Breast plastic surgery after mastectomy. How to restore breasts after mastectomy so that they look natural? (36 photos). What measures should be taken after breast reconstruction surgery?

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.

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.

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.

Modern aesthetic medicine works closely with medical surgery. Because of this, breast reconstruction after mastectomy is widely used. The price of recovery is sometimes too high - radical removal of the bust. Reconstructive breast surgery after mastectomy helps to return to its former shape.

Reconstructive breast surgery after mastectomy

Reconstructive mammoplasty can be performed simultaneously with removal of the affected areas or after several years. In this case, the surgeon's actions are limited by the result of the previous operation. The specialist will have to carry out the correction in several stages so that the patient is happy with the reconstructed breast. After a mastectomy, thanks to reconstructive mammoplasty, a woman feels confident and attractive.

Reconstruction methods:

Breast reconstruction after mastectomy - price

• The cost of this procedure directly depends on the method of performing the correction.
• Using a graft from your own structures is cheaper than using implants.
• The combined technique may be the most expensive, but its effectiveness justifies the cost.

Find out which method is right for you by scheduling a free consultation by calling the number listed on the website.

Reconstructed breasts - after a mastectomy, attractiveness does not disappear!

The best result of a surgeon’s work is the praise of his patients. Most women who applied for reconstructive mammoplasty noted that they liked the new forms even more than the previous ones, and it is almost impossible to distinguish a reconstructed bust from a natural one by touch!

Rbreast reconstruction after mastectomy performed using implants, your own tissue, or a combination of both methods. Which method is better? Will the reconstructed breast look natural? When is it better to perform reconstruction, simultaneously with mastectomy or delayed? We asked these and other questions to Professor, Doctor of Medical Sciences Vladimir Sobolevsky.

- Is a mastectomy necessary if breast cancer is detected?

In the initial stage of the disease, a mastectomy is not always necessary. If the volume of the gland is large, the tumor is small, and located far from the central parts, it is possible to perform radical resection, that is, to save most of the mammary gland. However, if the disease is stage 1 or 2 and a mastectomy is necessary, a subcutaneous mastectomy or skin-sparing mastectomy can be done in most cases. The difference between the two is that a subcutaneous mastectomy leaves all of the breast skin and SAC, while a skin-sparing mastectomy removes the nipple, areola, and breast tissue. If it is possible to preserve the skin pocket of the mammary gland, then when performing one-stage reconstruction, the aesthetic result will be better. The suture will pass only under the breast or only around the areola, and it does not matter what this pocket will be filled with, its own tissues or an implant, or a combination of an implant and the latissimus dorsi muscle - aesthetically this is better than delayed reconstruction

- From the point of view of aesthetic results, is immediate reconstruction (if possible) better than delayed reconstruction?

Definitely better. Primarily due to the fact that during a mastectomy it is not always necessary to remove all the skin of the breast. True, this is not possible in all cases and depends on the stage of the disease and the prospects for treatment. Now, both here and throughout the world, there is a tendency towards individualization of treatment - not only for breast cancer, but also for other oncopathologies. In the situation of locally advanced cancer involving the skin, preoperative treatment is required and after it a radical mastectomy with the removal of all skin, all gland tissue and axillary lymph nodes - mandatory radiation therapy is required after surgery. In such cases, it is better to do reconstruction later, since if it is done immediately, during a mastectomy, the aesthetic result will worsen due to radiation therapy.

- Does radiation therapy worsen the healing process after reconstruction?

Radiation therapy worsens the aesthetic result, but not due to the deterioration of healing, since it is carried out after it, but due to fibrosis and deformation of all tissues that fall into the field of radiation therapy. If reconstruction was done with one's own tissues, these tissues become sclerotic. If the breast is reconstructed with an implant, capsular contracture very often occurs.

- Do radiation or chemotherapy necessarily accompany a mastectomy?

Not necessary. The treatment method depends on the stage of the disease, the involvement of lymph nodes in the process and the type of immunohistochemistry of the tumor. If the tumor is highly receptor-dependent, then, as a rule, only hormone therapy is prescribed after surgery.

Breast cancer is a group of diseases that includes more than five completely different diseases. There is a set of diagnostic procedures that make it possible to determine cancer, its immunochemical subtype, the level of estrogen and progesterone receptors, the degree of cell atypia, Ki-67, Her-2neu, the prevalence of the process, whether the disease is localized in the gland or whether there is an interest in regional lymphatic collectors, whether there are distant manifestations of the disease. Depending on the immunohistochemistry, tumors are treated differently, with different prospects and prognoses.

