Breast surgery after mastectomy. Breast reconstruction after mastectomy. The advantages of the method are that

Quite often, it is this fear of breast loss that prevents women from undergoing a timely examination by an oncologist and starting special treatment.

For this reason, maintaining a good quality of life after a successful operation, as well as informing women about the existing possibility of adaptation after removal, is the most important task of modern plastic and reconstructive surgery.

Breast plastic surgery after removal is a complex of operations that allow you to “return” the lost mammary gland. In addition, the operation allows you to make a woman’s figure more aesthetically pleasing.

Thanks to modern methods of breast reconstruction after surgery and the high level of development of aesthetic surgery, it is possible to achieve a cosmetic result that is comparable in quality to all the aesthetic needs of women who strive to become the owners of attractive forms, and not just to compensate for a physical defect.

Breast reconstructive surgery makes it possible to restore volume and shape using different methods, which can be divided into two large segments.

Breast reconstruction after mastectomy using artificial materials:

Breast reconstruction using a breast implant

The first step is the installation of a tissue expander. Depending on the characteristics of the underlying disease and the extent of surgical intervention, it is possible to install a tissue expander immediately during a mastectomy or after a certain period of time.

After breast removal surgery, the volume of soft tissue on the chest (skin, subcutaneous tissue, pectoral muscles) may not be enough to install an implant. To create the required “reserve” of tissue, the doctor installs an expander, which is essentially an implant, with the ability to gradually increase the volume by filling it with saline solution. Thus, the surrounding tissues will gradually stretch and form the future contours of the reconstructed bust. This process begins immediately after surgery.

Expander filling is performed on an outpatient basis and does not cause any physical discomfort. Adaptation of tissues to the future volumes of a breast endoprosthesis in most cases takes 6 months.

The second stage is to replace the tissue expander with a special implant. This operation is performed to increase volume and also to give shape to the bust and, in fact, is similar to mammoplasty - breast plastic surgery after childbirth or increasing bust size.

If this stage allows you to achieve the desired aesthetic result (symmetry and attractive breast shape), then the main task of the aesthetic surgeon - restoring the quality of life - is considered completed.

The third stage is to optimize the aesthetic result. Modern possibilities of plastic surgery can also satisfy the patient’s aesthetic needs for correcting the shape of healthy breasts. These can be various options for mastopexy (breast lift), which make it possible to obtain the maximum possible symmetry of the mammary glands, and in addition, reconstruction of the nipple, which was lost during the mastectomy.

Breast reconstruction using autologous tissues

In such operations, in order to fill the volume of the mammary gland, a flap of soft tissue is used, which is moved from the back or abdomen. This technique has its own advantage - it allows you to get a good aesthetic and tangible effect of the reconstructed breast.

But such operations are more traumatic and require a separate assessment of the overall contours of the figure, since the moved flap can significantly change the outline of the donor site and leave an additional scar after the operation.

Rehabilitation after breast surgery

During rehabilitation, a woman must follow all doctor’s recommendations.

There are a number of general rules that must be followed:

• heavy lifting and all physical (including sports) activities should be avoided for approximately 6 months after surgery;
• if a woman plans to reduce her overall weight, then it is advisable to do this before breast reconstruction, since weight loss in the period after surgery can have a rather negative impact on the appearance of the bust;
• before surgery, it is necessary to eat nutritiously and well: any diet, lack of vitamins found in meat, vegetables, fish, fruits can only aggravate a woman’s condition in the postoperative period;
• It is recommended not to smoke during the rehabilitation period, as smoking has a negative impact on the healing process;
• It is better to avoid sexual activity for 3-6 weeks;
• Drinking alcohol is prohibited;
• It is prohibited to take medications that affect the blood clotting process (including aspirin);
• a woman should understand that in this case, scar correction will be required 6-12 months after breast surgery;
• You must wear a special bandage for about 6 months.

Modern aesthetic surgery does not stand still: women are offered options for correcting the nuances of their appearance. The main thing is not to delay the treatment of major ailments (to avoid the risks of complications), and also to strictly follow the recommendations of specialists.

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Who do you have to be to worry about your breasts and not your life? When my grandmother was in the oncology center, she was worried that the cancer was getting younger. There were 3 old ladies on the floor. The rest are girls under 40 years old. And by the way, after breast removal, they restore it free of charge.

There are a lot of such girls. For example, when was the last time you had a mammogram? I am several years old, and oncology can appear suddenly.

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What types of breast reconstruction are there after mastectomy?

Breast reconstruction is a big deal. During the reconstruction process, tissues of the back and anterior abdominal wall, as well as the second mammary gland, if its shape needs to be adjusted, may be affected.

Typically subject to restoration:

• volume of skin and subcutaneous fat in the area of ​​the removed mammary gland;
• the volume of tissue around the reconstructed mammary gland if adjacent tissue and the pectoralis major muscle were removed during the mastectomy operation;
• nipple-areolar complex;
• The shape and size of the second breast can be adjusted to improve the appearance of the bust and eliminate asymmetry.

Of all the known plastic surgery techniques, almost any can be used:

• use of Spanderov and thoracic endoprostheses;
• movement of skin, subcutaneous fat and muscles to the area of ​​the reconstructed breast;
• lipomodelling;
• laser polishing of scars;
• tattooing of the areola area;
• In some cases, it is possible to use vacuum devices to stretch the skin in the area where breast reconstruction is being performed after a mastectomy.

As you can see, breast reconstruction requires a large number of skills from a plastic surgeon, so such work should not be trusted to untested people.

What is it for

Lack of mammary glands is not only a psychological problem. Although in most cases it is psychological discomfort that is the motivator for most patients who decide to undergo plastic surgery.

In addition to problems associated with an unaesthetic appearance of the bust after a mastectomy, there may be:

• imbalance of the load on the thoracic spine on both sides: where the mammary gland is preserved, the load will be greater;
• secondary changes in the osteoarticular system associated with an imbalance of the load on the spine, which are expressed by poor posture, drooping of the shoulders, and curvature of the spine;
• consequences of spinal curvature: disruption of the functioning of the chest organs - heart and lungs.

Therefore, after a mastectomy, it is not only a way to regain self-confidence, but also an excellent preventative against a number of chronic diseases of the cardiovascular and respiratory systems.

Video: Life after a mastectomy

What determines the scope of plastic surgery during breast reconstruction?

Not all plastic surgeon patients undergo breast reconstruction operations in the same way. The volume depends on a number of criteria.

• The volume of tissue removed during surgery for cancer.

Depending on the extent of the cancer, varying amounts of tissue may be removed.

The simplest situation is the removal of local formations while preserving the healthy part of the mammary gland. In this case, retracted scars and areas of retraction are formed at the sites of removal of nodes and tumors.

All breast tissue may be removed, preserving the skin and subcutaneous tissue covering the breast. A relatively easy option for subsequent reconstruction. Currently, this type of cancer surgery is rare. In most cases, it is used to prevent breast cancer in people with a genetic predisposition to developing the disease.

Angelina Jolie, whose mother died of cancer, performed this operation on herself. Endoprostheses are installed in place of the removed glandular tissue. Total breast removal is the most common way to remove breast cancer in women.

