Reconstruction of mammary glands after mastectomy

Reconstruction of mammary glands after mastectomy is performed with the purpose of restoring appearance, loss of volume, size and shape of the breast. The main purpose of this procedure is to reduce the psychological discomfort of a woman who underwent a surgical operation. Restoration of mammary glands with the help of the method of reconstruction does not affect the risk of relapse.

It should be noted that the reconstruction of the female breast is a rather complicated surgical procedure, requiring the use of special medical equipment and including several microsurgical stages. Before carrying out this procedure, the doctor in an accessible form explains the patient about all the nuances of the operation, talks about possible problems of the postoperative period, in order to psychologically prepare the patient for such a responsible step.

The reconstructive method is based on plastic surgery and can be used simultaneously with the operation to remove the breast. A number of subsequent micro-operations are possible. At the moment, there are 2 types of surgical interventions: using prostheses and using the patient's own tissues. Sometimes a mixed type of operation is possible, in which implants are used together with autotkanami. The choice of surgical intervention depends on the condition and preferences of the woman, as well as on the number of remaining breast tissue.

[1], [2], [3]

Technique of the reconstruction of mammary glands after mastectomy

Reconstruction of mammary glands after mastectomy is aimed at restoring the previous type of breast and is performed at the request of the majority of women who underwent surgery. Preferring this method, the patient first of all seeks to restore femininity and beauty in order to re-feel full and start a new life after a serious operation to remove the breast.

Breast plastic surgery after mastectomy is a safe and very effective manipulation, which is aimed at restoring the natural shape and size of the breast. This step is very important for women who lost their breasts as a result of cancer (cancer, sarcoma), any pathologies (purulent process with gangrene), or due to serious injuries. Breast plastic surgery helps to restore both the physical and emotional state of a woman. After the procedure, you can again wear clothes with a deep neckline for the decollete, sunbathing on the beach, etc. Visually, the artificial breast will have the same shape as the real one, but it is devoid of sensitivity.

Women who are psychologically ready to undergo a full course of treatment can agree to mammoplasty and are absolutely sure of the correctness of such a decision. An important nuance is the absence of contraindications for surgical intervention, as well as diseases and pathologies that can impede the rehabilitation process and cause negative consequences.

Mammoplasty can be performed immediately after amputation of the mammary glands, or after some time, after the healing of the wound and recovery of the body. It should be emphasized that the success of the operation will largely depend on the psychological preparedness and emotional mood of the patient. It is very important for the doctor to explain in advance to the woman that the new breast may initially be slightly uncomfortable, and in general the mammogram will not give a perfect result, because after the operation on the breast and in the donor places there will be lines from surgical incisions.

Breast prosthetics after mastectomy

Reconstruction of the mammary glands after mastectomy is a serious operation, allowing artificial restoration of the shape and initial appearance of the breast after amputation. Sometimes it takes several procedures to get the desired result. Reconstruction can be done simultaneously with a mastectomy operation when the woman is still anesthetized, or later, some time after surgery. If the patient needs chemotherapy, doctors prefer to postpone this procedure. Complications after breast reconstruction occur extremely rarely, most often - infections, scars, bleeding.

Prosthetics of the mammary gland after mastectomy is necessary in order to "fill the void". Before such an operation, the surgeon clearly determines the size of the implant, the location of the future incision, designates the contour depending on the anatomical features of the patient's body. Prosthesis is the only method that allows you to accurately restore the shape, original appearance and size of the breast.

Prostheses can have various forms and are made of the following materials:

• silicone (most closely approximated to the natural type of breast);
• polyurethane foam;
• foam and fibrous filler (such "lightweight" dentures are recommended to be introduced at the end of the recovery period, since they are considered the most convenient for physical activity).

Ideal prostheses should correspond exactly to the appearance of real mammary glands, both in shape and weight. Modern methods of surgery allow you to make cosmetic sutures barely noticeable. Prostheses can be installed through different surgical approaches, - the choice of sites for the incisions depends on the decision of the operating surgeon.

Modern breast implants are bags with a silicone elastomer or saline solution. As for the technique of implantation, it is quite simple: through small incisions, empty sacs are introduced into the skin and filled with a solution.

Restoration of the breast nipples - a separate issue that requires a competent approach. The patient may prefer artificial nipples made of polyurethane and as close to the present in consistency, shape and color, which are attached to the breast with the help of small suckers. From other options, you can use tattoo or plastic surgery. Reconstruction of the nipples is usually performed 2-3 months after mammoplasty, when the swelling of the mammary gland falls off.

[4], [5], [6], [7], [8], [9]

Implant of the breast after mastectomy

Reconstruction of mammary glands after mastectomy is a restorative procedure, which is performed after complete and partial removal of the breast along with a malignant tumor. Practically all patients who have undergone a mastectomy resort to the most effective method of breast reconstruction - reconstructive plastic, to return to a full life and again feel feminine and attractive. 

