» Plastic surgery » Breast reconstruction
- Why is breast reconstruction necessary?
- How can you restore your breasts?
- Breast reconstruction with silicone implants
- Breast reconstruction using your own tissue
- Breast reconstruction using combined techniques
- Reconstruction of the nipple and areola; lipofilling
The mammary gland is a part of the body that plays a huge role in the life of a woman of almost any age. Unfortunately, among female cancer pathologies, breast cancer is the most common event. In some cases, when the tumor is detected in the early stages, organ-preserving treatment is possible, but in most cases, surgical treatment consists of a mastectomy - complete removal of the mammary gland.
Breast reconstruction allows you to restore the appearance of a lost breast and is a very popular technique throughout the civilized world.
In leading clinics, including the Century Clinic, breast reconstruction is performed simultaneously with mastectomy, which allows saving most of the breast skin, and in some cases, the nipple and areola. The clinic uses various methods for breast reconstruction after mastectomy, which, even if it is completely removed in another institution, allows you to restore the aesthetic appearance of the lost mammary gland. This type of reconstruction is called delayed.
Why is breast reconstruction necessary?
Breast reconstruction can help you feel more comfortable and not worry about what you will look like after the tumor is removed. Most women with a removed mammary gland experience significant psychological discomfort; their personal lives often change for the worse due to feelings of self-doubt and an inferiority complex. These effects are especially acute after the end of antitumor treatment, when the fear of the disease goes away and the time comes to return to normal life.
Which round implants are best to choose?
The opinion that round implants are only suitable for thin girls with small breasts is a myth. The choice of shape and type of endoprosthesis depends on the physiological structure of the mammary glands. When choosing, the structure of the chest, height, vest and body type are taken into account. It is also important to take into account the girl’s field of activity and the activity of her lifestyle.
When breast augmentation is done with round implants, you can achieve a natural effect, just like when using an anatomical shape. When installing endoprostheses under the chest muscle, the gel under pressure flows partially into the lower part and takes on a teardrop shape. The force of pressure depends on muscle development and physiological characteristics. If the endoprosthesis is inserted under the mammary gland, then this effect will not occur.
It is impossible to say for sure which implant manufacturers will be the best, because... they all have their positive and negative sides. But the most popular companies now are Mentor and Arion.
How can you restore lost breasts?
Breast reconstruction can be performed using the following methods:
- Using silicone implants
- Using your own fabrics
- Combination of own tissues and silicone implants
There is no “best” way of breast reconstruction. The method is selected together with the surgeon, taking into account the size of the mammary gland, the disease, the treatment performed or planned, as well as the constitution, general health and the presence of bad habits.
Your surgeon should explain to you the pros and cons of each method as it applies to your situation and give you his or her opinion regarding the choice of reconstruction method.
Currently, the incidence of complications of reconstructive interventions has been reduced to a minimum, but this is true for patients in whom the correct choice of reconstruction technique was made.
The risk of reconstruction complications may also be high in patients who are overweight, have chronic diseases such as diabetes, systemic connective tissue diseases, and cardiovascular diseases. A bad habit such as smoking can cause serious complications, so you should think about getting rid of it before reconstruction.
Most reconstructive techniques include several stages. The first stage, regardless of the method, always requires hospitalization and general anesthesia. The final stages, such as nipple and areola reconstruction or lipofilling, can be performed on an outpatient basis.
Rehabilitation
The recovery period is an obligatory stage in a woman’s life after any operation. During this period, it is very important to follow all the doctor’s recommendations and visit him at the appointed time. After reconstruction, the woman remains in the hospital for a little less than a week (5-6 days), depending on the condition. It is usually prescribed after the stitches are removed. There are a number of restrictions that must be observed at home:
- avoid active physical activity, especially on the upper shoulder girdle;
- do not swim or take hot showers;
- refuse any thermal procedures, including baths and saunas;
- Avoid UV irradiation (solariums and sunbathing).
Reconstruction requires quite a long rehabilitation period. But after the end of the recovery period, most patients feel that life goes on.
