Reasons why breast cancer requires modified radical mastectomy
1. Breast cancer in or near the areola area of the nipple;
2.Multicentric or multifocal breast cancer with small lesions;
3.locally advanced breast cancer with large tumor size is not suitable for breast-conserving surgery;
4.The size of breast cancer is very small, but the patient cannot accept post-operative radiotherapy or is unwilling to undergo radiotherapy;
5.The patient wants to remove the whole breast;
6.After breast-conserving surgery, it is found that the cut edge is not clean or there is local recurrence.
Principles of incision design for radical breast cancer treatment
In order to preserve the skin of the breast as much as possible, the incision should be more than 3cm away from the breast mass;
2.When the mass is small and deep, the distance can be reduced, and the pathological examination of the skin should be negative;
3. The incision for excision can be transverse, oblique, tree-shaped, etc;
4. The distance between the incision line and the swelling is kept farther and the suture line after excision is more beautiful.
Reasons and methods of skin preservation during radical mastectomy
Reasons for skin preservation: The skin of the breast gland, nipple areola and tumor surface is removed; most of the breast skin and submammary folds are preserved. The commonly used incision is periareolar incision, the reasons are.
1. To preserve the natural breast skin, which can accommodate the reconstructed breast, while the need for skin in the donor area is reduced;
2. The use of periareolar incision reduces the incision scar and the mismatch between the donor skin and the breast skin;
3. Preserving the inframammary fold can improve the natural shape and coordination of the reconstructed breast;
3.The skin peeling is appropriate, so that the tactile sensitivity of the breast skin can be preserved after surgery;
4.The symmetry between the reconstructed breast and the contralateral breast is good and should be maintained as much as possible to reduce the difference with the contralateral breast;
Indications.
1.Preventive mastectomy for patients with high risk of breast cancer;
2.Multi-centered or multi-focal ductal carcinoma (DCIS);
3.Early invasive carcinoma of the breast.
Contraindications.
1.Inflammatory breast cancer;
2.Tumor with extensive skin involvement.
Indications for preserving the nipple areola during radical treatment of breast cancer
1. The mass is located in the nipple areola more than 3 cm;
If the distance between the edge of the tumor and the areola is ≥ 2 cm, the areola of the nipple can be preserved, but the tissue below the areola should be taken at multiple points on the stage for pathology to further clarify whether the tumor invades the nipple.
3.The mass of the breast is less than 3cm; the patient does not have the manifestation of bloody nipple overflow;
4.The skin of the incisional margin should be sent for freezing examination and reported as negative;
5. The excised part of the nipple areola was sent for freezing examination and reported as negative.
Precautions for axillary lymph node dissection during radical breast cancer treatment
When preparing for breast reconstruction after radical mastectomy, the following precautions should be taken when clearing the lymph nodes
1. The skin flap under the axilla should be peeled off and the thickness of the subcutaneous tissue must be appropriate;
2. The extent of lymph node dissection must be determined according to the location, size and freezing results of the tumor;
3.According to the breast reconstruction plan, intraoperative attention should be paid to keep the subscapularis vessels intact, especially to expand the design of the latissimus dorsi muscle flap breast reconstruction, and also to prepare for the vascular anastomosis when necessary during TRAM breast reconstruction to increase the safety of the operation.
Criteria for prophylactic total mastectomy
1. For patients with high risk factors for breast cancer, prophylactic bilateral or unilateral mastectomy can be performed.
2.While one side has been diagnosed with breast cancer and mastectomy is performed, prophylactic mastectomy is performed on the other breast.
3.The incision for preventive surgery is mostly made in a half-ring at the lower edge of the areola, and sometimes it can be extended to the upper side to facilitate the operation.
4.For those who do not have obvious breast sagging, the in situ nipple areola and breast skin can be preserved.
5.If there is breast sagging, the excess skin tissue needs to be removed and the nipple areola is free for transplantation in the new position.
6, Prophylactic mastectomy is mostly performed along with immediate autologous tissue breast reconstruction and placement of prosthesis if necessary.
Superiority of using breast endoscopy
The application of breast endoscopy during radical mastectomy can reduce the surgical incision and can thoroughly clear the lymph nodes in the axillary area, making the breast reconstruction procedure more minimally invasive and making the breast shape more beautiful.
With the further improvement of mammaplasty technology, this will make breast cancer patients more personalized and humane in their treatment.
