Breast reconstruction forms part of the treatment plan for breast cancer. The decision to perform the breast reconstruction at the same time as a tumour-removal surgery, or later on, will depend on the recommendations of the oncology committee where the patient is seen.
There are 3 main types of breast reconstruction:
- Reconstruction using pedicled or free flaps
- Two-stage breast reconstruction: expander and implant
- Breast reconstruction with autologous fat grafting
Breast reconstruction using pedicled or free flaps
- Breast reconstruction using latissimus dorsi flap. his is a very safe and effective method. After radiotherapy, the breast often needs extra tissue. If we cannot perform a deep inferior epigastric perforator (DIEP) flap due to a lack of excess soft abdominal tissue, reconstruction using the latissimus dorsi muscle is recommended. An implant may also be inserted to increase the volume of the breast, or it may be combined with fat graft transfer in one or two stages.
- Reconstruction with DIEP flap. In our experience, this type of flap allows us to do one-stage breast reconstruction with very good results. Although technically more difficult, it enables tissue (skin and fatty tissue) to be obtained from the abdomen which is similar in consistency and appearance to the breast. One of the advantages of this method is that it does not alter abdominal muscle function and it leaves a scar similar to that of a tummy tuck. Our team has microsurgeons who are experts in this technique.
- Other Microsurgery Techniques. Gluteal and inner thigh free flaps: the gluteal free flap is based on the use of tissue from the buttocks to reconstruct the breast. This is an option for women who cannot or do not wish to use other types of flaps. The inner thigh flap uses the gracilis muscle together with the corresponding skin and fatty tissue to reconstruct the breast. The resulting scar is easy to hide. It is indicated in very slender women.
Two-stage breast reconstruction: Expander and implant
The first stage involves placing a saline-filled expander or implant which is gradually inflated with saline injections. If the tissue coverage is very thin, we recommend reinforcing the reconstruction with a collagen or titanium mesh.
Around 3 or 4 months later, once the expander has been fully inflated, a second operation is performed to replace it with a permanent breast implant. The opposite breast must often be reduced or lifted to provide symmetry. Nipple/areola reconstruction can then be done after about another six weeks.
Breast reconstruction with autologous fat grafting
The Coleman technique or injection of fat tissue grafts is also used for breast reconstruction. The grafts are extracted through low-pressure liposuction and injected under the skin of the breast. This method can be used for both partial and total breast reconstructions, bearing in mind that in most cases, several fat-graft injections will be necessary.
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