What does reconstruction with breast expanders involve?
It consists of the introduction of an empty implant into the bed of the mastectomy (where the breast was). This implant (expander) is periodically filled with liquid in the clinic, through an injection of a saline serum through the skin, until it has expanded and it is possible to place a definitive mammary prosthesis.
This type of reconstruction should be performed in two interventions, the first to put the expander in place and the second to replace it with a definitive prosthesis. There should be a period of three months between the first and the second surgery. Specific expanders are designed in a way that allow them to be maintained as definitive implants, which means that just one intervention would be required.
The placement of the implant is performed in an hour, under general anaesthetic, with a hospital stay of one or two days.
What options exist for mammary reconstructions with the patient’s own tissue?
These tissues can be transferred from the lower part of the abdomen, from the back or from the gluteal muscles.
Autologous reconstruction, while technically more complex, offers better aesthetic results and durability than reconstruction with implants and allows for reconstructions to be performed in a single surgery. In addition, the reconstructed area tolerates radiotherapy better.
With abdominal tissues
This technique allows for the reconstruction of the breast through the skin and the fat of the lower part of the abdomen (the area located between the belly button and the pubis).
These tissues can be transferred using the abdominal rectum muscle through a tunnel between the abdomen and the breast (pedicled TRAM flap) or through micro-surgical techniques (free TRAM flap, DIEP flap), aiding the reconstruction of voluminous breasts with a natural droop (breast ptosis).
The abdominal skin is closed leaving a horizontal scar above the pubis, providing the added benefit of improving the contour of the abdomen.
The intervention lasts for between 5 and 8 hours, depending on whether conventional or micro-surgical techniques are used to transfer the tissues, under general anaesthesia. The time spent in the hospital is approximately 5 days. It is essential to wear an abdominal band (like those worn after pregnancy) for 4 weeks after the surgery.
Who is it meant for?
It is meant for women in a good state of health and who have sufficient abdominal skin.
Who is it not meant for?
For patients who are very thin or very obese (for the risk of complications in the abdominal wall), in women who smoke (for the risk of necrosis of the abdominal skin) or when there are scars in the abdomen, although a caesarean scar does not contraindicate the use of this technique.
With Back Tissues
With this technique, the breast is reconstructed using the skin and fat from the back. It is transported to the breast by mobilising the latissimus dorsi muscle. The area of the back is closed, leaving a horizontal scar that can be covered with the elastic strap of a bra or a swimming suit.
The volume that the skin, fat and muscle of the back provides is not usually enough to make a breast of the same size as the other one. Thus, it is almost always necessary to add prosthesis.
The approximate duration of this intervention is 3 hours, under general anaesthesia, and requires a hospital stay of two to four days.
Who uses it? Women who cannot use the tissue from their abdomen for the reconstruction, such as those who are thin and do not have abdominal tissue or those with abdominal scars, as well as obese women and smokers.
With Gluteal Tissues
When it is not possible to use tissue from the abdomen or the back, the breast can be reconstructed with skin and fat from the buttocks. These tissues can be transferred using microsurgery. The resulting scar is located in the lower or upper part of the buttocks and is usually more difficult to hide than scars on the abdomen or the back.
The approximate duration of this intervention is 7 hours, under general anaesthesia and requires a hospital stay of approximately 5 days.
Who uses it? This technique is only used when it is not possible to use any other autologous technique.
Micro-surgery allows the plastic surgeon to suture arteries and veins of approximately a millimetre in diameter, through the use of a microscope and magnifying glasses.
This technique allows for the transfer of tissues from a distant area of the body (for example, the abdominal skin or the buttocks skin) to the breast that needs to be reconstructed and reduces the damage of different structures other than skin and fat, such as muscle.
Generally, micro-surgical techniques provide better results than conventional techniques, although interventions are longer (between 5 and 8 hours), which require specific surgical training. As such, not all surgeons provide these.