BREAST MICROSURGICAL RECONSTRUCTION

Breast cancer is now one of the most common pathologies in women. Its treatment has been improved in recent years. Tumors are diagnosed more and more early, easing the surgeon its removal and further control.

This positive development has improved survival ratios in women who had breast tumors. There are many women who have been operated and cured, and therefore is increasing the number of women that asks for breast reconstruction.

QUESTIONS AND ANSWERS

1. May my breast be reconstructed?
YES, of course. Most of the women who have had a mastectomy (breast resection) are a candidate to some kind of reconstruction. It doesn’t matter neither how long has it been since they had surgery, nor the aesthetic result of such surgery: How they look can always be improved.

2. What are my chances fot my breast to be reconstructed?
Breast reconstruction can be made in two different ways: Using prosthesis or using self patient’s tissues. In recent years a new method of breast reconstruction has been improved: Free flap reconstruction.

3. What is a microsurgical breast reconstruction?
Free flap breast reconstruction lets the surgeon transfer tissue from the place we choose to the breast area. This tissue (flap) is composed the patient own body’s tissue (autologous), and it’s composed by fat and skin fed by arteries and veins. We give this fat the shape of a normal breast, therefore we get a new breast that has a consistency and touch very similar to the original breast.
This new breast has an advantage: Since it’s a live tissue, it’s able to repair itself and to stay in optimal condition, it suffers the same changes as the patient and it looks much more like the original breast and the other breast that in any other kind of reconstruction.
The results are achieved in a single surgery, and the changes that the new breast suffers and the ones that the rest of the body’s fat tissue suffers are all the same.

4. What is a expander and prosthesis breast reconstruction?
To reconstruct a breast in this way it’s first required a 1-2 hour long surgery in which a ball is placed under the previous scar. This ball will be inflating by means of the injection of saline solution along some weeks in successive sessions. When the ball is inflated at all (it can last 2 or 3 months) the patient will have a new surgery for the expander to be removed and to let the surgeon put the definitive prosthesis in its place (2 hours). The reconstructed breast by the means of the expander and prosthesis is a hard breast, which has a prosthesis inside, and that has a touch, consistency and behavior very different to a normal breast.

5. What are the advantages of a breast reconstruction versus reconstruction by the means of expanders and prosthesis?
A breast that has an expander does not behave like a normal breast. It does not hang as a normal breast while you are standing and also it doesn’t while you are in lying position. Moreover, as any prosthetic stuff, prosthesis are not a living tissue and it cannot be self-repaired as time goes by, so they must be replaced soon or later. It’s not possible to know how much can a prosthesis last. So, once they are placed, we may be sure we will have more surgery in a few years, and we must be aware of the risk it involves.
On the other hand, mammary prosthesis may suffer a capsular contracture, that is, the growth of a capsule around the prosthesis and it’s later deformity, usually including a displacement, normally in the collarbone area.
However, microsurgical breast reconstruction let us to rebuild the breast in a single surgery, with no need of expanding any tissue, in a 5-6 hour long surgery, staying 3-4 days at the hospital. The tissue comes from the patient’s self body and it is self-repaired. It does not require any further surgical revision as time goes by: It last forever. The flap tissue’s look is very similar to a normal breast, and also its consistency.

6. What is a free DIEP/SIEA/TRAM flap?
There are many kind of flaps that can be used in microsurgical breast reconstruction. The “DIEP” flap and the “free TRAM flap” are the most common in our unit.
Except of simple differences, they are almost the same: A segment of fat tissue and skin feed by arteries and veins that comes from the abdomen. This tissue is placed in the thorax, where is shaped and sized so as to look like a breast, and the arteries and veins are connected to thorax arteries and veins by means of microsurgery. It’s necessary a high power microscope. There’s a small after-effect in the power of the abdomen, resulting also an alimming under the navel and a lineal scar that is hidden easily under the underwear or the bathing suit.

7. What is the probability of success of a microsurgical breast reconstruction?
The success of a microsurgical reconstruction (no matter the kind) is directly proportional to the surgeon’s microsurgical skill. In our unit, microsurgical techniques are used every day, and our success rate is 98% on the whole, and 99.8% in breast reconstruction.

8. Can reconstruction be done at the same time as the breast is removed (mastectomy)?
YES. Best results are achieved in the immediate beast reconstruction. Moreover, the surgery time is not increased so much, since a team works getting the flap while another team is doing the mastectomy.

9. How long must I wait after chemotherapy and/or radiotherapy for my breasts to be reconstructed?
If you’ve not just got a breast reconstruction, we recommend that you wait 3 months after the end of the chemotherapy for the properties of the skin to get back to its original state. If you’ve got radiotherapy, we recommend you to wait 6 months.

10. Why only a few plastic surgeons perform microsurgical breast reconstruction?
Microsurgical reconstruction means a big effort, it’s very hardworking and lasts more than other kind of reconstructions. Also it requires a microsurgery-trained team of surgeons, who practice it very often. That’s why most of plastic surgeons, apart from having received microsurgical training, do not use it in their usual practices.
Microsurgery is the “standard gold” for microsurgical procedures in our unit, and it’s performed every day. Also, Dr. Cavadas is the referenced plastic surgeon in microsurgical replantation of amputated limbs in the Valencian Community, Albacete, Murcia and Teruel. All of this shapes a microsurgical team who has big experience, like no other surgical team in Spain.

11. What is a Latissimus Dorsi reconstruction and when is it used?
Sometimes the patient may want her breast to be reconstructed and also the size of her healthy breast to be increased; or she may have a beast prosthesis and one of them may have to be retired because of a tumor; or maybe there’s not available fat in the abdomen.
In this case, the reconstruction, following the principle of symmetry, must be performed by means of breast prosthesis. We use a muscle (latissimus dorsi) and skin from the back that is moved forward, covering the prosthesis, for the reconstructed breast to offer a relatively natural-looking result. The outcome is a breast that has a prosthesis protected by a segment of live tissue, who has a normal looking, and the healthy breast that has a common breast prosthesis. The scar is an horizontal line and it’s placed in the back, covered by the underwear.