If you have suffered the misfortune of losing one or both mammary glands, and you have the opportunity to turn to mammoplasty, we hope that it will be successful. And our article will help you understand the methods and methods of doing it. Visit us again and share our articles via social networks with those who need them.
Breast reconstruction with silicone implants
This type of reconstructive surgery is the most popular in the world and is used in more than 80% of women who undergo breast reconstruction.
This popularity is due to the fact that this method is the least traumatic, does not create additional scars and has a fairly short recovery period.
Figure 1. The first stage of reconstruction - using an expander
Most often, this reconstruction method includes two main stages. In the first, a tissue expander is placed under the skin and muscle tissue of the chest wall, which is an “empty” silicone implant with a magnetic port that allows it to be filled with sterile saline (see Figure 1). Filling and stretching the expander allows you to stretch the soft tissue and create the volume and shape of the future mammary gland. Tissue expanders can be of various shapes and sizes, which allows you to choose the optimal one, taking into account individual characteristics.
“Pumping up” of the expander after implantation is carried out once every two or three weeks on an outpatient basis. This is an absolutely safe and painless procedure that allows you to gradually increase the expander volume. The process of filling the expander takes from two to five months, depending on its volume and tissue stretch.
At the second stage, the expander is replaced with a permanent silicone implant, the shape and volume of which is also selected individually. At this stage, the final shape of the reconstructed breast is usually created, and the opposite one is often corrected in order to improve its appearance and give the area a symmetrical appearance. Surgeries on the opposite gland are safe; they cannot provoke tumor growth, but only help to harmonize the external appearance of the body (see photos 1-7).
Photo 1. Before and after breast reconstruction with silicone implants. Patient 1
Photo 2. Before and after breast reconstruction with silicone implants. Patient 1
Photo 3. Before and after breast reconstruction with silicone implants. Patient 1
Photo 4. Before and after breast reconstruction with silicone implants. Patient 2
Photo 5. Before and after breast reconstruction with silicone implants. Patient 2
Photo 6. Before and after breast reconstruction with silicone implants. Patient 3
Photo 7. Before and after breast reconstruction with silicone implants. Patient 3
Figure 2. Single-stage breast reconstruction. Scheme
With one-stage reconstructions, in some cases it is possible to do without the expander stretching stage. In these cases, a permanent silicone implant is immediately placed after the mastectomy.
Such operations usually require the use of additional materials to stabilize the position of the implant (see Figure 2), the cost of which can be quite significant. However, in some cases, especially when it comes to bilateral operations, this approach may be the optimal choice (see photos 8-10).
Photo 8. Result of one-stage breast reconstruction
Photo 9. Result of one-stage breast reconstruction
Photo 10. Result of one-stage breast reconstruction
Review and photographs of a patient after breast augmentation surgery with Mentor 300 ml round implants
OP 09/10/2016 September 10, 2016 Today I had an OP, I’m wondering how anyone’s swelling went down? Have your breasts decreased in size significantly? Or not really?
Initially, I was simply worried that the doctor was giving me an implant size that was not the same size as I would like) now, in principle, I like everything, but the swelling is very strong, which is not surprising, of course. So I decided to ask those who have already gone through this)
I was given round Mentor 300 ml high profile. The doctor’s tactic is that he told me to put on a compression suit on the 2nd or 3rd day, now I get up and walk around without it, I admire it)) it’s a little scary, of course, it seems like it’s going to fall out now... Tomorrow at the doctor’s appointment I’ll try to find out everything.
Yes, I wanted more, at least 330 ml, I didn’t have my own source at all, 0.5 somewhere. There weren’t enough of my own fabrics, weight 52 kg and height 163 cm, the doctor said if I put in more, I’ll have a lot of contouring.
There is a cut under the armpit.
I feel quite normal, I didn’t even ask for a painkiller injection at night, I was ready for it to be worse. I move my arms normally, but I don’t lift them up and I don’t close them too close to my body. It’s just that getting up and lying down is very painful. Well, it’s like everyone else.
