Unfortunately breast cancer is a reality around us. It concerns not only older women but also young women, in the prime of their lives, in the reproductive phase of their lives and in their formative years.
Fortunately for us women, prevention, frequent examination and early diagnosis are the two most basic elements that lead to the correct treatment of the problem and to healing. Breast cancer is a multifactorial disease in its etiology, with a hereditary history in many cases.
It is very important for a woman’s life to undergo a mammogram and breast ultrasound and to be examined by a Breast Surgeon every year, after the age of 40 and from a younger age if there is a family history or any breast pathology, e.g. cysts etc.
In the event that breast cancer develops, the operation recommended by the Breast Surgeon is most often the removal of the breast gland together with the skin and the nipple. Depending on the stage of the disease and the histological examination, the oncologist will recommend radiation or chemotherapy to treat the problem. However, when the diagnosis is made at a very early stage (achieved by preventive examinations), the smaller the extent of the tumor, resulting in less surgery and possibly no need for further treatments.
In the past, women who underwent a mastectomy remained for life with one breast, which of course had a very heavy burden on the woman’s mental health as the breast is directly connected to the feminine nature, to “body image”, self-confidence and sexuality. Plastic surgery comes to give back to the woman the breast that has been removed. It is a series of operations (usually 2-3 operations) that can be started immediately at the same time as the mastectomy or later when the woman has finished possible treatments that she may need and the end goal is a breast similar in size and shape to the other breast and reconstruction of the nipple and areola complex.
There is no age limit when breast augmentation cannot be done. It just depends on the extension of the disease, the need for further treatment and the woman herself. In all cases reconstruction should be discussed with the breast surgeon and the plastic surgeon and the woman given all possible options. It is a decision that can be made by the woman even years after the initial mastectomy.
Reconstructive plastic surgery has developed different methods for reconstruction after mastectomy using increasingly today autologous tissues, i.e. parts of the body for the reconstruction of the breast. The decision that must be made initially is whether the reconstruction will begin in the same operating time along with the mastectomy or if it will be done in a second stage after the treatments. This decision is taken by the medical team dealing with the woman (Breast Surgeon, Oncologist and Plastic surgeon) and by the woman herself.
Methods of surgical reconstruction of the breast after mastectomy:
1. Tissue expander/ implant reconstruction:
The tissue expander is a really smart solution to rebuild the skin that has been removed in a mastectomy. It is essentially a silicone balloon that has an empty space inside. It also has a valve, which allows saline to be placed inside the empty space. Gradually with the placement of liquid of normal saline the special balloon slowly inflates. The principle on which it is based is simple, the skin has the ability to produce new skin by its gradual stretching. A similar “physiological process” occurs in the skin of the abdomen during pregnancy. The placement of the tissue expander can be done at the same time as the mastectomy or at a second time after some months. It is placed under the muscles of the chest wall. Its filling starts 2 weeks after the operation and is repeated every 2 weeks or so until we reach the desired size. The procedure can take from 2 to 6 months depending on the required volume to be created and the elasticity of the skin and the other treatments that can often be done at the same time.
Then there are 2 options: Either the expander can be removed and replaced by a silicone implant similar to those used in breast augmentation or it can remain in the body. The decision depends on the aesthetic result we have achieved with the expander because it is often harder than the silicone implant and many women prefer the more “natural” result of the implant in terms of texture and appearance.
2. Breast reconstruction using autologous tissues from the body with or without a silicone implant:
The development of microsurgery in the last 30 years has allowed plastic surgery to literally work miracles in cases where there are large deficits not only of skin but also of other body tissues such as muscles or bones in the body. So also in mastectomy we can restore the breast by transferring tissues from other parts of the body. Among the most common are the back (latissimus dorsi flap) and the abdomen (rectus abdominis flap). It is rarely used from the buttocks or other areas. Accurate knowledge of the anatomy of the body and the use of microsurgery allows the plastic surgeon to use tissue from these areas to recreate the breast volume. In some cases, it is also necessary to use a silicone implant under the transferable flap for greater volume.
These operations are generally large and require very good cooperation between the patient and the plastic surgeon.
3. Fat transfer/ Nipple Reconstruction:
Autologous Fat Tranfer: In the modern era of Plastic Surgery fat transfer is an important adjuvant method for optimizing breast reconstruction results.
Regardless of the restoration method, there is still a stage where the new nipple is reconstructed. It is done after the creation of the necessary volume has been completed, using a local flap and skin graft. Tattooing is an alternative method for creating a nipple with a very good result.