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Breast cancer is the most widespread disease among oncological ones in women worldwide. In most cases, treatment presumes full (mastectomy) or partial (lumpectomy) removal of breast. While finding themselves in such a difficult situation, women no longer feel themselves attractive and sexual. Luckily, modern plastic surgery can offer ways to return lost attractiveness with the help of surgical operations for reconstruction of breast.
Operation of Breast Reconstruction
Reconstruction of breast is a plastic operation which enables artificial restoration of initial shape of breast. Reconstruction can be immediate, i.e. carried out straight after removal of breast within one surgical operation or postponed i.e. done over some time. The reason of postponement is often the need to pass the full course of treatment (aggressive type of tumor, high risk of relapse of the disease etc.).
Photo: Breast surgery after mastectomy: before and after. Anatomy of polytech polyurethane. Enlargement with different sizes of implants, 20 days after surgery
While preserving skin pocket of breast, as a rule, esthetic result of reconstruction is better though it is not always possible to preserve nipple and areolar complex. Here, it is important to choose the method of restoration that will produce the best result.
Contraindications to breast reconstruction:
- Relapse of an oncological disease
- Less than one month after the end of a course of chemo and radio therapy
- Contagious diseases
- Disturbance of blood coagulation
- Uncompensated diabetes mellitus
- Overall hard condition of the patient
Methods of breast reconstruction
A plastic surgeon defines a method of reconstruction based on plan of treatment, volume of breast, availability of own tissues, condition and feeling of the patient. Restoration of breast may take place with the help of expanders and implants, musculocutaneous flap taken from another part of the body of the patient and with the help of own fat of the patient. Such operations are often carried out in combination with each other.
Reconstruction Using Implants and Expanders
This surgery involves restoring the shape of the breast by placing an implant or expander (temporary implant) in place of the removed breast tissue. This method provides the best aesthetic results. With the correct selection of implant size and shape, a beautiful and symmetrical appearance of the breasts can be achieved.
Implant Placement Without the Use of Expanders
In most cases of breast reconstruction after mastectomy (complete removal of the breast tissue), if the condition of the tissues allows, I perform implant placement without the use of expanders. This option has significant advantages:
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Reduced risk of complications: Modern microtextured or polyurethane-coated implants are significantly safer compared to the imperfect coating of expanders.
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One operation - fewer risks: Implant placement involves only one operation, unlike the two required when using expanders. This reduces the risks of complications that can arise during the second operation (replacing the expander with an implant).
Photo: Placement of anatomical implants after total mastectomy without expanders
To compensate for the lack of skin during breast reconstruction with implants, I use microneedling and rigotomy techniques. These methods improve the stretchability and area of the skin over the implant, which in most cases eliminates the need for flaps or expanders. The essence of the method involves microneedling (piercing the skin with micro-needles) combined with simultaneous stretching (rigotomy). This process allows the skin to easily increase in area while maintaining its integrity, without leaving additional scars. These methods not only improve the elasticity and quality of the skin but also enhance the condition of old scars. For the patient, this means one operation to place the implants instead of 2 or sometimes 3 operations if a flap is involved. This results in lower complication risks and a more natural and aesthetic outcome.
Implant placement without the use of expanders is best performed several months after mastectomy, allowing time for tissue trophism and lymphatic drainage to improve. As a result, the body better accepts the implants, significantly reducing the risk of postoperative complications.
Photo: Reconstruction of the left breast and augmentation of the right breast 6 months after mastectomy. Polytech polyurethane anatomical implant under the muscle. Augmentation with different sizes of implants. 14 days after surgery.
All breast reconstruction works presented in my gallery are performed using the technique without expanders.
Implants are often combined with lipofilling. Additionally, if necessary, a lift or reduction of the other breast can be performed.
