Post-breast cancer breast reconstructive surgery – Cannes & Nice | Dr Victor Médard de Chardon
There are now excellent options for breast reconstruction. Breast reconstruction helps to restore the physical integrity of a woman and numerous studies have demonstrated a significant improvement in the quality of life for women who undergo breast reconstruction surgery following a mastectomy.
What is the definition of a total mastectomy?
A total mastectomy (or total mammectomy) is breast surgery that consists of removing the entire breast including the nipple-areolar complex, mammary gland and skin of the breast. A total mastectomy is breast surgery that is necessary in certain forms of breast cancer. Sometimes, a mastectomy can preserve the skin of the breast (skin-sparing mastectomy) or the areola and nipple (nipple-sparing mastectomy).
What are the objectives of breast reconstruction following a total mastectomy due to breast cancer?
Reconstructive breast surgery (reparative surgery of the breasts) enables the patient to feel feminine again by avoiding the need to wear an external breast prosthesis. The aesthetic objectives of reconstructive breast surgery are to recreate breasts that are symmetrical, ensuring they are aesthetically pleasing and harmonious shape and volume.
What is the average number of interventions required and period of time that must be left between each breast surgery procedure before the treatment plan is achieved?
At least three main breast surgery procedures are necessary before achieving the final result of reconstructive breast surgery following a total mastectomy. The period between each breast surgery procedure must be at least 6 months, meaning that breast reconstruction can take between 18 to 24 months to complete.
What is autologous breast reconstruction surgery?
Autologous breast reconstruction is breast reconstruction surgery that uses the patient's own tissue without resorting to breast implants. This is the modern approach to reconstructive breast surgery. There are non-microsurgical techniques (autologous using the latissimus dorsi flap) and microsurgical techniques (perforator flap, for example DIEP). Breast reconstruction surgery without implants (autologous reconstruction) usually results in a more natural breast both in terms of touch and on ageing of the breast.
BREAST RECONSTRUCTION PRINCIPLES
PHASE 1: RECONSTRUCTION OF A BREAST THAT HAS BEEN OPERATED ON
The breast reconstruction can be performed at the time of the mastectomy (immediate breast reconstruction), or on a subsequent date in patients who have already undergone a mastectomy (secondary breast reconstruction).
Breast reconstruction has the aim of providing the breast with a container (skin) and content (volume):
Autologous breast reconstruction techniques
- Latissimus dorsi muscle flap. This concerns a flap harvested from the latissimus dorsi muscle and dorsal fat to provide volume to the breast. The sheath of skin can be reconstructed using an advancement flap made from abdominal skin.
- Perforator flaps. They enable the skin and the volume of the breast to be reconstructed without sacrificing functional muscles. They employ microsurgery techniques:
- perforator flaps taken from the abdomen. The best-known is the DIEP flap (Deep Inferior Epigastric Perforator flap). There is also the SIEP flap (Superficial Inferior Epigastric Perforator flap). They enable skin and fat to be taken from the tummy, leaving the largest, flattest muscles of the abdomen intact, which limits morbidity at the donor site.
- perforator flaps harvested from the buttocks. These are what are called sGAP and iGAP flaps.
- Lipostructure. Otherwise known as lipofilling or autologous fat transfer, this procedure is performed in combination with other techniques to further enhance the volume of the breast. Several sessions are usually necessary.
Breast reconstruction techniques with breast implants
- Breast implant + abdominal advancement flap The insertion of the breast implant is accompanied by reconstruction of the skin of the breast using an abdominal advancement flap.
- Breast implant + latissimus dorsi muscle flap. The flap reconstructs the skin of the breast and the breast implant gives volume to the reconstructed breast.
PHASE 2: SYMMETRISATION OF THE OPPOSITE BREAST
This second intervention takes place at least 6 months after the first one. Symmetrisation uses regular aesthetic surgery techniques which are adapted depending on the visual aspect of the opposite breast:
- The opposite breast is small. A breast augmentation using breast implants can be envisaged.
- The opposite breast is sagging. A treatment for breast ptosis (mastopexy) enables the breasts to be lifted.
- The opposite breast is hypertrophic. A breast reduction is performed.
PHASE 3: RECONSTRUCTION OF THE AREOLA AND NIPPLE
This often concerns the final operation that concludes the breast reconstruction protocol.
The objective is to reconstruct the nipple area, texture of the areola and the pigmented colour of the areolar-nipple complex.
- The opposite nipple is large: half of the opposite nipple is taken to be used as a graft on the reconstructed breast.
- The opposite nipple is too small: the nipple volume and area is then reconstructed using a local plasty.
Reconstructing the texture of the areola:
A graft is taken from the inguinal fold, thus enabling the texture of the areola to be reconstructed. This is sometimes pigmented, which harmonises the colour between the two areolae.
Harmonisation of the colour of the nipples and the areolae:
The colour of the two areolae is harmonised using dermopigmentation (tattooing performed by a specialist dermographer).
TECHNIQUES COMBINED WITH Midface LIFT
A face lift is usually combined with other rejuvenation techniques to subtly enhance the result or maintain it: botox injections, hyaluronic acid injection, chemical peels, laser therapy and injection of fat.
Mastectomy for breast cancer