In cases where there is a risk of spread of metastases, the entire mammary gland, pectoralis major muscle, and subcutaneous fatty tissue of half the breast are removed in order to remove the lymphatic vessels and lymph nodes to which lymph flows from the diseased mammary gland. This option is the most difficult for subsequent bust restoration and requires the special skill of a plastic surgeon.

The patient should be able to undergo the next operation and anesthesia without complications. Here you need to take into account that contraindications for plastic surgery will be much more stringent than for surgery performed for health reasons (for cancer, for example). And what did not prevent surgical treatment of cancer in the past can become a serious contraindication for reconstructive surgery on the mammary glands.

• The appearance of the second breast and the client’s wishes regarding the future size and shape of the bust.

It’s only at first that it seems like there is no life after a mastectomy. Over time, while thinking about and discussing with a plastic surgeon the details of the upcoming reconstructive surgery on the mammary gland, there is often a desire to “tidy up” the healthy mammary gland, if there is any signs of prolapse, or there is a desire to reduce or increase the size of the bust.

One of the reasons why many agree to this is the reluctance to subsequently undergo another anesthesia, when it will be necessary to undergo surgical breast lifting, breast reduction or enlargement.

Do you want that after plastic surgery there are no traces of surgical intervention left on your mammary gland? Find out more about seamless breast augmentation.

Read all about women's breasts, recovery after childbirth and breastfeeding at this link.

How can removal be carried out?

Until recently, it was believed that it was optimal to first remove the mammary gland, and perform reconstructive surgery only a year after the mastectomy.

Some surgeons still believe that this is the best way to prevent the development of metastases and cancer recurrence. But not all patients find it psychologically easy to wait that long. For some, the physical defect becomes so significant that even the fact of getting rid of cancer is no longer pleasing.

Family relationships are deteriorating. According to a number of reports from European authors of opinion polls and studies, 70% of marriages break up in the first two years after mastectomy. As a result, there is no disease, but the quality of life leaves much to be desired.

Therefore, in most cases, reconstruction is now performed simultaneously with removal of the mammary gland, unless there are serious health problems and contraindications to extensive surgery.

How soft tissue is restored in the area of ​​the removed mammary gland

There are several options for restoring tissue volume in the mastectomy area.

An expander can be used

An expander is a special device that is installed in the area of ​​breast reconstruction for a period of 3 to 6 months. It stretches the skin and forms a cavity sufficient for subsequent placement of the implant. Expanders are included in the list of products offered by most companies involved in the production of breast implants. The algorithm for two-stage use and a breast implant is shown in the video.

Video: Breast reconstruction (expander + implant)

It is placed under the skin and filled with liquid over a period of time. The liquid is injected using a syringe. The procedure is performed on an outpatient basis.

Advantages of using an expander:

• much less traumatic operation compared to transplantation of a musculocutaneous flap;
• The final volume of skin required for breast reconstruction is achieved twice as quickly as using a vacuum system.

Disadvantages of using an expander:

• The need for frequent visits to the doctor for injections;
• Unnatural breasts in appearance and to the touch;
• There is a risk of necrosis (death) of tissue over the expander if the skin is stretched too quickly;
• The implant is located directly under the skin, therefore there is a risk of rapid development of ptosis; there are restrictions on the use of a number of implants in terms of gel density, so that the final result is as close to natural as possible.

A vacuum device may be used to shape excess skin in the area where breast reconstruction is planned. For such cases, the Brava system has been developed. You need to wear it for a long time. You need to use it for an hour every day to get the desired result.

The essence of the method is that a special dome-shaped cup is placed on the area of ​​the mammary glands. A vacuum is created under the cup, thanks to which the skin is constantly in a taut state and gradually stretches.

The advantages of the method are that:

• performed simultaneously with liposuction;
• the method allows the use of both implants and transplanted own fat to restore the volume of the mammary gland;
• if fat grafting is used, there is no scarring.

The disadvantages of the method are that:

• you need to wear a special device on your chest for many months;
• it is difficult to achieve significant breast stretching to a large implant size;
• there is a risk of stretch marks and spider veins.

The whole technique consists of three stages:

Stage 1 - preparatory. It involves wearing a vacuum system for a certain period of time every day, hourly. The system can be worn both day and night.

Stage 2 - fat tissue transplantation. Fat is removed from areas where there is usually excess fat using liposuction. Fat tissue is moved to the breast area using injections.

Stage 3 is the final stage. The Brava system must be worn for another 3-4 weeks in order to increase the survival rate of the transferred adipose tissue.

Musculocutaneous flap transplantation

The flap can be transplanted from the back (latissimus dorsi muscle) or the anterior abdominal wall (rectus abdominis muscle).

• mammary gland natural in shape and touch;
• There are no problems associated with the use of implants, such as implant displacement or the need for replacement.

• long-term anesthesia (4-5 hours);
• very high invasiveness of the operation;
• long period of rehabilitation;
• there is a risk of necrosis of the transplanted musculocutaneous flap and its subsequent rejection;
• significant postoperative scars.

Combined technique

To reconstruct the breast, a skin graft from the buttock, abdomen or back and an implant are used.

Restoration of soft tissue around the removed mammary gland.

If an extended operation is performed to remove not only the mammary gland, but also the adjacent soft tissues of the breast, then during reconstruction it is necessary to restore their missing volume from the surgical intervention.

Typically, restoration is performed by transplanting fat tissue, which is taken from those places where there is excess fat.

Methods for restoring the nipple-areolar complex

Without restoration of the nipple and areola, breast reconstruction will be considered incomplete, since it is important for a woman to look good both with and without clothes.

There are three main ways to recreate the nipple and areola:

• the areola is recreated from the areola tissue from the healthy side;
• the skin of the labia minora is transplanted if it is pigmented;
• the nipple is formed from the tissue of the reconstructed mammary gland, and the areola is pigmented using tattooing.

Correction of the second breast

In order to eliminate asymmetry and improve the shape of a healthy mammary gland, a large number of methods are used:

• mastopexy;
• mastopexy with breast augmentation with an endoprosthesis;
• mastopexy with breast reduction.

Less commonly used methods are breast lift with threads and the use of fillers.

What plastic surgeries are performed on nipples and areolas? Read about all types of plastic surgeries performed for inverted nipples in the article - nipple correction.

Breast ptosis is a gradual drooping of the mammary glands and loss of their volume. See photos here.

Contraindications

• presence of infectious diseases;
• the presence of a tumor process of any stage and localization;
• serious diseases of internal organs that impair their function;
• diabetes;
• blood clotting disorder;
• age under 18 years;
• less than a year from the end of lactation;
• general serious condition of the patient;
• obesity;
• doubts about the need and advisability of reconstructive surgery on the part of the patient.

Preparing for surgery

• surgeon consultation;
• laboratory and instrumental examinations to identify possible contraindications to surgery;
• It is forbidden to drink alcohol two weeks before surgery, as this can lead to problems with anesthesia and recovery from it;
• It is recommended to stop smoking at least two months before surgery, especially if musculocutaneous flap transplantation is planned, to prevent problems with delayed healing and necrosis.

