A mastectomy is a major operation that can affect a woman's femininity and self-image. Breast-conserving surgery can also cause serious breast deformity.
Some women opt for breast reconstruction: a new breast that approximates the shape and volume of the other breast as closely as possible.
In a breast-conserving procedure, part of the breast gland is removed. This can sometimes cause a distortion of the breast, especially due to the effects of post-radiation.
If a breast deformity occurs some time after the operation, it can be addressed by various plastic surgery techniques. For example, a small indentation where the tumour used to be can be filled by means of lipofilling. This involves obtaining fatty tissue elsewhere in the body by liposuction, which can then be injected into the breast to fill the indentation.
If the breast has been severely reduced by the breast-conserving procedure, your plastic surgeon can often improve the symmetry by performing a breast reduction of your other breast.
We can divide breast reconstructions into two major groups: prosthetic reconstruction and autologous (own tissue) reconstruction. Both can be done immediately or at a later time.
A breast reconstruction can be performed at two moments.
1. Primary breast reconstruction
Happens immediately, i.e. at the moment of amputation
2. Later/secondary breast reconstruction
Is performed at a later stage. There is a waiting period of six months to a year.
Whether or not a patient is eligible for immediate breast reconstruction is decided in consultation with the oncologist and the breast surgeon or gynaecologist.
1. Prosthetic reconstruction
A prosthesis reconstruction means that a silicone prosthesis is inserted under the large pectoral muscle. It is filled with silicone gel or saline solution.
Apart from the risk of infection, the main problem is capsular contracture around the prosthesis. To reduce this risk, the prosthesis has a rough outer layer.
Capsular contracture occurs mainly when radiotherapy is part of the follow-up treatment. Therefore, definitive prosthetic reconstruction is not indicated if radiotherapy is part of your treatment.
Disadvantages of the technology:
2. Autologous (own tissue) reconstruction
With this technique, a large piece of skin and fat tissue is transplanted from the own body to the breast region to form a new breast. This is called a free flap.
With this type of breast reconstruction, a subcutaneous prosthesis is no longer required.
Advantages of this technique:
After about four months, the new breast will take its definitive shape, after which the finishing touches can be added.
The nipple is usually reconstructed under local anaesthesia with a small flap of skin at the site of the new nipple. This will create a small scar.
The areola is reconstructed by means of a tattoo of the areola region that camouflages the nipple reconstruction scar. This takes place one to two months after the reconstruction.
You can always request an informative consultation at the Plastic Surgery department. During the consultation, the reconstruction options are explained on the basis of photos. You will also have the opportunity to contact fellow sufferers who have already undergone such an operation. This will give you a realistic picture of the course and the results.