With the increase of conservative breast treatment, i.e. partial mastectomy plus radiation therapy, and the application of endoscopic technology, it makes it possible to apply a small axillary incision to accomplish partial mastectomy, axillary clearance, and excision and transfer of the latissimus dorsi muscle flap at the same time.
Rectus abdominis myocutaneous flap mammaplasty
Advantages of autologous tissue graft breast reconstruction
Autologous tissue transplantation for breast reconstruction is technically complex and can be divided into tipped transfer and free transplantation according to its transfer method, which is difficult to operate, but has the following advantages after surgery.
1, can make full use of the patient’s autologous tissue; the effect is long-lasting and realistic in appearance.
2.Avoid a series of complications that may be brought by the prosthesis;
3.Shaping shape can also correct the subclavian depression and anterior axillary wall defect deformity;
4.It can be applied to patients who have received radiation therapy and underwent extensive resection due to recurrence.
5.Autologous tissue with good blood flow has good texture, easy to shape, good sagging feeling, and can promote wound healing.
6, transverse rectus abdominis muscle flap has a large amount of tissue, good blood flow, and at the same time has the effect of abdominoplasty, especially suitable for middle-aged patients with bulging abdomen.
The reconstructed breast has a natural shape and will not lead to foreign body reaction and contracture of the envelope. The reconstructed breast is composed of skin and fat tissue and muscle, similar to normal breast, and the reconstructed breast can tolerate radiation therapy.
Disadvantages of autologous tissue transplantation
1. Autologous tissue transplantation takes longer, more traumatic and more complicated than prosthetic implantation;
2. Autologous tissue is not abundant in many breast cancer patients, which is difficult for patients to accept;
3. Sometimes the complications after surgery make the comprehensive treatment of breast cancer less compliant.
Therefore, rectus abdominis muscle flap graft and extended latissimus dorsi muscle flap graft are suitable for patients who have more tissue defects than can be reconstructed with breast implants and who do not want to accept breast implants.
Complications of transverse rectus abdominis muscle flap surgery with rectus abdominis tip
1. A small number of patients may have partial necrosis of the flap and fat liquefaction after surgery;
2, the excision of the rectus abdominis muscle increases the weakness of the abdominal wall, and there may be a risk of abdominal hernia formation;
3, transverse rectus abdominis muscle flap with rectus abdominis tip can carry unilateral rectus abdominis muscle as tip or bilateral rectus abdominis muscle as tip, although the latter increases the blood flow of the flap, but the cutting of bilateral rectus abdominis muscle undoubtedly increases the risk of abdominal complications.
4, In order to improve the blood flow status of the flap, some authors use delayed flap, that is, the main blood supply vessel of the flap, the inferior abdominal wall artery, is ligated 2 to 3 weeks before surgery, and the superficial abdominal wall artery is ligated at the same time, and there are also ligated bilateral vessels at the same time. This procedure is suitable for patients with high-risk factors, who are not suitable for anastomotic free flap grafting; or plastic surgeons do not have microsurgical techniques or equipment.
5, another way to improve flap blood flow is to anastomose the inferior abdominal wall artery or superficial abdominal wall artery distal to the flap with the axillary vessels while transferring with the superior abdominal wall artery with the tip.
Precautions for free transverse rectus abdominis muscle flap
1.With the inferior abdominal wall artery as the tip, its arterial blood supply comes directly from the penetrating branch of the inferior abdominal wall artery, and its venous blood returns directly to the inferior abdominal wall vein.
2, the vessel tip can be cut to carry the whole section of rectus abdominis muscle, part of rectus abdominis muscle or muscle sleeve.
3, The vessels in the recipient area can be dorsal scapular artery and vein or intrathoracic artery and vein, and the former is often exposed during axillary clearance. With the increasing refinement of microsurgical techniques, the focus is increasingly on how to reduce complications in the donor area while ensuring smooth vascular anastomosis and flap viability.
4. Blood flow relies on the supra-abdominal arterioles traveling within the rectus abdominis muscle. For transverse rectus abdominis muscle flaps in the middle and lower abdomen, the arterial blood flow of the flap must be from the superior abdominal wall artery, through the spiral microarterial anastomosis to the inferior abdominal wall artery, and then from the penetrating branch of the inferior abdominal wall artery to supply the flap. The venous return of the flap must be via the inferior abdominal wall vein, the spiral microvenous anastomosis to the superior abdominal wall vein. This is coupled with torsion of the tip and compression of the tunnel.
Autologous tissue graft free transverse rectus abdominis muscle flap
Transverse rectus abdominis muscle flap: with its large tissue volume, good blood flow, and simultaneous abdominoplasty effect, it is particularly suitable for middle-aged patients with an already bulging abdomen.
