women the reconstruction may even end with a breast appearance aesthetically improved, more youthful, firmer and lifted.