Complications

• bleeding;
• swelling;
• necrosis of the skin flap or skin over the expander;
• scars;
• delayed healing;
• infection;
• complications associated with wearing implants (capsular contracture, rotation and displacement of the implant, and others).

Rehabilitation

The time required for the body to fully recover after surgery depends on the extent of the operation itself. If we talk about the Brava method, it is the least traumatic method, which requires sick leave for a maximum of three days during liposuction and fat tissue transplantation.

Full restoration of performance occurs 2-3 weeks after the operation and does not require any restrictions other than a ban on thermal procedures. The use of expanders and endoprostheses essentially involves two operations. During the first, an expander is installed; during the second, it is removed and replaced with an implant.

After each operation, there is a need to limit exercise, take painkillers, and observe a ban on thermal procedures and sunbathing. After installation of implants, wearing compression garments is recommended.

The rehabilitation period is about 4 weeks. If we are talking about the formation of the mammary gland using the method of moving a skin-muscular flap, then the rehabilitation period is often difficult and long.

• the period of stay in the clinic is about days;
• sutures are removed on day 14;
• intense pain is possible, which gradually subsides towards the end of the rehabilitation period;
• ban on heavy lifting and intense physical activity for a period of at least 6 months;
• wearing a bandage or compression garments for at least six months after surgery;
• avoiding sexual activity for 3-6 weeks after breast reconstruction.

The recovery period in this case can be from 6 weeks.

What is false gynecomastia, symptoms, and how you can get rid of it, in this article. What methods exist in modern medicine for breast lift without implants, read the link.

Are you wondering if you can breastfeed your baby with silicone breasts? That way.

Photos before and after

Your feedback

I don’t understand why inserts in a bra are bad? Such a serious operation, and even with anesthesia.

What about without a bra? And it’s good if an even scar remains. And if the scars are rough and thick. You'll have to clean it up anyway. And it won't always work with a laser. This means it’s still an operation, and it’s still pain relief.

I did it for myself. To be honest, I was very afraid and very doubtful. And she did it only for her husband, because she was very shy about him. The second operation, which was for restoration, took place more than a year after removal. All the time I just wore a pad sewn into my bra, without any silicone inserts. I can say that the second operation was worse than the first (skin, fat and muscles were transplanted from the back). Maybe because it’s so complicated, or maybe because all this hassle with hospitals has exhausted me. And my husband wasn’t particularly supportive. Now I think that I would not agree to such a serious operation, since I am still recovering from it. What won me over was that there would be no problems with the implants later, but it would be better if I chose an expander.

But they didn’t take me for reconstructive surgery. They said it was because of arterial hypertension and something with the heart rhythm. Now I am treating my heart and blood pressure and hope that they will take me for the second time.

The topic is very difficult, I was affected by this situation a year and a half ago, my left breast was removed, I am not married and have no children, a very large complex formed, at first I also put a small pad in my bra, but as with a young man, before intimacy I just had a stopper, In the end, I decided to undergo such a complex operation in order to improve my personal life, fortunately all the medical indications were in my favor! The best surgeon in Moscow, Sazhienko Vladimir, operated on me at the Beauty Trend clinic, the operation was easy and without complications for me, now everything is fine, I came to my senses and began to enjoy life again!)

Breast surgery: aesthetics after mastectomy

Regardless of age, a woman always wants to feel desired and attractive. But when breast cancer appears in her life, radical treatment deprives her of confidence in her femininity. Breast plastic surgery will help the patient successfully undergo psychological and social rehabilitation after mastectomy.

Breast reconstruction surgery varies:

one-stage mammoplasty – performed immediately after the main breast surgery.

delayed mammoplasty - performed some time after breast removal.

By volume

plastic surgery after partial removal

reconstruction after complete removal

Based on materials

reconstruction using artificial materials (implants, expanders)

reconstruction using one's own tissue (skin flaps, cartilage grafts)

By type of symmetry

Contraindications

There are a number of contraindications to plastic surgery after mastectomy.

• Large tumors
• Severe forms of oncology
• Tumor relapses and metastases
• Cardiovascular diseases
• Lung diseases
• Diabetes

In addition, a specialist may refuse plastic surgery to a patient for other severe diseases of organs and systems, when the intervention will do more harm than good. One of the common reasons for a doctor’s refusal to perform mammoplasty after breast removal is the patient’s obesity.

One-step reconstruction

This type of mammoplasty does not always provide an excellent aesthetic effect. But at the same time, the patient will not have to experience a feeling of inferiority due to the absence of a mammary gland. Simultaneous reconstruction has a positive effect on the emotional state after mastectomy.

If plastic surgery is performed using implants, they must be selected in advance. Implants come in spherical and anatomical shapes, from various materials, with different structures. The desired one is chosen taking into account the patient’s wishes, but at the same time, it is important to draw her attention to the most suitable one from the point of view of harmony and symmetry.

After the main stage, mastectomy, the surgeon forms a bed for the implant in the muscles, places it there and sutures it. The patient is recommended to wear special compression garments for 6 weeks.

Two-stage mammoplasty

Often with mastectomy there is a deficiency of soft tissue. In this case, specialists choose a two-stage technique. First, the space under the skin is increased using an expander, a kind of dilator. Its peculiarity is a special valve, with the help of which a small thin expander already installed under the skin can be enlarged by adding a solution to it. The expander begins to fill 2-4 weeks after the mastectomy. And the entire process of expansion - expansion - can take from 4 weeks to several months. As soon as the soft tissues adapt to a certain volume, the doctor changes it. Thus, at the first stage, a bed is formed. At the second stage, the expander is replaced with a permanent implant.

Combined, infillable expander-implants are often used. They allow you to achieve a good cosmetic effect with one-stage mammoplasty. With their help, surgeons have even learned to simulate the natural descent of the breast. They deliberately overstretch the soft tissue and then reduce the implant to the planned size.

Plastic surgery using your own tissues

The surface of the breast after a mastectomy can be restored not only through stretching, and the volume does not have to be restored with implants. Modeling from your own flaps is a fast and effective operation. In this case, the filling is also formed from its own tissues. With this type of plastic surgery, the surgeon uses areas of skin, muscle and fatty tissue from the back, abdomen, thighs and buttocks.

Doctors use various methods of breast shaping after mastectomy, but the most popular all over the world is the “TRAM flap”. With this technique, the doctor cuts out a flap from the anterior surface of the abdominal wall in a special way. The tram flap must contain both skin and subcutaneous fat with arteries and veins, and muscles. This flap is moved, and the donor site is reinforced with a special mesh before being sutured.

Nipple and areola surgery

This final operation is the aesthetic culmination of female breast reconstruction. This stage is usually performed under local anesthesia. First, the surgeon restores the required volume, and then performs a medical tattoo.

If necessary, additional volume is added to the nipple using fat injections or a special gel.

You can get specialist advice:

About 20% of patients resort to repeated breast augmentation surgeries for both aesthetic and medical reasons, including incorrect choice of implant size, damage to the implant, caps.

McGhan Medical (Inamed, now Allergan) is a leading global supplier of breast implants. The collection of implants includes a huge selection of models, taking into account any anatomical features.

All materials on our website are for informational purposes only.