After the location of the tumor is determined, a decision is made: to start with surgery or chemotherapy (if the process is widespread). If the process is localized, we start with surgery and after it, having obtained the histology of the removed tissue, we determine whether chemotherapy, hormone therapy, or both are necessary.

Sometimes the need for radiation therapy is determined after surgery, after obtaining the final histology. The standard throughout the world is to carry out radiation therapy in the postoperative period if, during histological examination, we found more than 3 affected lymph nodes. Radiation therapy is carried out after healing and removal of stitches. If both chemotherapy and radiation are required, chemotherapy is given first, and at least 2-3 months should pass before radiation.

- Tell us about lumpectomy - an operation in which only part of the mammary gland with a tumor is removed.

Lumpectomy is rarely done here in Russia. Lumpectomy is an operation in which only the tumor in the breast is removed. This requires mandatory interoperative radiation therapy, and in some cases external beam radiation therapy is still performed. Such operations are indicated for a small group of patients with hormone-dependent tumors up to 2 cm in size. As a rule, these are elderly women. Units for intraoperative radiation therapy are very expensive (40–60 million rubles) and are installed only in centers that do not have external beam radiation therapy. We do not have facilities for intraoperative radiation therapy. But aesthetically, a minor radical resection would be the same as a lumpectomy.

When choosing treatment tactics, we focus not only on Western standards, but on the standards approved by the Ministry of Health. For example, in the initial stages of the disease, if according to ultrasound the lymph nodes are not changed, in the West they only do a biopsy of the sentinel lymph node: they take one lymph node under the arm, do an urgent study, and if there are no metastases, they do not remove it. Axillary lymph nodes are a regional site of breast cancer metastasis and very often cancer metastases are detected in them. Until recently, their removal was standard in the West. Now they are not removed for all stages and forms of cancer.

Unfortunately, according to the standards of the Ministry of Health, in case of infiltrative breast cancer, all lymph nodes under the arm must be removed. This is not always necessary, it is not entirely justified, but it takes time, effort and energy to review the standards of the Ministry of Health and change them in the right direction.

- Can the patient refuse to have lymph nodes removed?

No. She may refuse treatment and go abroad for treatment. Our research institute is a scientific center, it belongs not to the Ministry of Health, but to the Academy of Sciences, therefore, within the framework of scientific protocols, in some cases we may not perform such an extensive lymph node dissection.

- Are there situations in which reconstruction using only one’s own tissues, using the TRAM method, is possible? Or is there always a choice?

There is always a choice. There are two aspects to the treatment of our patients: medical and aesthetic. If we practically do not discuss the medical part with patients, depending on the stage and type of tumor they are entitled to one or another treatment, then we definitely discuss the aesthetic aspect with the patient.

Choosing a reconstruction method is always a very difficult problem. There is no universal method that would suit all patients. The choice also depends on the treatment plans: on whether the skin can be preserved during removal of the gland and in what areas, on the volume of the gland, on the presence of own tissues for reconstruction, on the constitution and somatic condition of the patient.

TRAM is not the only way to reconstruct with your own tissues. There are many areas where you can take your own tissue, and TRAM is the oldest and simplest method. The simple transferred TRAM flap includes the rectus abdominis muscle and transverse dermal-fat flap. The flap is moved on the muscles to the reconstruction site. Modern techniques allow the use of only a skin-fat flap on a vascular pedicle (rather thin arteries and veins supplying blood to this flap). You can use other flaps: gluteal, thigh, back. Now there are microsurgical techniques that are less traumatic than traditional ones. We do not use the abdominal muscles, we only take a fat flap. It is possible to transfer tissue without muscle on microvascular anastomoses from the abdomen, from the inner thigh, from the upper or lower gluteal region . In an area with excess tissue, we can take it with minimal cosmetic defect and fill the pocket after removing the breast tissue.

The latissimus dorsi muscle is often used in reconstructive operations on the mammary gland. Most often it is used to cover the lower pole of the implant (especially if it is large), while the upper pole of the implant is placed under the pectoralis major muscle. In some cases, the muscle is taken with a small skin area, due to which it is possible to reconstruct the SAH. When reconstructing a small gland, the skin pocket can be filled with one latissimus dorsi muscle. To do this, you need a small incision (5-6 cm) on the back along the line of the underwear.

- With which reconstruction method will breast sensitivity be greater or less?