September 11, 2016 I was also most afraid of anesthesia, my legs were already giving way, nothing went well, the same will happen to you. Today is the 2nd day, I’m holding on without painkillers and even went out into the yard for a walk, maybe it’s impossible of course, but it’s very fresh I wanted air)
I don’t feel very well, I’m swollen a lot, everything is scary, but I didn’t take any pills, I’m resting. I was discharged today, because I live right next to the clinic. They made a compra for me from elastic bandages, they tightened the top and bottom, but the chest itself is not tight , this is the technique used by Chinese surgeons. The next visit to the doctor is in a week to remove the stitches. Tomorrow I go to work, I’ll have to swallow pills.
September 12, 2016 I went to work, it was very hard to walk, but sitting in the office was basically normal, nothing hurt, thank God. Here is a photo, these are my boobs on the first day.
There is no photo of the source, but it was 0.5 in general: - < Of course, I still don’t understand what I can do, in clothes it seems that everything is the same as BEFORE, when I wore a bodice with Push, everything is somehow standing upright, I want everything at once so that it is beautiful 5e678 g
No, no one noticed, Lenchik. Visually, nothing really sticks out, oh how much time it still takes for it all to be there beautifully, we can only guess. September 13, 2016 I believe that you need to listen to the doctor in everything, he knows best in any case! For example, I am very grateful to mine, for the fact that he did not listen to me, but put the size that he considered necessary for my figure, so I feel with them as if they were my own from the first day, they fit in like family, I can’t imagine if they had inserted more , there would probably definitely be problems... The main thing is not to overdo it, so that everything is neat and beautiful!
Regarding the upper pole, the doctor may allow you to remove it in 2 weeks, I visited mine today, and he told me you’ll be able to walk for 2 weeks, but with the lower pole for a month. That’s how it is!
September 14, 2016 It’s already normal, getting up and lying down doesn’t hurt, sometimes something can shoot or gurgle somewhere, well, it’s all nonsense... I’m just like you, I’m very tired of these bandages, everything itches like crazy, I can’t take a shower... Swelling subsides, some bruises just appeared, it seems like they weren’t there... The view is certainly not impressive, you can’t see anything in clothes ((We’ll see how it goes, I read here that for some the swelling subsides and the size decreases, and for others it’s the other way around are fluffing up))
Yes, thank God, I never took painkillers at home, from the 2nd day everything was somehow tolerable, the doctor says that I have a high pain defect, usually with the same access as mine - axillary, it hurts a lot for people, but for me They don't bother me at all. Of course, I want them to fluff up and become bigger, I don’t know if this is possible)) now they stand rooted to the spot))
September 16, 2016 Everything is fine with me, some bruises just appeared, I sent a photo to the doctor, he says it’s normal, it will go away in a few days. The swelling has almost subsided, the muscles hurt only if I jerk sharply or reach for something, and in the morning for a few minutes I’m bursting in my chest as soon as I get out of bed. Tomorrow I’m going to take out the stitches, I’m not the least bit afraid, I can’t wait, I really want to take a shower, I hope I can tomorrow.
The doctor said that in a few days the bruises will go away, they are so healthy, I think they will definitely last 4-5 days. The armpits don’t hurt. Tomorrow the stitches will be removed, I’m afraid that the scars will remain large, I need to put something on it. And I’m also worried that stretch marks won’t appear, My skin is very prone to them ((who can say anything about this? Could they appear over time due to enlargement?
Very useful information, thanks! I really thought about it and regret that I didn’t apply anything until now. As much as I read here on the forum, no one paid much attention to this and no one wrote that stretch marks appeared after the operation, so I somehow didn’t take it seriously either. Tomorrow I’ll definitely ask I'll see my doctor and report back.
As I understand it, you need to take care of the skin of your breasts throughout your life, judging by the article that Koshka sent us, I’m wondering who actually does this?!