Be sure to consult a specialist.

Breast reconstruction after mastectomy

Modern plastic surgery can offer many correction operations. One of the most popular is breast reconstruction after mastectomy. Many women develop an inferiority complex due to partial or radical breast removal. Currently, it has become possible to fully restore not only the mammary gland, but also the nipples, as well as correct the shape of the second breast. Doctors recommend reconstruction surgery in one stage, that is, to simultaneously restore the glands, nipples and areolas.

Scope of reconstruction

Breast reconstruction often involves other parts of the body, including the second gland, areolas and nipples, as well as tissue from the front of the abdomen and back.

Key aspects of recovery:

• nipples and areolas
• tissue affected during mastectomy
• second gland in case of asymmetry
• fatty tissue and skin in the area of ​​the reconstructed gland

The volume of reconstructed material depends entirely on the condition of the patient’s mammary glands.

Doctors consider a number of factors to determine the extent of surgery:

1. The amount of tissue removed during mastectomy. The method of surgical treatment of breast cancer with the removal of only breast tissue and preservation of subcutaneous tissue and skin is extremely rarely used. However, in this case, the restoration operation becomes a fairly simple task. At the moment, they are increasingly resorting to surgical intervention, in which not only the entire mammary gland is removed, but also the pectoralis major muscle and subcutaneous tissue from at least half of the breast. This is necessary in order to be able to gain access to the lymphatic vessels and nodes with their subsequent removal. In such a situation, breast reconstruction after mastectomy is a complex operation and is trusted to top-class surgeons who can perform it without any complications.
2. General condition of the woman. The surgeon must evaluate the patient’s ability to endure repeated surgery and the introduction of anesthesia into the body. Unfortunately, plastic surgery has many more contraindications than surgical intervention necessary to save a life. Only a highly qualified specialist can assess the situation after conducting a complete health examination.
3. A woman's desires regarding the appearance, size and shape of both breasts. Only at first, most women are very worried about changes in their breasts after surgery to remove cancer cells. When considering the option of breast surgery to restore it, many people think not only about reconstructing the operated gland, but also about lifting the second one. Some even express a desire to change the shape and size of both mammary glands. This procedure has a positive effect on the psychological state of a woman.

Recovery methods and contraindications

The main recovery methods include:

• use of fabric expanders with further implantation
• use of rectoabdominal flap
• use of thoracodorsal flap

A silicone implant can be implanted either as a whole or in combination with a tissue expander. Such surgery is a fairly simple method of reconstruction and does not require taking tissue from other parts of the body. The method is used only in cases where there is a sufficient amount of tissue to insert the implant. Doctors call an unpleasant moment the fact that the result can be unnatural, spherical and hard-to-touch breasts. There is also a high likelihood of necrosis or tissue shrinkage. In these cases, immediate removal of the implant will be required.

The method using a rectoabdominal flap seems to be more positive. The tissue for implantation is taken from the thighs or abdomen. A large amount of material is taken, which makes it possible to reproduce breasts that are as close to natural as possible. Such a mammary gland will respond to all changes in the body, for example, weight gain or loss. However, a set of restorative procedures for the donor area will be required.

The third method is a combination of the first two, since the reconstruction uses one’s own back tissue and an implant. Tissue is needed to cover the implant, which allows for a more natural-looking breast. This method is more acceptable than using an implant alone. However, there are also disadvantages: a very noticeable scar forms on the back, and the flap may lose its elasticity over time, which will negatively affect the appearance of the gland.

Breast reconstruction after mastectomy can be performed using any of three methods, but the choice must be made by a qualified surgeon after assessing the patient's condition. He will also give detailed recommendations regarding the pre- and postoperative period.

Contraindications to plastic correction:

• organ diseases
• pregnancy and breastfeeding
• diabetes
• infectious diseases
• autoimmune pathologies
• poor blood clotting

Restoration of the nipple-areola complex

The completion of breast reconstruction surgery is usually plastic surgery of the nipples and areolas. This stage is extremely necessary to eliminate physical discomfort and bring the mammary glands to the desired appearance.

Nipple and areola reconstruction can be done in one of three ways:

• transfer
• tattoo
• using cartilage tissue and tissue flaps.

Nipple plastic surgery is often performed repeatedly. This is due to the fact that nipples can flatten over time and lose their natural appearance. The first nipple restoration can be performed three months after glandular surgery. At this time, the sutures begin to scar, and the swelling practically disappears. However, many surgeons advise performing the operation in several stages and simultaneously restoring the gland and nipple with areola.

Areola reconstruction is possible using:

• donor skin
• tattoo
• skin flaps taken from the external genitalia

Nipple reconstruction requires more skill from the surgeon due to the complexity of the procedure. The following methods are usually used using:

• fabric made from artificial materials
• donor skin
• areas of the patient’s own skin taken from other areas of the body

After transplantation, many patients are satisfied with the result. Areolas and nipples have a fairly natural appearance and color. However, in some cases, nipple rejection or displacement, as well as discoloration, may occur.

Preparation for surgery and possible complications

First of all, a woman will need to find a qualified surgeon who can perform plastic surgery as efficiently as possible. Next, the patient is examined and interviewed. The doctor must assess the situation as a whole and inform about all possible risks.

It is worth remembering that plastic surgery has a fairly large number of contraindications. For the most accurate assessment, it is necessary to undergo instrumental and laboratory examinations.

Mammologists give several recommendations regarding bad habits. For example, you need to stop smoking at least two months before the upcoming plastic surgery, and alcohol at least two weeks before. The first can significantly slow down the healing process, and the second can create problems with the effects of anesthesia on the body.

Plastic surgery, like any other surgical intervention, can result in complications:

• implant displacement
• bleeding
• necrosis of the skin flap or skin above the expander
• scars
• infection
• capsular contracture
• rotation of the implant
• slow healing
• swelling

Care and rehabilitation

The postoperative period often turns out to be quite a difficult time for a woman. The thing is that performing two operations in a short period of time greatly affects the general condition of the patient. After plastic surgery, doctors must establish regular monitoring for complications.

In cases where skin has been harvested for grafting, physiotherapy should be carried out to develop the donor areas. A physiotherapist helps a woman adjust to her new life with some restrictions regarding physical activity. The specialist talks about the most convenient ways to carry out daily tasks.

A few basic rules for the postoperative period:

• after discharge for 3-6 days it is recommended to extend bed rest for several weeks
• For the first 3-4 weeks, any physical activity and heavy lifting are prohibited
• In the first month, it is necessary to visit your doctor every week (sutures are removed on days 7-11)
• the desired result will be visible after two to three months

After nipple surgery, daily treatment of wounds with antimicrobial ointments and changing of a sterile dressing will be required. Decompression underwear will be an excellent assistant in the postoperative period. This bra will not cause discomfort, unlike a regular one.

Now a little about the secrets of dealing with chest pain

Carrying out a mastectomy becomes a serious blow to the emotional state of a woman. However, modern plastic surgery can help with reconstruction, even if the operation is extremely complex. This procedure allows women to get rid of complexes as quickly as possible and return to their normal lives.

