Breast Reconstruction

Implant breast reconstruction

Overview

It is important that enough skin remains after the mastectomy to perform a breast reconstruction using implants in order to fully cover them and allow for some flexibility. It is a great procedure for women who have always had small breasts and would like a breast augmentation.

Technique

Choosing the right implant is crucial. Anatomical implants used to yield the best results, but since the occurrence of a few rare cases of lymphoma in patients with those implants, round implants have become the safest choice. Thanks to lipomodelling, we can now improve the final shape of the breast and get even better results than with anatomical implants.

The implant is placed under the skin and the pectoral muscle. A fat transfer is sometimes needed before the implant is placed. If it is a secondary reconstruction, the scar of the mastectomy is used to place the implant and no additional scar is created.

If there isn’t enough skin, an expander will be used for a few weeks before the final procedure. An expander is a pouch placed under the skin where the future breast will be. It inflates with physiological serum during a painless procedure conducted at the medical office. This causes the creation of more skin, like during a pregnancy.

Procedure

The operation is performed at a clinic under general anesthesia. It lasts an hour and a half and the patient has to stay at the clinic for at least 24 hours/one night.

Follow-up

A special bra is immediately placed on the patient, who will have to wear it day and night for three weeks, except during showers of course! The patient can go home the next day or two days after the operation. The patient must take at least 10 days off from work after the procedure, although the recommended time is 3 weeks.

Results

Results are immediately visible, the volume is visible in the bra and the patient has a new, real cleavage. The result is fully permanent after about 2 months.

Breast reconstruction using dorsal muscle flap and fat autograft

Overview

Breast reconstruction using dorsal muscle flap has been used for over thirty years in France and Switzerland. It was originally performed with the placement of an implant a year after the end of radiotherapy treatment. Today, techniques have evolved and this procedure has become less complex and no longer requires a breast implant. When the skin cannot be stretched sufficiently or if the patient does not want to use an implant, skin from the back is placed on the breast to reconstruct it.

Technique

This procedure consists of removing part of the back muscle and the skin that covers it to transpose it towards the front, passing underneath the armpit to reconstruct the breast. The scar on the back is very small, thanks to the endoscopy technique. Once the muscle and skin are in place, the breast can then regain its volume via a fat autograft.

Procedure

The operation is conducted at the clinic under general anesthesia and lasts about three hours. The patient has to stay at the clinic for three to four days.

Follow-up

The patient will need to take off work for three weeks and avoid physical activities for three months. Physiotherapy sessions are highly recommended shortly after the operation to regain flexibility and sensibility.

Results

Results are immediately visible, although it takes about two months for the scars and muscles to heal and for the result to be fully satisfactory.

Breast reconstruction using free flap and microsurgery

Overview

DIEP (Deep Inferior Epigastric Perforator) breast reconstruction developed in the United States while latissimus dorsi (back muscle) breast reconstruction has remained the standard in Switzerland and in France for the last 20 years. Like the latissimus dorsi reconstruction, the DIEP reconstruction uses the patient’s own tissues to recreate the breast. However, instead of using back tissues, this technique utilizes stomach tissues located between the pubic bone and the belly button. This leaves an additional scar similar to that of an abdominoplasty.

Technique

This is a meticulous microsurgery procedure that requires multiple surgeons. It is usually performed at the hospital as it may require more postoperative surveillance and care. Skin and fat are removed from the stomach, which is then closed like after an abdominoplasty.
The tissues are then reconnected to thoracic blood vessels via microsurgery and reshaped to form the breast.

Procedure

The patient arrives at the hospital the day before the scheduled surgery. The operation is conducted under general anesthesia by two surgical teams: one team removes the tissues from the stomach, while the other prepares the receiving site by the breast. The patient is hospitalized for about a week.

Follow-up

The patient will need to take off work for a month and will have to wear a sheath and a special bra. An antithrombotic treatment will be prescribed for the first 15 days following the operation.

Results

The result is immediately visible but bruises and swelling may last up to weeks. The benefit of having such a complex procedure is to treat both the effect of the mastectomy and a prominent stomach at the same time. It is currently the most popular autologous breast reconstruction in Switzerland and in the United States.

Fat transfer breast reconstruction

Overview

Autologous fat transfer is a major achievement in reconstructive surgery, especially for breast reconstructions. Although is generally used as a complement to an implant or dorsal flap reconstruction, it can sometimes be sufficient for a full reconstruction on its own.

Technique

The fat cells are removed through liposuction, a technique specifically designed to preserve them. Although the concept of liposuction may seem simple, it is an especially meticulous procedure; if the cells are damaged when collected, they will not survive and the result will be disappointing. The collected fat cells are purified and reinjected according to precise criteria adapted to receiving tissues in the chest area. The graft is done through micro-incisions that allow for the deposition of living cells in every layer of tissue. The graft does not form any scars.

Procedure

A fat transfer reconstruction is conducted in several stages, depending on the volume of the final reconstructed breast. The average number of procedures is three.

The patient arrives at the clinic on the day of the procedure and can leave the following day. The operation lasts between one and three hours depending on the level of complexity of the fat transfer.

Follow-up

It is recommended that the patient wears a compression sheath in the areas where fat was removed for two weeks as well as a special bra for three weeks. Pains are mild or inexistent and the patient may have to take off work for only one day to one full week depending on their rate of recovery.

Results

The result is immediately visible and the final shape and volume are generally very satisfying. The swelling will reduce gradually, and about 30% of the grafted cells will disappear. The result will be fully stable after two months. Once the result is stabilized, we can proceed to a second complementary operation, since multiple procedures are generally necessary to obtain the patient’s desired result.
The greatest advantages of this method are: reduced time spent at the clinic (24 hours), almost completely painless, the breast’s flexibility and sensibility are preserved.

Areola and nipple reconstruction

Overview

The nipple contains mammary ducts and gland cells, which is why it usually has to be removed to treat a cancer. Areola and nipple reconstruction is conducted at the very end of the breast reconstruction process. Skin graft techniques usually yield the best results. The goal is to obtain a reconstruction that is symmetrical, natural, and stable over time.

Technique

For the nipple :
Nipple reconstruction is done either by using part of the other existing nipple, by using local skin flap, or by grafting skin from part of the earlobe.

For the areola :
Areola reconstruction is done using the external border of the labia majora, where it connects to the inside of the thigh, because the skin in this area is more colored, like the areola.

Procedure

The operation is conducted under local or light, superficial general anesthesia and lasts less than an hour. The patient can go home the next morning.

Follow-up

The patient will not experience any pain. Local treatments have to be applied on the breast and on the area where skin was removed for two weeks.

Results

The result is visible after a week, once the dressing is removed and the graft is visibly successful. It then takes about a month for it to be fully consolidated. Most patients only need to take off two days of work, although a full week may be recommended in some cases.

Results