Breast reconstruction

As Breast reconstruction This is a plastic reconstruction of the breast, which is very often carried out because of breast cancer.

What is breast reconstruction?

Breast cancer is one of the most common forms of cancer in women. As part of a therapy, the diseased breast has to be removed very often, which is also one of the main reasons for a subsequent breast build-up or breast reconstruction. With the help of implants or own tissue, the female breast can be restored in this way.

Function, effect & goals

Various methods are available to rebuild a female breast. Which method is chosen depends on various factors. These include:

• the quality of the remaining tissue

• the health of the patient

• Shape and size of the breast

• Desires of those affected

A basic distinction is made between breast reconstruction using the body's own tissue or with an implant. Here, saline or silicone-filled implants are available, although it has recently been possible to improve them considerably through the use of pretreated animal dermis, so that an often very complex reconstruction with the help of autologous tissue can be avoided. Implants are pushed under or onto the chest muscle. If the patient has a sufficiently large skin coat, the doctor will insert the implant directly.

If the skin is too tight after the operation, it is first stretched with an expander. For this purpose, a plastic bag is placed under the skin, which is filled with saline solution using an injection needle. After a few months, the skin is stretched and the implant can be inserted. Breast augmentation with an implant is a relatively simple and short operation and causes little pain. In a breast reconstruction with the body's own tissue, muscle or fat tissue is first removed from the abdomen, back or buttocks, and this type of operation requires a lot of experience. The surgeon detaches muscle tissue from the abdomen or back and moves it to the chest wall, where he models a new breast.

When tissue is transplanted, however, the tissue is completely separated from the body and reconnected to the blood vessels. One method that is used very often is the so-called TRAM flap method (Transverse Rectus Abdomis Muscle), in which fat or muscle tissue from the lower abdomen is used. Another technique is breast reconstruction with autologous tissue from the large back muscle (Musculus Latissimus Dorsi).

In addition, autologous fat from the abdomen or thighs is used to build up the breast. A method for building up the breast without muscles is the so-called DIEP flap transplantation (Deep Inferior Epigastric Perforator). For this, fatty tissue is removed from the abdominal wall and after preparation the doctor injects the fat with the help of cannulas. Subsequent treatment is usually required in order to complete the aesthetic shape.

A reconstruction can either take place at the same time as the operation of the tumor (primary reconstruction) or at a different point in time (secondary reconstruction). In this case, any necessary therapies (e.g. radiation therapy, chemotherapy, hormone therapy) must be completed.

Since the built-up breast can often change after a reconstruction, the surgeon does not reconstruct the nipples until a few months later. In this way it can be ensured that the built-up breast is also completely healed. A nipple is mimicked with either a skin graft or a local flap.

Skin that is more heavily pigmented and often comes from the inside of the thigh is used for the areola. This procedure is relatively short and can also be performed under local anesthesia. After a breast reconstruction has been carried out, physical strain such as carrying or lifting should be avoided. It is also useful to wear a special brassiere and massage the chest.

Risks, side effects & dangers

Implants with silicone gel are normally not harmful to health. However, since a risk can never be completely ruled out, it is necessary to have the built-up breast checked constantly. An implant is also a foreign body to the body, so it sometimes becomes hardened, which can compress the implant.

This causes pain and can deform the chest. In this case, another operation is necessary, in which the old implant is removed and replaced with a new one. However, there is no longer any risk of silicone leaking with modern implants. The silicone gels are no longer liquid, but very similar to breast tissue. They are also very stable and have a long shelf life. However, they do not last a lifetime, but have to be replaced after a few years.

A breast augmentation with your own tissue is more stressful and complex than inserting an implant. The operation takes longer and the risk of bleeding or complications increases. In addition, the patients also have to expect scars. Depending on the technique selected, there may be restricted mobility or circulatory disorders. The recovery phase after building up with your own tissue is longer than with a breast reconstruction with an implant. However, the body does not defend its own tissue, so that capsular contractures do not occur. In addition, there is no need to replace the implant. A breast augmentation with autologous fat (without muscles and skin) is a method that is not yet fully developed and is therefore rarely used.