Breast reconstruction refers to all surgical techniques aimed at restoring the body integrity of a patient following a total or partial amputation of her breast(s). It is most often performed as part of the treatment of a malignant tumor (cancer) of the breast, but can also be used to treat congenital or acquired breast deformities.
Breast reconstruction after breast cancer
Breast reconstruction is an integral part of breast cancer treatment and even if it is not mandatory (some patients prefer to remain with a flat chest without reconstruction) all clinical studies on this subject have shown a major benefit on the quality of life of patients who have had their breasts removed, whatever the reconstruction technique chosen.
It can be proposed in 2 situations
- or as part of an immediate breast reconstruction. The breast is immediately reconstructed during the mastectomy
- or as part of a secondary breast reconstruction 6 to 12 months after the mastectomy.
Overall, immediate breast reconstruction is reserved for cases where postoperative radiation therapy is not considered. This concerns cases such as small invasive tumors when the patient does not wish to keep her breast, diffuse carcinoma in situ, prophylactic mastectomies in case of BRCA mutations and recurrences after lumpectomy + radiotherapy (conservative treatment).
There are 2 main types of breast reconstruction after cancer:
- without silicone implant (autologous breast reconstruction) with the following techniques
- PAP gluteal flap
We favor the use of autologous breast reconstruction because it gives better results in terms of quality of life and does not require long-term reoperations.
Thus, our therapeutic decision tree is as follows:
If you are slightly overweight and have excess skin and fat on your belly, we suggest a DIEP flap because it is the technique that gives the best results in breast reconstruction.
If you do not have an excess belly, several solutions are possible and depend on your morphology and your personal choices:
- the placement of an implant after one or two lipofilling sessions
- in rare cases, a reconstruction by exclusive lipofillings
- the use of an autologous dorsalis major flap
- the realization of a PAP gluteal flap if your buttock is slightly drooping
The benefits and risks of these different procedures will be explained to you during the consultation so that you can choose the breast reconstruction that best suits you.
Once the shape and volume of the breast have been restored, the last surgical step will be the reconstruction of the areola and the nipple.
Breast reconstruction in case of breast malformation
Plastic surgery is used to treat breast deformities, whether congenital (present at birth or appearing during development) or acquired (mainly related to a breast infection or the after-effects of surgery). Here too, autologous techniques have taken on a predominant role, notably the injection of purified fat or lipofilling. The following conditions can be treated in this way:
- Breast asymmetry: It is possible that one breast develops and not the other. In this case, the treatment includes a volume increase of the underdeveloped breast and sometimes a volume decrease of the overdeveloped breast.
- Tuberous breasts: The breast does not develop in its lower part because of a congenital fibrous ring that stops its growth. It then has an unsightly tubular appearance. The treatment is based on fat injections followed eventually by an implant
- Poland syndrome: this is a malformative syndrome that associates a lack of breast development with hypotrophy of the pectoralis major muscle. Its treatment is based on fat injections.
- The cure of invaginated nipples: the treatment can be medical or surgical
- Sequelae of breast surgery: the removal of benign tumors (adenofibroma), breast abscesses, complications from breast implants, can cause significant deformities of the breast. Here again, the treatment is most often based on lipofilling.
Reconstruction of the areola and nipple is the final step in total breast repair after mastectomy. We use an original technique that allows us to avoid harvesting a skin graft at the root of the thigh.
Have a question? Please contact us!
Docteur Yaël Berdah and Docteur Marc-David Benjoar
Plastic surgeons in Paris France