September 18, 2016 And I girls went to the doctor yesterday, my stitches were removed, the top tape was removed, they didn’t put on a compression garment for me from the first day, they just tightened an elastic bandage from below and I’ll walk with it for a month. They sent me home, they told me to come back in a month. We’re here today Day 8, I felt good, but about a couple of hours ago I started to feel severe numbness in my chest, what could it be? Has anyone had this? This really scares me(((
He says that this is a normal phenomenon, that everything will pass with time. But I decided to write here anyway, I’m kind of scared (((
September 19, 2016 Hello, I’m already showing off in a T-shirt, it’s just tightened at the bottom. Nothing hurts, but in the morning the discomfort and bruises haven’t gone away. I try to take care of myself, but whenever possible I do everything myself) I even washed my hair myself)
Lenochka, I have the same symptoms as you and I also associated it with the weather, sometimes there’s nothing, but sometimes everything drags and aches. Although, well, why be surprised, after all, recently the OP was like what you have and what I have...
I also prepared for the worst and the doctor said that I wouldn’t be able to move my arms at all, but from the first day everything was very tolerable and it didn’t really interfere with my life) The scars are of course large and will be visible for a long time, at the hospital they told me that I could buy ointment from them which heals scars well, BUT it doesn’t help some, that is, there is no guarantee, it’s not cheap, I’m in two minds... I don’t know what size I am yet, I can’t try on anything yet, we’re only 9 days old today. They still stand rooted to the spot. I think they still have to change their shape a little, I’ll wait until a month and go get new underwear. Anyway, you can’t wear underwired busts for another 3 months. I want to know what they will be like) For now, revenge seems to me that it won’t be enough)) there is still hope that they will drop a little, as they say, they will fluff up)) Not by size, of course, but still)
September 21, 2016 I made an OP 10.09 incision under the armpit. I am very glad that I chose this particular approach, from the first day the stitches did not bother me, I moved my arms and lifted them a little carefully, and I did not experience any wild pain. Today is the 11th day, I Almost returned to the rhythm of my normal life. Well, in general, of course, everything is different for everyone, a different pain defect.
September 22, 2016 I still have no idea which one I have. C or D, probably, last week I tried to try on old underwear to compare, but the boobs were still stone, now they are a little softer and more pleasant to the touch. But I’m not in the mood for shopping yet, I think it’s too early yet.
The tape prevents me from trying it on normally, the one I have on the bottom. I hope they’ll take it off in a month and then I’ll go dancing) Now sometimes I allow myself to wear a top with thin foam rubber, although the doc forbade me from putting anything on them at all, he said a loose T-shirt is okay, so that it’s comfortable to wear and doesn’t damage the seams under the armpit.
I don’t know about anyone else, I don’t regret that I chose this access, from the first day nothing hurt there. Everything is fine, the stitches have been removed, a very neat stitch, I hope by the time of vacation the scar will turn white and nothing will be visible at all. But I didn’t want to go through the areola because I’ve read that lactation isn’t always possible later, depending on your luck, but I’m planning another year or two I love you)
September 23, 2016 Today is my 13th day, I notice that the swelling has gone away and their volume has decreased a little, but I’m not particularly upset, my boobs have started to look neater)))
I'm really looking forward to this moment))) When will they fluff up)
We are 2 weeks old)
I don’t know what compra is, no one put it on me) You need to be patient and wait for the final result, in a month some kind of picture will emerge, I think)
September 27, 2016 My swelling is also going away, I can’t help but cry... It’s also partially going away, one is larger than the other, the interbreast is generally incomprehensible, something that will eventually be difficult to imagine (((
I had a slight asymmetry BEFORE, my sin is that the doctor should have foreseen this for me and placed implants of different sizes, or did I already think this up?!
there is no BEFORE photo unfortunately. Everything went wrong with the operation for me, the doc examined me once, told me how much I could install as much as possible and that’s it, then I saw him before the operation itself, when the implants were ordered and delivered ((
Here in the photo is what we have today, 17 days
Let's hope and wait)
I also have hard ones, there is still swelling. Len, what happens when the swelling completely goes away, they will be even smaller??!!((
October 01, 2016 We will also be a month in a week) Hurray)
I already feel normal, in the morning there is only slight discomfort, while I’m getting out of bed, apparently the swelling has not gone down yet. Yes, I’ll definitely go within a month. For now I’m wearing a T-shirt, a top without paralon, sometimes without anything at all, I only have a tape tied at the bottom, I think in a week it will be removed) Has your swelling gone completely? When’s the next time to see the doctor? I didn’t ask when you can play sports?