Transverse rectus abdominis muscle flap with rectus abdominis tip.
Blood flow relies on the arterioles of the superior abdominal wall that travel within the rectus abdominis muscle. For transverse rectus abdominis flaps in the middle and lower abdomen, the arterial flow to the flap must be from the superior abdominal wall artery, through the chockanas tomosis, to the inferior abdominal wall artery, which then supplies the flap with a penetrating branch of the inferior abdominal wall artery. The venous return of the flap must be through the inferior abdominal wall vein and the spiral micro-artery anastomosis to the superior abdominal wall vein. This is coupled with torsion of the tip and compression of the tunnel.
Free transverse rectus abdominis muscle flap.
With the inferior abdominal wall artery as the tip, a series of anatomic studies have shown that its arterial blood supply comes directly from the penetrating branches of the inferior abdominal wall artery and its venous blood returns directly to the inferior abdominal wall vein. Its vascular tip can be cut to carry a whole segment of the rectus abdominis muscle, part of the rectus abdominis muscle or a muscle sleeve. A series of clinical applications have shown that it has the advantage of few complications. The vessels in the recipient area may be dorsal scapular arteries and veins or intrathoracic arteries and veins, with the former often exposed during axillary clearance. With the increasing refinement of microsurgical techniques, the focus is increasingly on how to reduce donor-area complications while ensuring unobstructed vascular anastomosis and flap viability.
TRAM flap transfer.
Using the contralateral rectus abdominis muscle as the tip, a TRAM flap is cut and transferred to the chest via a subcutaneous tunnel to close the abdominal incision. The rectus abdominis muscle flap is excised and, depending on the blood flow of the muscle flap, can form.
1) a tipped myocutaneous flap with the rectus abdominis muscle as the tip above;
2) a free myocutaneous flap with the subabdominal vessels as the tips, and a vascular anastomosis with the subscapular artery and vein using an additional axillary incision;
3) a vascularized myocutaneous flap with a combination of the above two methods to strengthen the blood flow of the myocutaneous flap, i.e., the upper part of the myocutaneous flap is tipped with the rectus abdominis muscle for the arterial and venous supply of the upper abdominal wall, and the lower part of the myocutaneous flap is tipped with the subabdominal wall vessels and vascularized with the subscapular artery and vein to strengthen the myocutaneous flap by 70 cm. Transferred to the blood supply.
Transverse rectus abdominis myocutaneous flap
With its large tissue volume, good blood flow, and simultaneous abdominoplasty effect, it is particularly suitable for middle-aged patients with an already bulging abdomen.
The transverse rectus abdominis muscle flap with a rectus abdominis tip relies on the arteries of the superior abdominal wall that travel within the rectus abdominis muscle for blood flow. For transverse rectus abdominis flaps in the middle and lower abdomen, the arterial flow to the flap is via the superior abdominal wall artery, via a chockanastomosis to the inferior abdominal wall artery, which then supplies the flap with a penetrating branch of the inferior abdominal wall artery. The venous return of the flap is via the inferior abdominal wall vein and the spiral microvenous anastomosis to the superior abdominal wall vein.
This method is often associated with partial necrosis of the flap and liquefaction of the fat, and the excision of the rectus abdominis muscle increases the risk of abdominal wall weakness and abdominal hernia formation, because of the torsion of the tip and the compression of the tunnel. The transverse rectus abdominis muscle flap with rectus abdominis tip can carry unilateral rectus abdominis muscle as the tip or bilateral rectus abdominis muscle as the tip, and although the latter increases the blood flow of the flap, the cutting of the rectus abdominis muscle bilaterally undoubtedly increases the risk of abdominal complications. In order to improve the hemodynamic status of the flap, some authors use delayed flap ligation, in which the main blood supply vessel of the flap, the inferior abdominal artery, is ligated 2 to 3 weeks before surgery, and the superficial abdominal artery is ligated at the same time. There are also simultaneous ligation of both vessels. This procedure is suitable for patients with high-risk factors, who are not candidates for anastomotic free flap grafting; or for plastic surgeons who do not have microsurgical skills or equipment. Another method of improving flap blood flow is to anastomose the inferior or superficial abdominal wall artery distal to the flap to the axillary vessels while transferring it with the superior abdominal wall artery with the tip.
