Breast reconstruction

Breast reconstruction after breast cancer:

Breast reconstruction takes full part of the treatment of breast cancer and although it is not mandatory (some patients prefer to stay with a flat thorax without reconstruction) all the clinical studies on this subject have revealed a major benefit on the quality of the patients’ life having had an ablation of the breast and that whatever the technique of reconstruction is chosen.

The breast reconstruction is suggested in 2 situations

Either the context of immediate breast reconstruction. The breast is immediately reconstructed during mastectomy
Or as part of secondary breast reconstruction from 6 to 12 months after mastectomy.

Overall, immediate breast reconstruction is reserved for cases where postoperative radiotherapy is not contemplated. This concerns cases such as small invasive tumors when the patient does not want to keep her breast, diffuse in situ carcinomas, prophylactic mastectomies in case of BRCA mutations and recurrences after lumpectomy + radiotherapy (conservative treatment).
There are 2 main types of breast reconstruction after cancer:

• With silicone implant
• Without silicone implant (autologous breast reconstruction) with the following techniques:
• • Lambeau Diep
  • Lambeau Dorsi flap
  • Under gluteus flap PAP

We prefer the use of autologous breast reconstruction because it gives better results in terms of quality of life and does not require another interventions in the long term.
Therfore, our therapeutic decision tree is the following:

If you have a slight overweight and your belly has excess skin and fat, we offer a DIEP flap because it is the technique that gives the best results in breast reconstruction.

If you do not have excess belly, several solutions are possible and depend on your morphology and your personal choices:

• The placement of an implant after one or two sessions of lipofilling
• In rare cases, reconstruction by exclusive lipofillings
• The realization of an autologous latissimus dorsi flap
• The realization of a flap under gluteus PAP if your buttock is slightly falling

The benefits and risks of these different interventions will be explained to you during the consultation so that you can choose the reconstruction breast procedure that will suit you best.

Once the shape and volume of the breast is re-established, the last surgical time will be the reconstruction of the areola and nipple.

Breast reconstruction in case of breast malformation

Plastic surgery can treat breast malformations whether if they are congenital (present since birth or appearing during development) or acquired (mainly related to breast infection or its surgical sequelae). Again, autologous techniques have taken a major place, in particular the injection of purified fat or Lipofilling. It is indeed possible to treat the following conditions:

• Breast asymmetry: It is possible that one breast develops and not the other. The treatment then includes the increase in volume of the breast of low development and sometimes the decrease of volume of breast too developed.
• Tuberous breasts: The breast does not develop in its lower part because of a congenital fibrous ring that stops its growth. It then has a tubular aspect. The treatment consists in fat injections, possibly followed by an implant.
• A syndrome of Poland: it is a deformity syndrome that associates an absence of breast development with a hypotrophy of the pectoral major muscle. Its treatment consists in fat injections.
• The invaginated nipple cure: the treatment can be medical or surgical
• The sequelae of breast surgery: benign tumors ablation (adenofibroma), breast abscesses, breast implants complications, can cause significant breast deformities. Here again, treatment is most often based on lipofilling.

Reconstruction of the areola and nipple :

Reconstruction of the areola and nipple is the final stage of total breast repair after mastectomy. We use an original technique that avoids taking a skin graft at the thigh’s root.