Breast reconstruction is a big deal. During the reconstruction process, tissues of the back and anterior abdominal wall, as well as the second mammary gland, if its shape needs to be adjusted, may be affected.

Typically subject to restoration:

• volume of skin and subcutaneous fat in the area of ​​the removed mammary gland;
• the volume of tissue around the reconstructed mammary gland if adjacent tissue and the pectoralis major muscle were removed during the mastectomy operation;
• nipple-areolar complex;
• The shape and size of the second breast can be adjusted to improve the appearance of the bust and eliminate asymmetry.

Of all the known plastic surgery techniques, almost any can be used:

• use of Spanderov and thoracic endoprostheses;
• movement of skin, subcutaneous fat and muscles to the area of ​​the reconstructed breast;
• lipomodelling;
• laser polishing of scars;
• tattooing of the areola area;
• In some cases, it is possible to use vacuum devices to stretch the skin in the area where breast reconstruction is being performed after a mastectomy.

As you can see, breast reconstruction requires a large number of skills from a plastic surgeon, so such work should not be trusted to untested people.

What is it for

Lack of mammary glands is not only a psychological problem. Although in most cases it is psychological discomfort that is the motivator for most patients who decide to undergo plastic surgery.

In addition to problems associated with an unaesthetic appearance of the bust after a mastectomy, there may be:

• imbalance of the load on the thoracic spine on both sides: where the mammary gland is preserved, the load will be greater;
• secondary changes in the osteoarticular system associated with an imbalance of the load on the spine, which are expressed by poor posture, drooping of the shoulders, and curvature of the spine;
• consequences of spinal curvature: disruption of the functioning of the chest organs - heart and lungs.

Therefore, after a mastectomy, it is not only a way to regain self-confidence, but also an excellent preventative against a number of chronic diseases of the cardiovascular and respiratory systems.

Video: Life after a mastectomy

What determines the scope of plastic surgery during breast reconstruction?

Not all plastic surgeon patients undergo breast reconstruction operations in the same way. The volume depends on a number of criteria.

• The volume of tissue removed during surgery for cancer.

Depending on the extent of the cancer, varying amounts of tissue may be removed.

The simplest situation is the removal of local formations while preserving the healthy part of the mammary gland. In this case, retracted scars and areas of retraction are formed at the sites of removal of nodes and tumors.

All breast tissue may be removed, preserving the skin and subcutaneous tissue covering the breast. A relatively easy option for subsequent reconstruction. Currently, this type of cancer surgery is rare. In most cases, it is used to prevent breast cancer in people with a genetic predisposition to developing the disease.

Angelina Jolie, whose mother died of cancer, performed this operation on herself. Endoprostheses are installed in place of the removed glandular tissue. Total breast removal is the most common way to remove breast cancer in women.

In cases where there is a risk of spread of metastases, the entire mammary gland, pectoralis major muscle, and subcutaneous fatty tissue of half the breast are removed in order to remove the lymphatic vessels and lymph nodes to which lymph flows from the diseased mammary gland. This option is the most difficult for subsequent bust restoration and requires the special skill of a plastic surgeon.

• The patient's health status.

The patient should be able to undergo the next operation and anesthesia without complications. Here you need to take into account that contraindications for plastic surgery will be much more stringent than for surgery performed for health reasons (for cancer, for example). And what did not prevent surgical treatment of cancer in the past can become a serious contraindication for reconstructive surgery on the mammary glands.

• The appearance of the second breast and the client’s wishes regarding the future size and shape of the bust.

It’s only at first that it seems like there is no life after a mastectomy. Over time, while thinking about and discussing with a plastic surgeon the details of the upcoming reconstructive surgery on the mammary gland, there is often a desire to “tidy up” the healthy mammary gland, if there is any signs of prolapse, or there is a desire to reduce or increase the size of the bust.

One of the reasons why many agree to this is the reluctance to subsequently undergo another anesthesia, when it will be necessary to undergo surgical breast lifting, breast reduction or enlargement.

How can removal be carried out?

Until recently, it was believed that it was optimal to first remove the mammary gland, and perform reconstructive surgery only a year after the mastectomy.

Some surgeons still believe that this is the best way to prevent the development of metastases and cancer recurrence. But not all patients find it psychologically easy to wait that long. For some, the physical defect becomes so significant that even the fact of getting rid of cancer is no longer pleasing.

Family relationships are deteriorating. According to a number of reports from European authors of opinion polls and studies, 70% of marriages break up in the first two years after mastectomy. As a result, there is no disease, but the quality of life leaves much to be desired.

Therefore, in most cases, reconstruction is now performed simultaneously with removal of the mammary gland, unless there are serious health problems and contraindications to extensive surgery.

How soft tissue is restored in the area of ​​the removed mammary gland

There are several options for restoring tissue volume in the mastectomy area.

An expander can be used

An expander is a special device that is installed in the area of ​​breast reconstruction for a period of 3 to 6 months. It stretches the skin and forms a cavity sufficient for subsequent placement of the implant.
Expanders are included in the list of products offered by most companies involved in the production of breast implants. The algorithm for two-stage use and a breast implant is shown in the video.

Video: Breast reconstruction (expander + implant)

It is placed under the skin and filled with liquid over a period of time. The liquid is injected using a syringe. The procedure is performed on an outpatient basis.

Advantages of using an expander:

• much less traumatic operation compared to transplantation of a musculocutaneous flap;
• The final volume of skin required for breast reconstruction is achieved twice as quickly as using a vacuum system.

Disadvantages of using an expander:

• The need for frequent visits to the doctor for injections;
• Unnatural breasts in appearance and to the touch;
• There is a risk of necrosis (death) of tissue over the expander if the skin is stretched too quickly;
• The implant is located directly under the skin, therefore there is a risk of rapid development of ptosis; there are restrictions on the use of a number of implants in terms of gel density, so that the final result is as close to natural as possible.

A vacuum device may be used to shape excess skin in the area where breast reconstruction is planned. Designed for such cases. You need to wear it for a long time. To get the desired result, you need to use it for 10-12 hours every day.

The essence of the method is that a special dome-shaped cup is placed on the area of ​​the mammary glands. A vacuum is created under the cup, thanks to which the skin is constantly in a taut state and gradually stretches.

The advantages of the method are that:

• performed simultaneously with liposuction;
• the method allows the use of both implants and transplanted own fat to restore the volume of the mammary gland;
• if fat grafting is used, there is no scarring.

The disadvantages of the method are that:

• you need to wear a special device on your chest for many months;
• it is difficult to achieve significant breast stretching to a large implant size;
• there is a risk of stretch marks and spider veins.

The whole technique consists of three stages:

Stage 1 - preparatory. It involves wearing a vacuum system for a certain period of time every day for 10-12 hours. The system can be worn both day and night.

Stage 2 - fat tissue transplantation. Fat is removed from areas where there is usually excess fat using liposuction. Fat tissue is moved to the breast area using injections.

Stage 3 is the final stage. The Brava system must be worn for another 3-4 weeks in order to increase the survival rate of the transferred adipose tissue.

Musculocutaneous flap transplantation

The flap can be transplanted from the back (latissimus dorsi muscle) or the anterior abdominal wall (rectus abdominis muscle).