Free transverse rectus abdominis muscle flap: using the inferior abdominal wall artery as the tip, was proposed by Holmstrom in 1979. A series of anatomic studies have shown that its arterial blood supply comes directly from the penetrating branches of the inferior abdominal wall artery and its venous blood returns directly to the inferior abdominal wall vein. Its vascular tip can be cut to carry the entire rectus abdominis muscle, part of the rectus abdominis muscle or the muscle sleeve. A series of clinical applications have shown that it has the advantage of few complications. The vessels in the recipient area can be either the dorsal scapular artery or the intrathoracic artery, with the former often exposed during axillary clearance. With the increasing refinement of microsurgical techniques, the focus is increasingly on how to reduce donor-zone complications while ensuring smooth vascular anastomosis and flap viability.
Inferior abdominal wall arteriovenous perforator flap
The greatest advantage of this flap is that it preserves the integrity of the rectus abdominis muscle and its anterior sheath, avoiding postoperative weakness of the abdominal wall and abdominal hernia, allowing the patient to recover quickly after surgery and having good long-term results. Because of the simultaneous abdominoplasty effect, the infra-abdominal arteriovenous perforator flap has become the preferred method for autologous tissue graft breast reconstruction.
The DIEP (Deep Inferior Epigastric Perforator Flap): proposed and promoted by Koshima (1989), Allen (1994), Blondeel (1994), and Xu Jun (2000) in recent years, is a further refinement of the free transverse rectus abdominis muscle flap. It is a further refinement of the free transverse rectus abdominis flap. The greatest advantage of this flap is that it preserves the integrity of the rectus abdominis muscle and its anterior sheath, avoids postoperative abdominal wall weakness and abdominal hernia, and enables the patient to recover quickly after surgery with good long-term results. Because of the simultaneous abdominoplasty effect, the subabdominal arteriovenous perforator flap has become the preferred method for autologous tissue graft breast reconstruction.
The Need for Autologous Breast Reconstruction
The advantages of autologous tissue grafting for breast reconstruction are
1, natural shape of reconstructed breast
2, will not lead to foreign body reaction and contracture of the envelope.
3. The reconstructed breast is composed of skin, fatty tissue and muscle, similar to normal breast.
4. The reconstructed breast can tolerate radiation therapy.
Shortcomings of autologous tissue transplantation.
1. Longer surgery time than implantation method;
2. The surgery is very traumatic and complicated, which is difficult for many breast cancer patients to receive.
3. Poor compliance of treatment.
Application objects.
Breast reconstruction with rectus abdominis muscle flap graft and extended latissimus dorsi muscle flap graft is suitable for patients with more tissue defects that cannot be reconstructed with prosthesis implantation method and those who do not want to accept breast implantation.
Reasons for patients who cannot apply TRAM.
1. Disruption of the superior abdominal wall artery or paramedian penetrating vessels;
2, presence of chronic obstructive pulmonary disease;
3. Heavy scarring in the abdominal flap donor area.
Breast contouring during autologous tissue reconstruction
Transfer the myocutaneous flap to the subcutaneous part of the breast after mastectomy, place the patient in a semi-sitting position, adjust the myocutaneous flap inside the breast skin to the appropriate position, trim the myocutaneous flap, and compare the bilateral breasts, if more breast tissue is transplanted, remove the excess skin and autologous tissue to make the reconstructed breast shape symmetrical with the healthy side.
For patients who retain skin in the areola area, excess epidermis is removed if necessary, and the flap is folded and shaped in basic agreement with the contralateral side.
When suturing the wound edges of the incision, the subcutaneous dead space of the breast is eliminated.
Other myocutaneous flap mammaplasty procedures
Gluteus maximus muscle flap.
Based on its source of blood flow, it can be divided into the superior gluteal artery gluteus maximus muscle flap and the inferior gluteal artery gluteus maximus muscle flap. The gluteus maximus myocutaneous flap has a hidden wound in the donor area and is suitable for patients who do not have enough abdominal tissue or do not want to leave a scar on the abdomen or back. The disadvantages are that the patient’s position must be changed during the operation, the vessel tip is short, and sometimes a vein graft is required. When removing the tip of the inferior gluteal artery, care should be taken to protect the sciatic nerve.
Supragluteal artery perforator flap and inferior gluteal artery perforator flap.
The superior gluteal artery gluteus maximus muscle flap and the inferior gluteal artery gluteus maximus muscle flap can both be perfected as superior gluteal artery perforator flaps and inferior gluteal artery perforator flaps. The vascular perforators are separated from the gluteus maximus muscle fibers to preserve the integrity of the gluteus maximus muscle, reduce complications in the donor area, and increase the effective length of the vessel tip for easy vascular anastomosis.