The implant of the mammary gland after mastectomy is introduced in one stage ("one-stage reconstruction"). Most often, the implant is made of silicone (or rather, silicone gel and physiological solution, taken in equal proportions). Introduction of the implant occurs through a small incision under the large pectoral muscle.

It should be noted that after the introduction of an implant under the skin around it, a capsular fibrous tissue can form. This is a natural process that is associated with normal wound healing. Approximately in 15-20% of cases, such a "capsule" can cause discomfort and provoke deformity of the breast. In order to prevent such a process, the patient is recommended to perform physical exercises and a special restoring massage is prescribed. Radiation therapy for 40-50% increases the risk of scar tissue formation. Sometimes implants can shift, in which case a special massage is necessary. It should also be noted that in most implants over time (after about 10 years) there is a slight leakage of contents. Such a process does not cause harm and does not cause dangerous consequences.

The advantages of introducing a silicone implant consist in the speed of surgical technology and the low traumatic nature of such an operation. Among the shortcomings, one can note the high cost of the procedure due to the rather high cost of endoprostheses.

Recurrence of breast cancer after mastectomy

Reconstruction of the mammary glands after mastectomy is carried out by introducing a prosthesis or expander - depending on the specific situation. This operation can be carried out in the process of mastectomy, or delayed for several weeks, until the healing of wounds and recovery of the body.

Recurrence of breast cancer after mastectomy implies the re-development of oncology after a certain time after surgical treatment and chemotherapy. Unfortunately, such a process occurs in most cases, especially if the cancer was diagnosed at the last stages. Most often, the tumor develops at the primary site, but a new tumor may appear in another breast or other area of the breast. The term "relapse" refers to the "return" of a disease. If the tumor is diagnosed elsewhere (internal organs, bone system, lymph nodes), this means that the cancer has "started up" metastases.

Of course, the recurrence of cancer greatly scares a woman and raises many questions about the correctness of the treatment technique and the operation performed. Most often, this problem arises due to the fact that malignant cells can not be fully identified and destroyed, and they fall with a current of blood or lymph in the surrounding tissue.

If we talk about the time frame, then usually a relapse occurs between 2 and 5 years after the course of therapy. If this process is suspected, an in-depth examination of the patient's body (MRI, PET), as well as histological examination or biopsy, is carried out.

Among the prognostic indicators, which allow to predict the recurrence of cancer, it is possible to distinguish the aggressive course of the primary disease, the large size of the malignant neoplasm, and the diagnosis of the late stage of the primary disease. Relapses are often caused by neoplasms containing certain oncogenes, as well as the presence of malignant cells with a high atomic index. After surgical treatment of the patient, the oncologist should evaluate the situation for the possibility of developing a relapse in the future.

Palpation of the mammary glands is one of the main methods of detecting cancer. In the process of developing relapse, the following symptoms can be observed:

• any changes in the nipple (shape, color, atypical discharge);
• itching and burning of the chest;
• changes in the structure and size of the breast;
• redness or any discoloration of the skin of the breast, change in temperature.

In case of relapse, local treatment is prescribed, including radiation therapy and surgical intervention, as well as systemic treatment involving hormonal and chemotherapy. If a relapse did not happen in the first 5 years after the treatment, then most likely, there will not be a second oncology.

Care after the procedure

Reconstruction of mammary glands after mastectomy is carried out with the purpose of one-stage reconstruction of the breast, i.e., the shape and volume of the mammary gland.

Rehabilitation after mastectomy of the breast includes a set of activities, the main task of which is to return a woman to a full life and improve her quality. The oncologist must warn the patient about the difficulties and problems that may arise during the recovery from surgery. Typical complications after surgery are post traumatic. This is hypercoagulability, asthenic conditions, so-called. "Phantom pains." Postoperative stress is often accompanied by a worsening of wound healing, the formation of a coarse postoperative scar, and an extension of the period of lymphorrhea. In addition, it is necessary to distinguish such symptoms and consequences as:

• pain syndrome arising in the shoulder joint;
• reduction of muscle strength at the site of surgery;
• swelling of the upper limb;
• atrophy of the muscles of the shoulder girdle;
• violation of posture.

The scheme for carrying out rehabilitation measures is associated with the manifestation of postmastectomy complications and depends on the results of an objective examination and complaints of the patient. The program of rehabilitation measures should be developed individually for each patient. The effectiveness of such a program will favorably restore the working capacity of women.

Reconstruction of the mammary glands after a mastectomy is a matter for which a decision must be taken responsibly, in all seriousness, taking into account the peculiarities of the course of the disease in each individual case. Plastic surgeons from different countries of the world agree that reconstructive surgery is one of the main stages of cancer treatment, a safe method of rehabilitation.

[10], [11], [12], [13]