Advantages of the technique:

• mammary gland natural in shape and touch;
• There are no problems associated with the use of implants, such as implant displacement or the need for replacement.

Flaws:

• long-term anesthesia (4-5 hours);
• very high invasiveness of the operation;
• long period of rehabilitation;
• there is a risk of necrosis of the transplanted musculocutaneous flap and its subsequent rejection;
• significant postoperative scars.

Combined technique

To reconstruct the breast, a skin graft from the buttock, abdomen or back and an implant are used.

Restoration of soft tissue around the removed mammary gland.

If an extended operation is performed to remove not only the mammary gland, but also the adjacent soft tissues of the breast, then during reconstruction it is necessary to restore their missing volume from the surgical intervention.

Typically, restoration is performed by transplanting fat tissue, which is taken from those places where there is excess fat.

Methods for restoring the nipple-areolar complex

Without restoration of the nipple and areola, breast reconstruction will be considered incomplete, since it is important for a woman to look good both with and without clothes.

There are three main ways to recreate the nipple and areola:

• the areola is recreated from the areola tissue from the healthy side;
• the skin of the labia minora is transplanted if it is pigmented;
• the nipple is formed from the tissue of the reconstructed mammary gland, and the areola is pigmented using tattooing.

Correction of the second breast

In order to eliminate asymmetry and improve the shape of a healthy mammary gland, a large number of methods are used:

• mastopexy;
• mastopexy with breast augmentation with an endoprosthesis;
• mastopexy with breast reduction.

Such methods are less commonly used, such as the use of fillers.

Contraindications

• presence of infectious diseases;
• the presence of a tumor process of any stage and localization;
• serious diseases of internal organs that impair their function;
• diabetes;
• blood clotting disorder;
• age under 18 years;
• less than a year from the end of lactation;
• general serious condition of the patient;
• obesity;
• doubts about the need and advisability of reconstructive surgery on the part of the patient.

Preparing for surgery

• surgeon consultation;
• laboratory and instrumental examinations to identify possible contraindications to surgery;
• It is forbidden to drink alcohol two weeks before surgery, as this can lead to problems with anesthesia and recovery from it;
• It is recommended to stop smoking at least two months before surgery, especially if musculocutaneous flap transplantation is planned, to prevent problems with delayed healing and necrosis.

Complications

Rehabilitation

The time required for the body to fully recover after surgery depends on the extent of the operation itself. If we talk about the Brava method, it is the least traumatic method, which requires sick leave for a maximum of three days during liposuction and fat tissue transplantation.

Breast reconstruction after mastectomy is aimed at restoring the previous appearance of the breasts and is carried out at the request of most women who have undergone surgery. By preferring this method, the patient, first of all, strives to restore femininity and beauty in order to feel complete again and start a new life after a difficult breast removal operation.

Breast augmentation after mastectomy is a safe and highly effective procedure aimed at restoring the natural shape and size of the breast. This step is very important for women who have lost their breasts as a result of oncology (cancer, sarcoma), any pathologies (purulent process with gangrene), or due to serious injuries. Breast surgery helps restore both the physical and emotional state of a woman. After the procedure, you can again wear clothes with a deep neckline, sunbathe on the beach, etc. Visually, the artificial breast will have the same shape as the real one, but will be devoid of sensitivity.

Women who are psychologically ready to undergo the full course of treatment and are absolutely confident in the correctness of making such a decision can agree to mammoplasty. An important nuance is the absence of contraindications for surgical intervention, as well as diseases and pathologies that can impede the rehabilitation process and cause negative consequences.

Mammoplasty can be performed immediately after amputation of the mammary glands, or some time later, after the wound has healed and the body has recovered. It should be emphasized that the success of the operation will largely depend on the psychological readiness and emotional state of the patient. It is very important that the doctor explains to the woman in advance that the new breast may cause some discomfort at first, and in general, mammography will not give a perfect result, since after the operation there will be lines from surgical incisions on the breast and at the donor sites.

Breast replacement after mastectomy

Breast reconstruction after mastectomy is a serious operation that allows you to artificially restore the shape and original appearance of the breast after amputation. Sometimes several procedures are required to obtain the desired result. Reconstruction can be done at the same time as the mastectomy surgery, while the woman is still under anesthesia, or later, some time after surgery. If a patient requires chemotherapy, doctors prefer to postpone this procedure. Complications after breast reconstruction are extremely rare; most often they are infections, scars, and bleeding.

Breast replacement after mastectomy is necessary to “fill the void.” Before such an operation, the surgeon clearly determines the size of the implant, the location of the future incision, and marks the contour depending on the anatomical features of the patient’s body. Prosthetics is the only method that allows you to most accurately restore the shape, original appearance and size of the breast.

Prostheses can have different shapes and are made from the following materials:

• silicone (closest to the natural appearance of the breast);
• polyurethane foam;
• foam and fiber filler (such “lightweight” prostheses are recommended to be introduced at the end of the recovery period, since they are considered the most convenient for physical activity).

Ideal prostheses should exactly match the appearance of real mammary glands, both in shape and weight. Modern surgical methods make cosmetic stitches barely noticeable. Prostheses can be installed through different surgical approaches; the choice of incision sites depends on the decision of the operating surgeon.

Modern breast implants are sacs filled with silicone elastomer or a saline solution. As for the technique for inserting implants, it is quite simple: empty bags are inserted through small incisions in the skin and filled with a solution.

Restoring breast nipples is a separate issue that requires a competent approach. The patient may prefer artificial nipples made of polyurethane and as close as possible to the real ones in consistency, shape and color, which are attached to the breast using small suction cups. Other options include tattooing or plastic surgery. Nipple reconstruction is most often performed 2-3 months after mammoplasty, when the swelling of the mammary gland has subsided.

Breast implant after mastectomy

Breast reconstruction after mastectomy is a reconstructive procedure that is performed after either complete or partial removal of the breast along with a malignant tumor. Almost all patients who have undergone a mastectomy resort to the most effective method of breast restoration - reconstructive plastic surgery - in order to return to a full life and feel feminine and attractive again.

A breast implant after a mastectomy is inserted in one stage (“one-step reconstruction”). Most often, the implant is made of silicone (or rather, silicone gel and saline solution, taken in equal proportions). The implant is inserted through a small incision under the pectoralis major muscle.

It should be noted that after the implant is inserted under the skin, capsule-shaped fibrous tissue may form around it. This is a natural process that is associated with normal wound healing. In approximately 15-20% of cases, such a “capsule” can cause discomfort and provoke deformation of the mammary gland. In order to prevent such a process, the patient is recommended to perform physical exercises and is prescribed a special restorative massage. Radiation therapy increases the risk of scar capsule formation by 40-50%. Sometimes implants can move, in which case special massage is necessary. It should also be noted that most implants will experience some minor leakage over time (after about 10 years). This process does not cause harm and does not cause dangerous consequences.

The advantages of introducing a silicone implant are the speed of surgical technology and the low traumatic nature of such an operation. Among the disadvantages, one can note the high cost of the procedure due to the fairly high cost of endoprostheses.

