Mammary reconstruction after total mastectomy
Breast reconstruction consists of three stages:
- Reconstruction of the VOLUME of the amputated breast,
- SYMMETRISATION of the breast on the other side
- The reconstruction of the areola and nipple area (ANA)
Reconstruction of the volume of the amputated breast
– If the skin is of satisfactory quality and suppleness (especially if it has not been burned by radiotherapy) it is possible to simply insert an IMPLANT or sometimes perform LIPOMODELLING.
– If the skin is of satisfactory quality but of insufficient quantity to allow for an implant to be inserted at the outset, an EXPANDER can be inserted initially. This is a balloon inserted under the skin with a valve that can be tweaked from the outside (like a portacath) in order to expand it using physiological serum, thus gradually distending the skin (as would happen in pregnancy to the abdominal skin). There will be one or two inflation sessions per week for between one and three months until a sufficient amount of skin has been stretched. The balloon is then removed and the prosthesis inserted during a second operation.
– If the skin is of poor quality, an equivalent amount of healthy skin must be inserted to replace the patch of skin that was removed. It is possible to take this skin either from the back (horizontal scar hidden by the bra) or from the belly (horizontal scar above the pubis). These are skin flap sections taken from the LARGE DORSAL (back) or abdominal (TRAM – transverse rectus abdominis) areas.
| PROSTHESIS | Hospitalisation generally for one to three days |
| Advantages | Little scarring, quick operation |
| Disadvantages | Risk of a significant shell (++ greater if there has been radiotherapy) Breast reconstruction via prosthesis – See the information file |
| EXPANDER (then prosthesis) | Hospitalisation for one to four days x 2 in general |
| Advantages | Little scarring, fairly short operation |
| Disadvantages | Not always performable, numerous appointments are required, more operations and risk of a serious shell formation (even more if there is radiotherapy) |
| GRAND DORSAL | Hospitalisation generally for four to seven days |
| Advantages | Quite reliable, contributes healthy skin |
| Disadvantages | Scarring on the back and breast (diamond-shaped scar), requirement for a prosthesis and muscle extraction from the back Breast reconstruction through the Large Dorsal muscle – See the information file |
| TRAM | Hospitalisation generally for five to eight days |
| Advantages | No need for an implant, re-stretches the belly skin (++ if there is an apron) |
| Disadvantages | Less reliable than using the large dorsal flap, abdominal + breast scar (diamond-shaped), weakens the abdomen (flap) – See the information file |
| LIPOMODELLING | Hospitalisation for one day in general |
| Advantages | No foreign bodies inserted, intervention less mutilating and no additional scarring |
| Disadvantages | Very long operation, one that generally has to be repeated several times to get enough volume, cannot be performed on all patients. See the information file |
Symmetrisation of the opposite breast
This has to be done once the reconstructed breast has taken its final shape (at least two months after the first operation).
- If the other breast is identical in shape and volume to the reconstructed breast, nothing needs to be done.
- If the other breast droops, it needs lifting (with a SCAR around the areola, that may be extended by a vertical or anchor-shaped scar) and the volume may need to be reduced.
- If the breast is small, a PROSTHESIS may need to be inserted (especially if a prosthesis was inserted on the other side. For this symmetry operation, one to two days in hospital will be necessary.
Reconstruction of the ANA (areole and nipple area)
- TATOOING is performed at the doctor’s office but does not make it possible to restore the relief of the nipple.
- Skin GRAFTING requires hospitalisation for one day. The skin is taken from the fold between the pubis and the thigh. The transplant is combined with nipple surgery to restore its volume.