Breast reconstruction after breast cancer surgery

      In the United States, it took the completion of breast reconstruction to mark the end of surgical treatment of breast cancer. Breast surgery has entered an era of minimally invasive and functional, physiological and psychological excellence. In China, although many breast cancer patients still choose modified radical surgery because their fear of the disease exceeds their concern for their own appearance, more and more patients are accepting the concept of foreign developed countries. That is: having breast cancer is an unfortunate thing, but I am still a woman, I don’t want to be an unfortunate woman, I also have the right to have a perfect life.       For early stage single breast cancer that is less than 2 cm away from the nipple areola, breast-conserving surgery can be performed to minimize the trauma and impact on the external shape. In some cases, because the part to be removed is larger than the whole breast volume, it is not possible to perform satisfactory repair after removal, and breast-conserving surgery will result in significant local depression of the breast. For some patients whose lumps are closer to the nipple areola area, the entire breast tissue needs to be removed. Zhongshan Hospital is one of the first units in China to carry out breast reconstruction. The breast specialty group of general surgery and the breast specialty group of plastic surgery are strongly united. The doctors of the breast specialty group of general surgery are responsible for the complete removal of the whole breast tissue with the smallest incision and strictly following the principles of surgical oncology, and the plastic surgery is responsible for the reconstruction of the breast in the most appropriate way with the aesthetic perspective of the academy, and have been cooperating for more than ten years and have completed a large number of cases of latissimus dorsi flap, rectus abdominis flap and prosthesis reconstruction.      Breast reconstruction can be divided from the timing of surgery into stage I reconstruction and stage II reconstruction. stage I reconstruction requires only one surgery and the patient suffers the least pain, but the patient does not have enough time to overcome the fear. stage II reconstruction is a remedy for breast cancer after modified radical surgery and is a well-thought-out choice for the patient, requiring multiple surgeries, and is usually performed 2-3 years after surgery. In terms of fillers, it is divided into autologous tissue reconstruction and prosthetic reconstruction.      Autologous reconstruction is the transfer of the patient’s own latissimus dorsi or rectus abdominis muscle to the chest to obtain a fuller shape and to compensate for the lack of skin. The advantage of autologous reconstruction is that the flap is taken from the patient’s own body and used for the patient’s own body, so the appearance and touch are more satisfactory. The disadvantage is that there is a risk of ischemic necrosis of the flap, which is difficult to remedy if it occurs, and there will be varying degrees of depression in the back or abdomen, leaving a relatively large scar of 15 cm (latissimus dorsi flap) to 40 cm (rectus abdominis flap), as well as a degree of impaired movement or support due to the absence of muscle in the area. With the rapid progress in the field of cosmetic surgery breast augmentation, the safety, tactility, and shape of current implants have come a long way. Prosthetic reconstruction is currently the most widely used postoperative breast cancer reconstruction technique abroad. The disadvantage is that some patients are resistant to the implantation of prosthesis in the body, and the chance of infection and rupture after implantation of prosthesis is very small, but there is a risk of rupture and regular review is needed. In case of infection or rupture, the prosthesis needs to be removed, and after removal, the prosthesis can be replaced again, which cannot be emulated by autologous tissue reconstruction, because once the muscle or skin flap is necrotic due to ischemia there is no replacement spare; once the muscle contracture hardens, there is no feasible remedy.      In the past, due to the large amount of skin defects during mastectomy, the I-stage surgery only involved the implantation of expanders, followed by monthly injection of saline into the expansion period, and then removal of the expanders and implantation of the prosthesis after the skin had expanded to a satisfactory degree. In recent years, subcutaneous total mastectomy/mastectomy with preservation of the nipple areola has become more and more widely used in clinical practice, and the risk of recurrence after surgery is no different from that of modified radical mastectomy with removal of the nipple areola as long as the surgical indications are met. In Europe and the United States, a transverse incision through the nipple-areola area, about 7 or 8 cm long, is often used. In combination with our lumpectomy technique, we use a curved incision along the areola, about 3-4 cm long, to remove all the breast tissue and then reconstruct the prosthesis. Because the area around the areola is not smooth and is dark in color, the scar after surgery is not only small, but also not easily noticeable.