Why do I need breast reconstruction?
It is a woman’s nature to love beauty, and beauty is destined to be the constant melody in the season of a woman’s life. The most important sign of female charm is physical beauty, and the charm of women depends on physical beauty, which is a woman’s treasure and a source of happiness, and is the root of female beauty. The breast is the representative of female physical beauty. Since ancient times, the breast is a symbol of female beauty, full and upright, proportionate and healthy breasts, is the best embodiment of female charm. The lack of breast shape and imperfection will directly affect women’s physiological and psychological health and their social interpersonal communication. Therefore, breast reconstruction is necessary for patients who have missing breasts and some of them are in poor shape.
What kind of patients need breast reconstruction?
Breast reconstruction is needed for various reasons. The causes of breast defects are broadly classified into three categories: tumor, traumatic and congenital. Most of the oncologic cases are mastectomy for breast cancer and simple mastectomy for multiple breast fibroids, and some patients with poor breast shape due to breast surgery. Traumatic are those with missing or underdeveloped breasts caused by trauma such as burns. Congenital has Poland’s syndrome and other causes of underdeveloped or dysplastic breast.
What is the purpose of breast reconstruction after breast cancer surgery?
Breast cancer surgery not only causes great physical trauma to women, but also causes post-operative psychological problems such as frustration and depression, making it difficult to resume daily work and life and reintegrate into society. Breast reconstruction can restore the patient’s appearance, avoid the above psychological problems and enable breast cancer patients to truly recover. Moreover, post-operative patients can achieve symmetry on both sides after wearing underwear, so that they do not need to wear prosthesis and avoid all the discomfort caused by wearing prosthesis, and they can move freely and avoid embarrassment caused by dislodging prosthesis when wearing prosthesis.
What kind of patients should not undergo breast reconstruction after breast cancer surgery?
There are three types of patients who are not suitable for breast reconstruction after breast cancer surgery: firstly, patients who do not want to undergo breast reconstruction, secondly, patients who are too weak to undergo another surgery, and thirdly, patients with poor prognosis, local recurrence, or distant metastasis.
When can breast reconstruction be performed after breast cancer surgery?
There are two types of breast reconstruction after breast cancer surgery, one is immediate reconstruction, which means breast reconstruction is performed at the same time of breast cancer surgery. The advantage of this is that only one anesthesia and surgery is required, which results in a short hospital stay, less cost and recovery time, and reduces the psychological trauma of mastectomy to the patient. The other case is postponed reconstruction, after completing chemotherapy and radiotherapy, with no abnormalities on physical examination by a mammographer.
Does postoperative breast reconstruction have any effect on the monitoring of postoperative recurrence of breast cancer?
According to a large sample survey of modern medicine, the local recurrence rate and long-term survival rate of patients with and without breast reconstruction after breast cancer surgery are the same, and breast reconstruction after breast cancer surgery does not affect the monitoring of postoperative breast cancer recurrence.
What is the procedure of breast reconstruction after breast cancer surgery?
Breast reconstruction after breast cancer requires multiple surgeries to create a perfect breast. The first surgery completes the reconstruction of the basic shape of the breast and usually requires hospitalization. The second surgery is performed six months after the first surgery and after the reconstructed breast is basically stable. The second surgery focuses on the reconstruction of the nipple areola and some local trimming, which can usually be done on an outpatient basis. If necessary, multiple surgeries can be performed to perform some minor revision.
What are the different methods of breast reconstruction after breast cancer surgery and what are the advantages and disadvantages of each?
There are two major types of breast reconstruction methods after breast cancer surgery, one is breast implant-based and the other is autologous breast reconstruction.
Prosthesis-based breast reconstruction involves placing an implant under the skin or pectoralis major muscle to replace the excised breast. If the amount of skin or subcutaneous tissue is insufficient, a flap can be placed over the surface of the implant, usually the latissimus dorsi flap. Prosthesis-based breast reconstruction is a simple procedure and patients recover faster than with autologous tissue breast reconstruction. However, its biggest disadvantage is that it leaves a large scar on the back. Secondly, some patients may experience contracture of the implant capsule, causing deformation of the reconstructed breast and surgical failure, especially in patients who require radiation therapy. Other complications include breast pain, peri-implant infection, and implant leakage.
Autologous breast reconstruction involves reconstructing the breast with tissue from the rest of the patient’s body. The advantages include: the reconstructed breast feels the same as the contralateral breast, both are predominantly fatty tissue, and the tissue has the same mobility as the contralateral breast. Also, the reconstructed breast, like the contralateral breast, can blossom as the body gets fatter or sag with age. The disadvantage is that the surgery is more complicated and the recovery time is longer.
What are the most common methods of autologous tissue breast reconstruction? What are the advantages and disadvantages of each?
Commonly used methods of autologous breast reconstruction include transverse rectus abdominis flap (TRAM), inferior abdominal wall artery perforator flap (DIEP), gluteal muscle flap, etc. depending on the donor area (the part of the body that provides the tissue for reconstruction).
Gluteus medius flaps are not suitable for breast reconstruction in the Eastern population because of the generally smaller buttocks.
Transverse rectus abdominis flap (TRAM) uses the excess skin and fat of the patient’s lower abdomen to reconstruct the breast, which not only reconstructs the breast, but also reduces the fat in the lower abdomen, killing two birds with one stone. However, its biggest disadvantage is that it requires partial or even total excision of the rectus abdominis muscle and the anterior rectus abdominis sheath, which affects the function of the rectus abdominis muscle and is prone to postoperative abdominal wall hernia, which affects the patient’s abdominal muscle motor function.
DIEP is the latest technique for breast reconstruction based on the transverse rectus abdominis flap (TRAM), which only removes excess skin and subcutaneous fat from the lower abdomen on the basis of preserving all the rectus abdominis muscle and the anterior rectus abdominis sheath, which protects the function of the rectus abdominis muscle and makes it less likely for a postoperative hernia to occur and preserves the motor function of the abdominal muscle. The disadvantage is that the operation is more complicated and requires more clinical experience.
What should I do before breast reconstruction after breast cancer surgery?
For immediate reconstruction, no special preparation is needed. For patients with delayed reconstruction, it is better to have breast reconstruction after completing chemotherapy and radiotherapy, in good physical condition, and after routine examination to confirm that there is no local recurrence or distant metastasis.
What are the common methods used for breast reconstruction in Jiu Hospital Plastic Surgery?
Our plastic surgery department has been performing breast reconstruction since the 1980s, and so far, we have performed more than 500 cases of various types of breast reconstructions, and we can choose the appropriate procedure according to the patient’s condition.