Broad fascial tensor fasciae myocutaneous flap.
The lateral vessels of the rotator femoris are used as the tip, and they are used for chest wall repair and breast reconstruction. This procedure requires strict indications and is certainly a two-pronged approach for patients with flat abdomen and buttocks and bulging thighs on both sides.
Rubens flap.
An iliolumbar flap with a deep iliac vessel as the tip. It is suitable for patients with a flat abdomen and buttocks and a full iliolumbar region.
Latissimus dorsi mammaplasty
The superiority of applying the latissimus dorsi muscle flap
1.With the thoracic dorsal vessels as the tip, a myocutaneous flap or muscle flap can be formed and transferred forward to the chest with the tip, which is simple and easy to perform.
2.It is commonly used in early stage to cover the wound after mastectomy for breast cancer. Due to its limited amount of tissue, it often needs to be combined with breast prosthesis.
3.The latissimus dorsi muscle flap is also used for wound debridement and repair after partial necrosis of the transverse rectus abdominis muscle flap.
4.With the increase of conservative breast therapy, i.e. partial mastectomy plus radiation therapy, and the application of endoscopic techniques, it is possible to apply a small axillary incision to complete partial mastectomy, axillary lymph node dissection, and excision and transfer of the latissimus dorsi muscle flap at the same time.
Surgical procedure of latissimus dorsi muscle flap
1.With the blood vessels of the thoracic dorsum as the tip, a myocutaneous flap or muscle flap can be formed and transferred forward to the chest with the tip.
2.If the amount of tissue is limited, it often needs to be combined with breast prosthesis.
3.The latissimus dorsi muscle flap is also used for wound debridement and repair after partial necrosis of the transverse rectus abdominis muscle flap
Comparison of tipped TRAM reconstructive surgery and latissimus dorsi muscle flap breast reconstruction
1. TRAM reconstruction is considered to be the standard procedure for breast reconstruction. However, TRAM reconstruction surgery with a tipped flap is more difficult and has some difficulties in promotion.
2, Chinese women’s breast shape characteristics determine that the latissimus dorsi muscle flap can basically meet the needs of breast reconstruction. The latissimus dorsi muscle flap alone can satisfy, and the postoperative shape is symmetrical with high patient satisfaction.
3, the latissimus dorsi muscle flap reconstruction appears more flexible, alone the latissimus dorsi muscle flap to meet the reconstruction of smaller breasts, combined with the prosthesis is suitable for larger breast reconstruction, and the operation is easy to learn and faster.
4, the application of the prosthesis should be safe and does not affect the treatment as a premise. Patients with lymph nodes felt in the axilla can be reconstructed, but try to avoid the use of prosthesis, which is not a good choice with a tipped TRAM.
Advantages of breast reconstruction with implants
Indications.
1. Patients who do not have the conditions for autologous breast reconstruction;
2.Young and unwilling to sacrifice autologous tissue from other parts of the body for breast reconstruction.
3.Limited to small volume of reconstructed breast with good local soft tissue coverage, and
Advantages.
Simple operation, easy to deal with various problems after surgery.
The significance of breast reconstruction with prosthesis
1, breast prosthesis was applied in the early 60s, and prevailed in the 80s. Now the number of patients using breast implants has increased.
2, reconstructed breast volume is small, the patient is young, not willing to sacrifice other parts of the body autologous tissue.
3.The implant filled with silicone, silicone gel or saline is placed under the flap or under the pectoralis major muscle after mastectomy, which is a simple and easy method.
4.If after mastectomy, the local tissues cannot provide enough cavity to accommodate the required size of the prosthesis, skin expanders can be placed first, and regular water injections after surgery, and when sufficient cavity is formed, the expanders will be replaced with breast implants by surgery again.
5, breast prosthesis in the process of improving there are different forms, can be replaced with hairy surface, imitation breast anatomical form and built-in injection pot expander.
6, complications of breast reconstruction with prosthesis include local flap necrosis, wound dehiscence, prosthesis rupture, prosthesis displacement, infection and periosteal contracture. If complications occur, the prosthesis can be removed and replaced with autologous tissue.
The disadvantages of using breast implants
1. The combined application of autologous tissue and prosthesis is necessary for the reconstruction of larger breasts;
2, the combined application of autologous tissue and prosthesis brings a greater risk of prosthetic complications;
2, the prosthesis has different degrees of contracture, exposure and other complications, there is a need to replace the problem.