Recurrence of breast cancer after mastectomy

Reconstruction of the mammary glands after mastectomy is carried out by introducing a prosthesis or expander, depending on the specific situation. This operation can be performed during the mastectomy, or delayed for several weeks until the wounds heal and the body recovers.

Recurrence of breast cancer after mastectomy implies the re-development of oncology after a certain time after surgical treatment and chemotherapy. Unfortunately, this process occurs in most cases, especially if the cancer was diagnosed in the last stages. Most often, the tumor develops at the primary site, but it is possible for a new tumor to appear in another breast or another area of ​​the mammary gland. The term “relapse” itself means the “return” of the disease. If the tumor is diagnosed in another place (internal organs, skeletal system, lymph nodes), this means that the cancer has metastasized.

Of course, a relapse of cancer greatly frightens a woman and raises many questions regarding the correctness of the treatment method and the operation performed. Most often, this problem arises due to the fact that malignant cells cannot be completely identified and destroyed, and they enter the surrounding tissues through the blood or lymph.

If we talk about the time frame, then usually a relapse occurs in the period from 2 to 5 years after the course of therapy. If the development of such a process is suspected, an in-depth examination of the patient’s body is performed (MRI, PET), as well as a histological examination or biopsy.

Among the prognostic indicators that make it possible to predict cancer recurrence, one can highlight the aggressive course of the primary disease, the large size of the malignant neoplasm, and the diagnosis of a late stage of the primary disease. Relapse is often caused by neoplasms containing certain oncogenes, as well as the presence of malignant cells with a high atomic index. After surgical treatment of the patient, the oncologist must assess the situation for the possibility of relapse in the future.

Palpation of the mammary glands is one of the main methods for detecting cancer. During the development of relapse, the following symptoms may be observed:

• any changes in the nipple (shape, color, atypical discharge);
• itching and burning of the chest;
• changes in the structure and size of the mammary gland;
• redness or any change in color of the skin of the breast, change in temperature.

In case of relapse, local treatment is prescribed, including radiation therapy and surgery, as well as systemic treatment, which includes hormonal and chemotherapy. If there is no relapse in the first 5 years after treatment, then most likely there will be no recurrent cancer.

Approximately 20% of women have breast cancer, making it the second most common cancer in the world. To avoid further tumor growth and worsening metastases, the patient undergoes an operation called mastectomy. The malignant tumor and often the breast itself are removed.

To restore the mammary gland, surgeons resort to plastic surgery after breast removal. This intervention has its own nuances, types, risks and contraindications.

Contraindications

Contraindications:

• obesity;
• minority;
• period less than one year after graduation lactation;
• problems with coagulability blood;
• heavy the patient's condition;
• suffering from sugar diabetes;
• Availability defeats important internal organs and disruption of their normal functioning;
• infectious diseases;
• presence of foci tumors at any location;
• the patient’s reluctance to undergo plastic surgery after breast cancer due to the lack of it profitability, necessity and expediency.

Types by time

There are several types.

One-step

This type of plastic surgery is performed immediately after removal of the mammary gland. It is aimed more at returning to its former form than appearance.

It does not restore halos and nipples, but only creates volume commensurate with the breasts so that the consequences of the operation are not noticeable in clothing. A pre-prepared implant is inserted into the empty cavity.

It comes in various shapes and consists of various materials, spherical or anatomical in shape. The implant is chosen by the patient based on her own preferences, but under the supervision of the surgeon, who must take into account the symmetry and harmony of the implant.

After this operation, the patient must wear special compression garments. To achieve complete breast symmetry, after some time you will need to have surgery on the second breast.

Delayed or two-phase

This type of operation is performed if the patient does not have enough soft tissue. The surgical intervention is carried out in two stages.

During the first of them, an expander is inserted under the skin, which begins to be filled through a valve with a special solution a few weeks after installation. This stretches the skin, and therefore problems with soft tissues disappear.

The whole process can take up to several months, since only soft tissues are stretched to fit the size of the expander. After the bed is formed, the expander can be replaced with a durable implant.

Types by materials

There are 4 types.

Using artificial materials (implants, expanders)

Operations using artificial materials (implants, expanders) are the most common among such surgical interventions. The operation is considered the simplest surgically and is characterized by low blood loss and a relatively short recovery period for patients. Artificial materials are used in both immediate and delayed mammoplasties.

They come in three types: silicone, permanent and tissue expanders. Permanent expanders are placed in a bed and do not require further replacement, while tissue expanders are replaced with silicone implants after a certain amount of time.

In a single-phase operation, a silicone implant placed in a socket creates only a small breast shape and is therefore not suitable for all women. At that time, the permanent expander is able to achieve greater success. It consists of 2 compartments: one of them is silicone, and the other is hollow, filled with saline solution.

It is after its removal that the tension on the stretched soft tissues is relieved, and the breast takes on a natural shape. Tissue expanders are placed in the bed for several months, during which saline solution is poured into the cavity.

After this, the tissue expander is replaced with a silicone implant, and the areola, nipple and opposite breast are reconstructed to achieve symmetry.

Complications that may occur:

• breakthrough soft tissue implant (extrusion);
• destruction implant and pouring saline solution out;
• education hematomas in the operated breast;
• hit infections;
• education contractures– scar tissue around the implant.

Using your own tissue (skin flaps, cartilage grafts)

An operation using autologous (own) tissue is a rather lengthy and complex, but effective process. Often this type of surgical intervention leads to the desired aesthetic results. There are two types of surgery: thoracodorsal transplantation (TDL, or TDM) and the use of a TRAM flap.

Thoracodorsal transplantation (TDL, or LDM)

This type of operation is considered one of the least traumatic. Donor tissue for the breast is taken from the latissimus dorsi muscle. The abundance of tissue helps create more volume in the surgical area and a natural appearance of the inframammary fold.

The best aesthetic effect can only be achieved in combination with a silicone implant, which will give the breast a natural appearance. Women with small breast volume are suitable for surgery, since the graft is limited in volume.

The surgical period for thoracodorsal transplantation is longer, since it is carried out in two stages: transplantation of donor tissue and direct formation of the breast shape.

Patients recover from LDM much longer. The recovery process and the amount of donor tissue directly depends on the stitching of blood vessels.

Complications that may occur during and after surgery:

• death donor tissue (necrosis);
• education blood clots at the site of implantation of new tissue;
• spicy painful sensations and long healing process;
• rough noticeable scarring at the site of tissue collection;
• deformation backs due to improper tissue sampling;
• limitation volume implant.

Use of TRAM flap

This technique is the most popular and least traumatic. It involves the collection of soft abdominal tissue without the use of synthetic implants.

In this case, the scar formed at the donor site can be covered with underwear. Subcutaneous transferred adipose tissue changes shape well with the natural movement of the body, therefore it is able to form the necessary shapes.

The use of a TRAM flap allows you to remove as much cancerous tissue as possible, work with even large breasts, establish symmetry between the mammary glands at the first stage of the operation, and obtain the best aesthetic results.

Through additional reconstructive procedures and secondary surgeries

Secondary corrective procedures are necessary for almost all women. They are carried out six months after the first surgical intervention, when the course of chemical and radiation therapy has been completed, the scars are fully formed, as is the general appearance of the breast.

