Conditions suitable for postponed breast reconstruction
1.After radical surgery of breast cancer, the patient has completed all kinds of comprehensive treatment and the general condition has completely recovered, so breast reconstruction can be performed after 2 years.
2.Patients who have undergone neoadjuvant chemotherapy, or extensive radiotherapy and chemotherapy before radical breast cancer surgery can delay breast reconstruction 2-3 years after the completion of all treatments for breast cancer and after the condition is stabilized.
3. For patients whose breast tumors are not highly malignant or who have undergone mastectomy for non-cancerous diseases, delayed breast reconstruction can be performed at any time after 6 months after surgery.
Advantages and disadvantages of delayed breast reconstruction
Advantages.
1. The patient’s fear of cancer recurrence is significantly reduced during this period, and it is easier to accept breast reconstruction psychologically;
2. After a long period of suffering from breast loss, patients are psychologically more likely to feel satisfied with reconstructed breasts.
Disadvantages.
1, to bear the pain of the second surgery;
2, the reconstructive effect is relatively not as good as the first stage;
3. The cost of treatment increases and is not reimbursed by public health care.
Common methods of delayed breast reconstruction
1, rectus abdominis flap transfer reconstruction.
Generally, the following transverse rectus abdominis flap (i.e. TRAM flap) is most commonly used for reconstruction. The method of reconstructed breast volume, better shape, without prosthesis, and at the same time has the dual effect of abdominal weight loss, and therefore in the United States is known as the standard procedure for breast reconstruction.
2, latissimus dorsi muscle flap transfer reconstruction.
The breast reconstructed by this method is easy to survive, and the operation is relatively safe and reliable. However, for most patients, the amount of autologous tissue that can be used in this method is relatively small, and additional prosthesis is needed.
3, gluteus maximus muscle flap free transplantation reconstruction.
The best shape of the reconstructed breast is achieved by this method. However, this method relies on microsurgical techniques, and the risk of surgical failure is high.
Risks of delayed breast reconstruction surgery
1. Regardless of the reconstructive method used, there is a possibility of partial or even total necrosis of the reconstructed body. This risk exists in descending order for free flap reconstruction, tipped rectus abdominis flap reconstruction and latissimus dorsi flap reconstruction.
2, the reconstructed shape is not good. Generally, the best shape is obtained by free gluteus maximus flap grafting, but the operation is complicated and the risk is high. The transverse rectus abdominis flap with tip is moderately risky, and the shape obtained is better.
3, larger scars, yellow people are more likely to grow scars than Caucasians. This problem is more serious in scarred individuals.
4, other: such as the rectus abdominis flap reconstruction also has the risk of postoperative abdominal wall hernia.
Pros and cons of various methods
1, autologous tissue breast reconstruction has the advantages of good feel and resistance to radiotherapy; however, it increases the trauma of the donor area, which most patients are not willing to accept.
2.Simple placement of breast reconstruction has the advantages of simple method, small trauma and no donor area trauma, but there are disadvantages such as mismatch between skin and pectoralis major muscle, restricted size of reconstructed breast, lack of dynamic feeling and contracture of prosthesis envelope.
3.Expansion breast reconstruction overcomes some disadvantages of simple prosthesis placement, especially for patients with simple glandular excision and asymmetric breast deformity.
Nipple reconstruction for delayed mammaplasty
1. Nipple reconstruction is usually performed after breast reconstruction, at least 3 months later;
2.The procedure is small and can be performed on an outpatient basis;
3, can directly use the local epidermis reconstruction; contralateral nipple reconstruction can be used for larger nipples;
4, the patient does not want to operate again, can also choose the method of tattooing to achieve the effect of fakeness.