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Breast reconstruction after mastectomy

Written by: Prof. Paolo Persichetti
Edited by: Top Doctors®

In developed countries, breast cancer is second only to skin cancer. This cancer is also debilitating in the psychological aspect, because the breast is not an essential part of the life of the organism, but an important part of the female body. A woman placed before the diagnosis of breast cancer, in fact, will face two heavy problems: on the one hand to defeat the disease; the other to see his body change. The professor. Paolo Persichetti, an expert in Plastic and Reconstructive Surgery , explains how a woman can regain his form after undergoing a mastectomy



What is the goal of breast reconstruction?

The goal of building a breast after a total mastectomy is to ensure that women have the sensuality and femininity he possessed before his illness. This element should not be underestimated: If she feels good about her body, there will be more chance that you will feel better even from the physical point of view.


What are the differences between a woman who undergoes breast surgery for cosmetic reasons and another who is suffering from cancer?

The patients who also require radiotherapy are a challenge for the surgeon: for this type of patients with breast implants procedures often prove difficult, since the fabrics have lost elasticity after radiation therapy, with a risk of infection and rejection of 'plant much greater than the patients who undergo an operation breast for cosmetic reasons.


How do you rebuild a breast after a mastectomy?

Currently on the market are three types of plants: temporary tissue expanders, expanders permanent and definitive plant tissue.

The final systems offer a wide choice regarding the surface, filling, shape and size of the prosthesis. Prostheses are constituted by a silicone elastomer envelope and containing silicone gel or a saline solution. The surface of the prosthesis can be of three types: smooth, textured or polyurethane. As regards the shape, the prosthesis can be either round that anatomical. The latter have a teardrop shape and give it a more natural look.

The prostheses are chosen by the surgeon with the patient, on the basis of three parameters: height, projection and base diameter. This is because the profile and size of the breast must fit and be proportionate to the woman's body: the very large implants are not suitable, for example, the body of a very slender woman.

The temporary tissue expanders are systems whose purpose is to stretch the tissues and reconstruct the breast pad, creating the space needed to position following the definitive implant. The process, known as tissue expansion, consists of a series of saline injections through a valve, which allows the expander to achieve the desired volume. The expander is then left in the breast for a period of about 4-6 months, the time necessary to prepare the tissues to accommodate the definitive implant.

Permanent tissue expanders, called prostheses Becker, have two purposes: to expand the tissues and act as long-term implants for breast. They are, in fact, designed to remain inside the breast once accomplished the expansion process. This is to avoid a second surgery for the definitive implant placement and to maintain the ability to manipulate the volume through a valve, usually located in the axillary region. Even for this type of prosthesis, there are different models, but the percentage of the prosthesis emptying is higher than that of temporary installations.


Temporary facilities: the solution adopted after a mastectomy


Temporary installations generally represent the most viable alternative for breast reconstruction after a mastectomy.

The first step is to set up a sottomuscolofasciale pocket underneath the pectoralis major muscle, pectoralis minor and serratus anterior. It is, then, placed the plant, which is filled for about 20% of its volume from a saline solution. Two drains are placed in the axillary region and the muscle pouch. The expansion, which often takes place thanks to a separate valve, can begin two weeks after surgery and continuing for 6-8 weeks, until reaching the volume and the desired shape. Chemotherapy does not affect the expansion, the two can be carried out simultaneously, except in the case of severe neutropenia.

Once you reach the desired volume, the surgeon removes the temporary facility and enters the final one. For this step, however, we must wait until the end of chemotherapy and the patient is in good physical shape.

Breast reconstruction after a debulking surgery such as total mastectomy proves very important for the patient, who in the new breast will regain self-confidence and awareness of defeating the disease.


Editor Karin Moscow

*Translated with Google translator. We apologize for any imperfection

By Prof. Paolo Persichetti
Plastic surgery

Prof. Paolo Persichetti specializes in Plastic, Aesthetic and Reconstructive Surgery. He completed his training by attending some of the most important Italian and foreign centers and universities (Brazil, France, Germany, USA). It deals in particular with breast reconstructions (tubular, tubular and gynecomastia), reconstruction of the face and body remodeling after weight loss or post-bariatric, as well as neoplasms and skin reconstructions. He is also an expert in the reconstructive Chrirugia of the pelvic-perineal region and of the chest wall, and of the treatment of aging of the face. He is currently Head of the Complex Operative Unit Plastic, Reconstructive and Aesthetic Surgery of the Rome Bio-Medical Campus, Director of the School of Specialization in Plastic, Aesthetic and Reconstructive Surgery of the Campus Bio-Medico University of Rome and Full Professor at the same University . Since 2004 he has been a Councilor of the Association of Plastic Surgeons of Central Italy and since 2010 he is a Member of the Executive Committee of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery (IPRAS).

*Translated with Google translator. We apologize for any imperfection

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