Implant Placement with the Use of Expanders
Sometimes, when there is not enough skin and muscle tissue of the chest to create a pocket for the breast implant, it is recommended to place an expander (a tissue expander). The expander is placed over the pectoralis major muscle, initially flat and partially filled with saline solution. A special port extends from the expander, through which the surgeon injects 30-40 ml of solution every 2-3 weeks, gradually increasing volume and stretching the tissue. These procedures are performed on an outpatient basis.
Once the skin and subcutaneous tissue are sufficiently stretched, the expander is replaced with a breast implant.
Rehabilitation: similar to breast augmentation with implants
Breast TRAM Flap Reconstruction
This method presumes use of own tissues of the patient i.e. transplantation of musculocutaneous flap taken from the area of abdomen, back or buttocks into the area of breast. Flap reconstruction is efficient in case when part of breast was removed together with pectoral muscle.
Photo: Reconstruction of breast with the use of own tissues of the patient
This method is rather traumatic and has a complex rehabilitation with lengthy healing of donor and acceptor zones.
Breast Reconstruction with Lipofilling
Operation consists of restoration of shape of breast with the help of own fat of the patient transplanted from donor areas (abdomen, hips, back). Immediately I would like to discuss drawbacks of this method which are not written about in the Internet:
- for achievement of visible results, one needs at least 3-4 operations of lipofilling of breast as on average 50% of fat is taken and it is not possible to inject too large volume at a time
- often patients simply do not have the necessary quantity of fat for operation and a lot of it is needed
However, lipofilling suits ideally for correction of pits, deeps, small asymmetry. Therefore I recommend doing it in addition to operation of restoration of breast with implants if necessary.
Imitation of presence of nipple and areola is possible with 3d tattooing (permanent make-up). One can choose a pigment fully identical to color of areola of the other breast.
When is breast reconstruction possible after mastectomy?
Breast implants can be placed immediately after mastectomy, after six months, or after one year. The issue lies in the complications and the results that can be achieved depending on this period. If we place the implant immediately after total mastectomy or after radiation therapy, the tissues are significantly damaged, and the likelihood of complications is much higher. Many women after such operations have drains for a long period, fluid accumulates, and the implant is an additional factor that leads to additional problems. Therefore, achieving a more beautiful result, placing a larger implant of the required shape is much easier if we do it a year after mastectomy. Tissues heal maximally by this period, trophism is restored, vessels grow, lymphatic flow improves, and we can place an implant proportional to the other breast and of sufficient size, which cannot be done immediately after removal. Immediately after mastectomy, a small implant is placed, which will cause minimal tissue reaction. Therefore, I recommend waiting at least six months, but preferably a year, and only then considering reconstruction.
Content author - plastic surgeon Valentyn Zykov
- Practicing surgeon since 1998
- I perform more than 500 operations a year
- Laureate of the 21st national program "Person of the year"
- I operate in Poland (Warsaw) and Greece (Athens)
Reviews
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Review by Elena 05/15/19
En: Thank you so much for my daughter Lisa. We bow our heads to you in deep respect. May God bless you and your family with great health. With immense respect to you from our entire family. She is very satisfied. She no longer has any complexes. We are your advertisement. Wishing you the best of luck. -
Review by Julia 06/13/20
Dr. Zykov and his entire team are simply amazing, they are people with big hearts!!! Never before have I been treated with such care, attention and warmth. They sincerely care about every patient. My previous surgery for breast cancer was 2 years prior and I was very nervous and anxious before the surgery but made sure every one of my questions/fears were addressed. Almost a month has passed since the operation, and I am amazed at the work of Dr. Zykov. I like the result and I feel complete again. I highly recommend him, not only for his surgical experience, but also for his genuine care for his patients! -
Review by Natalia 03/11/18
Just 7 days after breast reconstruction with an implant, I basically felt like a woman. When the swelling went down, the doctor performed lipofilling on the right healthy gland and now the breasts look perfectly symmetrical and beautiful! To be honest, I couldn’t even think that it was possible to achieve such an aesthetic result with the original source that I was left with after a breast mastectomy. Thanks to such aesthetes as Valentin Zykov, we have a chance to remain beautiful despite difficult life situations