I haven’t bought anything yet, my breasts are not mobile, you can’t really measure anything on them. The top is softer every day, and the bottom is kind of plasticine. How are you doing with this?? I’ll go to the doctor on the 10th, I’ll have exactly a month if the doc doesn’t call him first. I’ll sign off of course
October 03, 2016 Well, I think I got the second one somewhere. It’s hard to say... Now I’ll also post pictures, from the outside it might be clearer what size I am
23 days from the date of OP
The story of patient “Karina888” was taken from the forum.
Breast reconstruction using your own tissue
An alternative to silicone implants in breast reconstruction can be the use of one’s own tissue in the form of flaps, which include skin with subcutaneous tissue, as well as a fragment of muscle through which the blood supply to this flap occurs (see Figure 3).
Figure 3. Breast reconstruction using your own tissue. Scheme
Most often, these techniques are used to create a large mammary gland, as well as in cases where the stretching of the reconstruction area is compromised by scar changes or radiation therapy.
The most common site for tissue collection for reconstruction is the lower abdomen. Some women develop excess fatty tissue in this area with age and are not averse to getting rid of it. They remove this excess in the same way as an abdominoplasty, but this tissue is then used to create volume and shape to the lost breast.
This is a rather complex and labor-intensive operation that lasts several hours and may require a stay in the intensive care unit, blood transfusions and a hospital stay of 7 to 10 days. In this regard, the cost of reconstruction using your own tissues is significantly higher than using silicone implants.
However, reconstruction with your own tissue rarely requires repeated interventions, and also allows you to create symmetrical breasts of almost any size compared to the opposite one (see photos 11-16).
Photo 11. Before and after breast reconstruction using your own tissue. Patient 1
Photo 12. Before and after breast reconstruction using your own tissue. Patient 1
Photo 13. Before and after breast reconstruction using your own tissue. Patient 1
Photo 14. Before and after breast reconstruction using your own tissue. Patient 2
Photo 15. Before and after breast reconstruction using your own tissue. Patient 2
Photo 16. Before and after breast reconstruction using your own tissue. Patient 2
In what cases is repeat mammoplasty necessary?
After the first plastic surgery, complications may arise that must be addressed immediately. Let's look at the problems that, according to statistics, most often lead to repeat mammoplasty.
For example, 28% of patients who returned to a plastic surgeon were diagnosed with capsular contracture. The fibrous tissue formed around the implant leads to its deformation; the integrity of the prosthesis shell may be compromised in this case, which poses a threat to women's health. According to the timing of manifestation, contracture can be early and late; early contracture manifests itself within the first 12 months after surgery.
In patients who do not follow the doctor’s recommendations after surgery or who violate the rules of life during rehabilitation, the implant may become displaced. Displacement of the prosthesis can be caused by lying on the stomach or side, or lifting heavy objects.
Violation of the integrity of the implant shell, resulting from sudden mechanical impacts (accident, fall), requires mandatory correction. Due to the installation of a large implant, a woman’s skin integrity may be compromised, tears and cracks may form.
In addition, repeated surgery is necessary if a woman has the following reasons:
- oncology was detected;
- displacement of the prosthesis due to an incorrectly formed pocket;
- contouring formation;
- seroma;
- ptosis (drooping);
- a prosthesis of poor quality that has lost its shape during use;
- double fold.
A sharp change in body weight, pregnancy, breastfeeding, age-related changes are common reasons why breast correction becomes necessary.
Breast reconstruction using combined techniques
There are situations where your own tissue is required, but it is not enough to create sufficient breast volume. In such cases, combined techniques are used, when a small flap from the back is used, moved to the chest wall area and a silicone implant of the required volume and shape (see Figure 4).
Figure 4. Combined breast reconstruction. Scheme
This reconstruction method is used in women who have had radiation therapy. To reduce the risk of complications and improve blood supply to the area, these patients require repositioning of vascular-rich tissue that will provide long-lasting aesthetic results (see Figure 17).