Types of breast reconstruction surgery
1.The prosthesis filled with silicone, silicone gel or saline is placed under the skin flap or under the pectoralis major muscle after mastectomy.
2. If the local tissue does not provide enough space to accommodate the desired size of implant after mastectomy, a skin expander can be placed first, and after surgery, water is injected periodically, and when sufficient space is formed, the expander is replaced with a breast implant in another surgery.
Selection of breast implants
1, preoperative measurement of bilateral breasts, according to the volume of the breast to choose the volume of the equivalent prosthesis.
2.If the volume of the healthy side of the breast is less than 250ml and there is no obvious sagging, choose a single capsule implant;
3.For larger tumors, the transverse diameter of the excised breast skin is greater than 5cm or the volume of the healthy side of the breast is greater than 250ml, you can choose breast expander or Beck double capsule prosthesis and further expand the skin after surgery to expand the volume of the filling.
Types of breast implants
Silicone gel prosthesis: Because of the physical and chemical characteristics of the material itself, it makes some complications that are not easy to correct after breast augmentation. For example, the silicone rubber capsule in the outer layer of silicone gel prosthesis is easy to excite the tissue around the prosthesis to form a fibrous connective tissue envelope, contracture of the envelope and hardening of the breast, making the breast lose its beautiful shape and soft elasticity. In addition, the silicone gel inside the silicone rubber capsule leaks into the body, and there are reports of unexplained connective tissue disease. All of the above has discouraged many women who want to undergo breast augmentation, limiting the development of breast augmentation. In response to these conditions, many manufacturers of silicone gel breast implants have improved their products. For example, changing the smoothness of the implant envelope, changing the smooth outer membrane to a rough outer membrane, with the aim of destroying the integrity of the fibrous tissue envelope around the implant and reducing the incidence of envelope contracture.
Physiological saline prosthesis: Replacing the silicone gel with physiological saline can minimize the impact of silicone gel on the human body. However, this type of implant also has some embarrassing phenomena such as saline leakage that gradually reduces the volume of the breast, or bilateral breast asymmetry, as well as the disadvantage of a harder feel.
Double-lumen breast implant: The capsule of this implant is composed of two layers of silicone rubber membrane, the outer membrane is rough, the inner cavity is filled with silicone gel and the outer cavity is filled with saline. At present, this kind of prosthesis is more popular among doctors and patients because of its scientific nature. This kind of prosthesis is still not free from silicone gel as a substance, and the possibility of postoperative contracture of the envelope still exists.
Hydrogel implants: At present, the more advanced breast implants are hydrogel implants. The application of this breast implant can not only create a full, natural and soft breast, but also, its outer membrane has good tissue compatibility with human tissue, which can reduce the irritation of the implant to the surrounding tissues to a greater extent and reduce the incidence of periosteal contracture. Once the outer membrane of this implant ruptures, the hydrogel filled inside can be safely eliminated from the body via the kidneys. It is also worth mentioning that these hydrogel breast implants have excellent x-ray penetration and do not interfere with routine breast examinations. This is of great interest for breast cancer screening in women of childbearing age. Nowadays, this new hydrogel breast implant has been used in our country, especially for patients who have had silicone gel breast implants and now have hardened breasts, localized pain, and require breast implant replacement. The only disadvantage is that it is expensive.
Breast implantation without breast expansion
Indications for simple implantation.
1. Radical breast cancer surgery with skin preservation. Due to the small amount of skin loss, simple implantation can achieve satisfactory results.
2.Smaller volume of the healthy side of the breast and no obvious sagging.
Methods of placing breast implants.
1.Keep the local skin defect not larger than about 3cm during modified radical breast cancer surgery;
2.Simple implantation of breast implants can easily make the reconstructed breast augmented, and there is no obvious tension in the skin suture;
3.In addition, if the healthy side of the breast is large or the breast has sagging, after the breast is placed into the prosthesis, the contralateral breast can be corrected at the same time or after the surgery.
Breast reconstruction with breast expander
Advantages of breast reconstruction with breast expander: In the case of radical mastectomy with partial removal of breast skin, if an implant is placed behind the pectoralis major muscle in the first stage, the implant will be restricted by the pectoralis major muscle and its surface skin, making the shape of the reconstructed breast less natural. If the breast is expanded first, the pectoralis major muscle and its surface skin can be expanded at the same time to obtain the appropriate size of the breast cavity, so that the reconstructed breast will have a more natural shape and achieve a symmetrical effect with the opposite breast.