Some cases of breast cancer unfortunately require the partial or total removal of the breast affected by the tumor (mastectomy).
Ablation of the affected breast is a very sensitive event in terms of femininity and seduction. Advances in reconstructive surgery techniques make it possible to repair the breast affected by the tumor and to obtain a breast more and more similar to the other breast – in terms of shape and firmness. Breast reconstruction is always a personal choice and an intimate surgery.
The plastic surgeon will accompany you in this process by explaining the options available and the advantages and disadvantages of each technique.
Treatment of breast cancer by mastectomy
Breast cancer is a malignant tumor of the mammary gland. It is one of the most common forms of cancer for women. 85% of cases occur after the age of 50 years.
The different treatments
There are several categories of Breast Cancer Treatment:
- Hormonal therapy
- Targeted therapy
Surgery is usually the first treatment undertaken, in combination with another type of treatment, usually given after the surgical procedure to destroy cancer cells that may remain in the breast or have escaped from the main tumor.
What is a mastectomy?
Mastectomy is the surgical procedure that removes the cancerous breast tumor. She may be partial or total (removal of mammary glands, fatty tissue, nipple and skin). The choice of the type of mastectomy is based on several criteria, including the size of the tumor, its type and location in the breast. About 20% of breast cancer cases must be treated with total mastectomy.
Depending on the case, a breast reconstruction can be performed during the same procedure or at a later date (" secondary reconstruction”), after the end of the cancer treatment.
A breast reconstruction aims to recreate the volume and contents of the breast and also reconstruct the areola and nipple. Most often, a first intervention recreates the shape and volume of the breast and a second intervention allows the reconstruction of the areola and nipple.
Surgical options for breast reconstruction
- Breast reconstruction with implants
- Latissimus Dorsi Flap Breast Reconstruction
- Reconstruction by other flaps
- Breast lipofilling
The surgeon will advise you on the different surgical options regarding to your initial anatomy and your desire. Each technique has its advantages and disadvantages. These will be explained by the surgeon during the preoperative consultation.
A breast reconstruction is an act of restorative surgery that is supported by social security (in France).
Breast reconstruction with implants
A breast reconstruction with implants consists in reconstructing the missing volume and the contours of the breast by the establishment of a breast implant below the pectoral muscle. The intervention can be performed at the same time as the mastectomy (immediate reconstruction) or in a second operation (secondary reconstruction).
The incision used during the mastectomy is generally used as an access route to place the breast implant.
What kind of implants?
It can be a permanent or a temporary implant for tissue expansion. The latter makes it possible to progressively increase the quantity of tissues that will be used to cover the permanent prosthesis.
If a temporary prosthesis makes it possible to give a more natural aspect to the reconstructed breast, it should be noted that this option has the disadvantage of requiring two surgical procedures.
Reconstruction of the areola
The placement of the implant is the first step in a breast reconstruction. In a second stage, the reconstruction of the areola and nipple may be considered, as well as possible intervention on the other breast to improve symmetry.
Latissimus Dorsi Flap Breast Reconstruction
What is the Latissimus Dorsi?
The Latissimus Dorsi Flap is a fine muscle and extended back which is not indispensable on a functional level for the gestures of everyday life.
Its role in a breast reconstruction
The Latissimus Dorsi Flap breast reconstruction technique consists in picking up the muscle and transfer it to the chest. The muscle is rotated to the chest, passing through the armpit to rebuild the breast, and inserted between the mastectomy scar and the sub-mammary fold.
In some cases, the volume that will be obtained will not be enough. We can then consider the use of a prosthesis or the injection of autologous fat to increase the volume of the reconstructed breast.
When using an implant, the latissimus muscle is used as a muscular cover and as an additional skin cover. This technique has the advantage of being able to form a breast of any volume immediately.
In the case of autologous reconstruction, the muscle is removed with fatty tissue, which is the basis of breast volume. It must be considered that the muscle will tend to atrophy in the weeks following the intervention since it is not used anymore as a muscle.
Once breast volume stabilized (between 4 and 6 months), a lipostructure will carve the breast and change its volume.
Reconstruction of the nipple and areola
A reconstruction of the nipple and areola is an intervention that follows a breast reconstruction. It consists of reconstructing a colored areola and a central relief similar to a nipple.
The operation can be performed once the volume of the reconstructed breast is considered stabilized. It is necessary to distinguish the reconstruction of the areola (area of pigmented circular skin) and that of the nipple (colored part located at the top of the breast balloon).
Reconstruction of the areola of the breast
There are three techniques to rebuild the areola.
- Tattoo : a sterile pigment is introduced into the dermis to pigment the area of the areola. If the pigmentation fades with time, other tattoo sessions may be considered.
- Skin graft : Skin is removed at the fold of the groin. It is a naturally pigmented area that appears brown when grafted into the breast area. The result is usually durable and natural. If the pigmentation is not sufficient, the grafted skin can be tattooed in a second time.
- Transplantation of the peripheral half of the areola on the other breast.
Reconstruction of the nipple
There are two techniques for recreating the nipple.
- The contralateral graft which involves taking a part of the nipple of one breast to graft on the other breast. This technique generally leaves no trace and does not alter the sensitivity of the areolar area. This technique can be considered if the nipple is sufficiently projected and generous.
- The local flap technique which involves taking a local flap of skin, wrapping it around itself so as to restore the relief of the nipple. The scar associated with the removal of the skin is usually concealed under a skin graft or by the tattoo that reconstructs the areola.