Photo 17. Result of combined breast reconstruction
CASES FOR BREAST RECONSTRUCTION
Breast reconstruction surgery solves aesthetic and physiological problems. The absence of breasts leads to a change in the load on the spine - over time, this provokes deterioration of posture, drooping of the shoulders and other secondary changes in the osteoarticular system. Due to the curvature of the spine, the functioning of the lungs and heart is disrupted.
To use services for breast reconstruction after mastectomy, make an appointment on the website, call the reception (+7 (8617) 309-001) or request a call back.
Author of the article
Plastic surgeon
Astashkin Pavel Vyacheslavovich
Mammoplasty via axillary access
Revision mammoplasty through the axillary approach, also called the axillary approach, takes place in the area where the armpit is located. With the help of subcutaneous tissue, penetration occurs into a certain layer. This allows you to install implants not only under the pectoral muscle, but also under the genital glands. The breast tissue itself will not be affected in any way. The main advantage of this approach is the absence of scars after surgery.
In the absence of ptosis, the axillary approach is the best option. It is low-traumatic, and you won’t be able to damage anything even by accident. During any type of operation, the smallest vessels are crossed, but this should not be feared, because they are capable of regenerating. Implants are used both round and teardrop-shaped. Problems arise only with overly large implants.
Why scars form after mammoplasty
The formation of barely noticeable scars and rough, unaesthetic scars after completion of mammoplasty is due to several factors. First of all, it is worth mentioning about people whose skin is not prone to scarring. Injuries and cuts pass without a trace for them, reminding of themselves only as a thin, barely noticeable line.
The reasons for pronounced hypertrophy in women after breast augmentation are associated with tension in the skin and the edges of the suture. Access to the area where the implant will be installed is provided through the inframammary fold or an incision along the diameter of the areola. The affected areas scar over time.
Why else do scars remain after mammoplasty:
- Heredity. The tendency to form keloids is often associated with a genetic factor. It is almost impossible to identify it at the stage of planning the operation.
- Sloppy work of the surgeon. Mammoplasty involves layer-by-layer dissection and division of the mammary gland. At the end of the operation, stitches are applied. Inaccurate stitching of tissues leads to roughening of the operated area.
- Suture material. Incorrectly selected threads, in particular absorbable ones, provoke aseptic inflammation and scarring of the dermis.
- Poor quality electrocoagulation. The procedure of “sealing” the capillaries is necessary to prevent bleeding. The outer layers of the mammary glands cannot be treated with an electrocoagulator.
The visibility of a scar on the breast after breast augmentation, reduction or lifting depends on the experience of the specialist and the technique he uses. If a woman follows all the doctor’s recommendations regarding the postoperative period, the risk of rough sutures will be minimal.
Types of scars after mammoplasty
Modern technologies for plastic surgery, which include breast size correction and breast lift, suggest that the scars will be barely noticeable.
To perform mammoplasty, the surgeon practices one of the methods of cutting the breast tissue:
- Submammary - access through the fold under the mammary gland. The scar resembles an imprint from a bra band.
- Periareolar - an incision between the pigmented areola of the nipple and the skin of the breast is made for the purpose of tightening. After removing excess skin, a small scar remains on the stitched area. It resolves and becomes barely noticeable after about six months.
- Transabdominal – subcutaneous passage for implantation is carried out through an incision in the periumbilical region. The procedure is easily tolerated by the body and does not leave noticeable marks on the stomach.
- Transaxillary - incisions are made in the armpits. The method is rarely used due to the risk of bleeding. It is not suitable for correcting asymmetrical breasts and displacement of the natural fold.
To drain fluid, patients are given drainage tubes. Their presence causes swelling and bruising. Sutures cannot be wetted or treated with special preparations immediately after surgery, and bruises cannot be removed either. To reduce swelling, experts recommend applying elastic bandages and wearing compression garments.
Plastic surgeons do not use self-absorbing threads to suture the mammary glands. 10 days after the operation, the sutures have to be removed as usual, which causes pain and discomfort.
In women, scars after mammoplasty, photos of which are given below, form in several varieties:
- Normotrophic – light and elastic.
- Hypertrophic - pink seals slightly rise above the surface of the epidermis.
- Keloid – noticeable lesions protrude above the skin and have an uneven texture.
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