It is during this period that problem areas of the implanted tissue are corrected, excess fat tissue is liposuctioned, and nipples and halos are restored.

Types by type of symmetry

There are several types.

One-sided reconstruction

This is the first stage of symmetric breast reconstruction. The operation is performed on the breast that has been affected by cancer cells and has undergone a mastectomy. She recreates the required shape in various ways depending on the type of operation, the nipple and the areola around it.

Bilateral recovery

The second stage of symmetrical breast reconstruction. To achieve complete symmetry between both mammary glands, surgeons resort to correction of the second, healthy breast.

Secondary breast reconstruction (nipple and areola plastic surgery, correction)

After the patient has fully recovered from the previous operation and has completed the entire course of adjuvant therapy, nipple and areola plastic surgery becomes a kind of final stage of breast reconstruction. During a mastectomy, the areola may be severely damaged or completely removed.

In this case, surgery to create a nipple and areola is required. The intervention is performed under general anesthesia, during which surgeons create the additional required volume and apply medical tattooing.

Also, a special gel or fat is sometimes injected into the nipple for additional volume. Those areolas that were transplanted from a skin fold in the groin area acquire the greatest aesthetics.

Does breast reconstruction affect the risk of cancer coming back?

Breast surgery after mastectomy does not in any way increase the chance of breast cancer coming back. But all patients must regularly check their breasts using mammography in order to prevent and detect recurrent cancer.

Rehabilitation process

After all operations to remove a malignant tumor and improve the aesthetic appearance of the breast, and completion of chemical and radiation therapy, a long period of rehabilitation begins. To avoid any complications, you must strictly follow councils specialist and perform regular examinations to identify complications that may appear after several months or years.

For patients who have undergone surgery using their own (autologous) tissue, additional procedures, such as physical therapy, may be required. It should help the woman cope with the weakness of the area where the donor tissue was taken from and heal it more quickly.

The specialist should also talk about how various types of activities, including simple household chores, should be carried out today. A woman needs to regain her strength and get used to some of the physical limitations that will occur after such a serious operation.

The rehabilitation period is associated not only with restrictions on activities and recovery procedures, but also with changes in clothing. In most cases, specialists prescribe patients to wear special corrective compression garments that support the soft tissues in the correct position.

Mastectomy or breast removal, which is used in the presence of cancerous tumors, leaves an indelible mark not only on a woman’s soul, but also on her body. After all, the absence of even one breast makes normal life unbearable: you will have to give up your favorite summer clothes, swimsuits, and, therefore, a beach holiday. Difficulties in relationships with men and a serious decline in self-esteem may appear.

But, fortunately, plastic surgeons offer a solution - breast reconstruction, which is carried out in many clinics. Breast reconstruction surgery is not tied to a mastectomy, so it can be postponed indefinitely: the effect of restoration will be the same in a month and a year. Breast reconstruction can be done in one or several stages. However, surgeons recommend a one-stage operation, during which both the breast itself and the areola and nipple will be restored.

Breast reconstruction methods

Breast reconstruction can be performed in several ways:

rectoabdominal flap;

tissue expanders and subsequent installation of implants;

thoracodorsal flap.

The first recovery method is the best of all three. Thanks to it, you can achieve the best results without implants, using your own tissue taken from the abdomen and thighs.

A large volume of tissue taken allows you to simulate a breast as close as possible to the natural appearance, which will influence weight fluctuations like a real one. When restoring the mammary gland using a silicone implant, either only the prosthesis itself can be used, or implant in combination with a tissue expander.

Benefits of restoration with implants:

there is no need to remove tissue for implantation;

The operation is easy to perform.

This method of reconstruction is not the best, as it has unpleasant consequences:

the breast may turn out unnatural, spherical, hard;

there is a high risk of tissue necrosis and other complications, after which it will be necessary to remove the implant before the breast heals;

Capsular contracture (skin tightening) may form around the implant, and the implant will also have to be removed.

This method is used if the patient has enough tissue on the chest to create a bed for the prosthesis. The third method is breast reconstruction using a toradox flap, – involves both the implant and your own tissues. The prosthesis is covered with tissue taken from the back, or rather with a musculocutaneous flap.

With this method, the risk of complications becomes much lower than when using only an implant. Breasts look much more natural. But there are some drawbacks:

after tissue removal, a large scar remains on the back;

The musculocutaneous flap settles over time and atrophies, which can change the appearance of the breast not for the better.

The choice of method usually remains with the surgeon, who will also give recommendations on preoperative nutrition, vitamins and medications that need to be taken before surgery.

Contraindications for all methods of breast restoration are the same:

infectious diseases;

pregnancy and lactation;

problems with blood clotting;

serious diseases of internal organs;

diabetes;

autoimmune diseases.

Nipple and areola reconstruction

This is the final stage of breast reconstruction surgery, which is very important to ensure that the new breast is no different from healthy breasts and does not create physical discomfort. There are many methods for restoring the areola and nipple:

with the help of tattoos;

tissue flaps and cartilage tissues;

using nipple transplantation, etc.

Since such nipples tend to flatten, the nipple reconstruction operation will most likely have to be repeated again. The first operation can be performed approximately 3 months after the main breast surgery, when the sutures have more or less healed and swelling has subsided. It is easier to restore the areola than nipple, for this they use:

skin flaps from the external genitalia (for color accuracy);

leather and other materials taken from the donor;

a tattoo applied to the mammary gland is the best and easiest way.

Restoring the nipple requires special skill, since, unlike the areola, it is three-dimensional. The following methods are used:

donor tissue transplantation;

fabrics made from artificial materials;

other areas of the skin.

Complications possible after reconstruction of the breast and nipple area Restoration of the mammary glands, like any complex surgical operation, can bring complications:

blood may accumulate in the area of ​​the operated breast and suppuration may develop, which will require additional examination and repeated operations in the future;

formation of keloid scars at the site of skin grafting and the new breast;

asymmetrical position of the mammary glands, nipples and areolas;

rarely – wound necrosis;

formation of a scar capsule around the implant followed by its removal.

Complications after nipple reconstruction:

nipple rejection;

nipple displacement;

loss of color.

Rehabilitation and timing after surgery

For some period after the operation you will have to adhere to a certain routine and rules, if followed, healing will proceed faster.

• Discharge after breast reconstruction occurs on the 3rd or 6th day after the operation itself, but doctors recommend bed rest for the next few weeks.
• Any physical activity is prohibited for 3-4 weeks; heavy objects cannot be lifted above the chest.
• You will need to visit your doctor once a week for a month; the stitches will be removed in 7-11 days. The final result of the operation can be seen in 2-3 months.

After nipple reconstruction surgery, antimicrobial ointments and clean bandages should be applied to the wound site for 2 weeks. It is also necessary to wear decompression underwear - it will not create discomfort.

Photos before and after breast reconstruction surgery

Prices for breast reconstruction after mastectomy

Depends on the city in which the operation will be performed, the clinic and the plastic surgeon. Also important is the way the operation is performed, with what materials, and how many stages will be needed for recovery. Therefore, the price in each case will be calculated individually, but judging by the data located on the clinics’ website, the price tag starts from 180,000 rubles.