Reconstruction of the breast after cancer

Breast cancer affects women in two ways. First, they have to deal with being seriously ill with breast cancer. On the other hand, the treatment of breast cancer can bring amputation of the breast or both breasts. For many women, the loss of their breasts is associated with the supposed loss of their femininity. They feel less attractive and suffer from inferiority complexes. However, with medical advances, it is now possible in many cases to operate on breast cancer without sacrificing survival.

Implants as an alternative

If breast-conserving surgery is not possible, plastic surgery offers options for surgically reconstructing the breast using implants or own tissue. Patients should inform themselves before an operation whether such a reconstruction is suitable for them or not. Because not every woman is the reconstruction of her breast after breast cancer is a must. Some consciously choose against any form of surgical reconstruction, as they do not want to define femininity solely through their breasts. For other women, reconstruction is a relief and help with disease management.

In addition to individual preferences, factors such as health suitability and tolerability of implants must always be taken into account. It is therefore advisable to clarify with his doctor before the treatment for breast cancer, if and how the breast should be rebuilt. Above all, the surgical technique and possible risks and complications of the procedure should be the content of the conversation.

Breast prostheses or breast implants

In an optical reconstruction of the breast, a distinction is made between outer breast prosthesis or breast implants. An outer breast prosthesis is worn in the brassiere. These are cotton or silicone inserts that completely fill the bra cups and are stored in medical supply stores. Their weight and mobility are similar to natural breast tissue. Silicone also adapts very well to the skin and the remaining breast so that you can not see from the outside that it is a prosthesis. Such a breast prosthesis is suitable for the period shortly after the operation and is well tolerated by most patients.

In warm weather, unpleasant sweating under the prosthesis may be a problem. With appropriate laundry and a special skin care, however, can be remedied. In addition, tensions and back pain can occur with a large bust if the weight of the prosthesis and breast do not match. A new adaptation of the prosthesis in the specialized trade usually alleviates these problems.

Operative reconstruction of the breast

In an operative reconstruction of the breast, there are three possibilities: breast augmentation using artificial breast implants is a possibility. Other options are breast augmentation with the body's own tissue or a combined procedure using breast implants and own tissue.

Breast augmentation thanks to breast implants

The preparation for a later breast build-up is already taken during the mastectomy. An inflatable cushion is inserted under the large pectoral muscles. A small valve, which sits in the armpit, allows saline solution to be injected into this so-called expander. The pillow expands and expands the skin in this way.

At weekly intervals, the procedure is repeated until the desired breast volume is reached. So that the skin does not lose its strain state, it should be waited approximately half a year until the replacement of the implant. In a second operation, the saline-filled cushion is removed and a final implant is inserted. The procedure also restores the nipple.

Benefits of breast implants

This form of breast reconstruction is usually the least stressful of all operative forms. Although it takes about nine months from mastectomy to reconstruction, this form of surgery often produces good cosmetic results. It is especially suitable for women with small and medium breasts, where the pectoral muscle is still intact.

The patient should not be sensitive to implanted foreign materials. It should also be assumed that no irradiation will take place. If this is the case in retrospect, the result may be worsened. In rare cases, a type of connective tissue capsule (capsular contracture) can form around the implant so that it has to be removed or exchanged. An exchange of the implant should be made after about 15 years. These follow-up operations must be considered when deciding on breast reconstruction.

Breast build-up with body-specific tissue

This form of surgical breast reconstruction is much more laborious and usually riskier than a breast augmentation with an artificial implant. It uses the body's own skin, muscle and adipose tissue of the abdomen, buttocks or back to create a breast. The skin-muscle flap is released from the corresponding body site so that the supplying blood vessels are still connected to it. He is then placed under the armpit through a skin tunnel on the upper body and sewn there. This way, the new breast will continue to be supplied with blood.

The loss of the tissue and muscle flap at the appropriate location usually means no restriction on their mobility for women. From a cosmetic point of view, the loss of skin is not a problem. The method also has the advantage that no foreign body is used. The risk of sensitivity to the new tissue does not exist. Especially women who receive radiation after the operation can have their breast reconstructed in this way.

Risks in rebuilding the breast

Nevertheless, they must be in good overall health, as the surgery takes a relatively long time, with re-bleeding and infection occurring in three to four hours, and sometimes a second nipple repair operation, if desired. It can also happen in rare cases that the tissue flaps are poorly supplied with blood and must be removed in a second operation again.

Another risk is when the tissue has been removed from the abdomen. The stability of the abdominal wall can be so affected in rare cases, so that it sometimes comes to abdominal wall fractures. Therefore, this variant is not suitable for women who have had abdominal surgery or abdominal wall fractures. Even overweight, diabetic and smoking women is advised against this operation as well as patients with vascular disease discouraged.

Which option of breast reconstruction is the most appropriate and which risks should be considered, should be clarified in a personal consultation with a doctor.

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