This does not depend on the type of reconstruction, but on whether the nipple and innervation are preserved. Sensitivity is almost always impaired. Our task is first of all to restore the shape and volume, and, if possible, the consistency of the mammary gland. The choice of method depends on many factors: excess or lack of tissue, where and how much skin can be preserved, the condition of the second mammary gland - after all, symmetry is needed, and in half of the cases corrective surgery has to be done on the other side.

- How to achieve symmetry during reconstruction? Is it possible to make an individual implant more similar to a second breast?

If we are talking about a woman 20-30 years old with good volume and shape of the mammary gland, then, when performing reconstruction with an implant or expander, we try to create a spherical mammary gland with good filling. If a woman is being operated on with severe ptosis, an empty second gland, stretched skin, and a nipple projection below the inframammary fold, there is no point in trying to create a second similarly ptotic gland. Both in the West and here, corrective surgery for the second gland - mastopexy or augmentation - is a common practice.

- How is the incision made for immediate reconstruction and what shape will the suture be?

The incision is made not during reconstruction, but during a mastectomy, and the shape of the incision depends on its type. The standard mastectomy incision is a horizontal scar from the sternum to the edge of the armpit.

In the West, a mastectomy is performed by a general surgeon, and reconstruction is performed by a reconstructive surgeon. These two specialists jointly prepare for the operation and perform each step differently. We have one person doing everything. This has its pros and cons. By performing a mastectomy, I can already position the incision in a way that is convenient for me, so that after reconstruction it will be in an aesthetically insignificant area.

- Please tell us about restoration with a tissue expander.

The use of a tissue expander involves a two-stage reconstruction and is performed when both breast tissue and a large amount of breast skin need to be removed. For example, in a locally advanced process involving the skin of the breast, it is necessary to treat before surgery, then undergo a radical mastectomy without skin sparing, and then, possibly, radiation therapy will be needed. After performing the operation, we can immediately place a tissue expander, conduct radiation therapy, and after its completion, through the built-in or external port in the expander, stretch the skin of the anterior chest wall (filling the expander with saline solution) in order to create a supply of skin for the future mammary gland.

Typically, at least 3 months must pass from the first stage (mastectomy and expander installation) to the second (implantation) for a capsule to form around the expander. The capsule is a valuable plastic material with which we work when replacing the expander with an implant, forming a submammary fold. If the expander is replaced with your own tissue, it may take less time. In general, the process takes no more than 6 months.

- Does the expander affect the future shape of the breast?

Affects. There are different types of expanders: anatomical expanders take on a drop-shaped shape when inflated, round expanders evenly stretch the skin. The choice is made depending on where the skin needs to be stretched - in the lower pole, middle, upper. Expanders vary in width and height of the base, in projection, and are selected individually for each patient.

- Tell us about the filling of expanders and implants. Which manufacturers' products are used in breast reconstruction?

All expanders are filled with saline solution. The implants are filled with either silicone gel or saline solution. Mentor and McGhan also produce endoprosthetic expanders and stretchable implants: this product combines both an implant and an expander. There is a cavity inside such a prosthesis and through an external port (a tube with a port), the surgeon can inject a solution that will increase its volume - slightly, up to about 150 cm 3. As long as the port is not removed, the volume can be changed. Once the desired solution size is reached, the portico is pulled out and the valve is closed.

The choice of implants is great, there are quite a lot of manufacturers, there are Korean, English, French brands. I have not heard of Russian-made products.

- What implants do you use in your practice?

Different. We are a state medical institution and operations are performed according to quotas issued by the Ministry of Health. Patients do not pay for either implants or expanders; their cost is covered by a quota. Our institute has a government contract with the Mentor company, and I am satisfied with their products. Manufacturers' products are mainly aimed at the market of aesthetic surgeons who perform breast augmentation, and they need a wide range of conventional implants, rather than expanders and endoprosthetic expanders. Mentor and 2-3 other companies have the products we need.

- How predictable is the shape of the breast and how does the chosen reconstruction method affect the shape?

This largely depends on the professionalism and experience of the surgeon. The second factor that can affect the shape is radiation therapy, during which, as a rule, the created gland is deformed. The shape also depends on the reconstruction method. A priori, reconstruction with one's own tissue is better than with an implant. But according to statistics, reconstruction with implants is more often chosen all over the world, since it is technically simpler, the recovery period after surgery is shorter, there is no additional scar: implants have a number of advantages. However, iron restored using its own tissues looks more natural. Its volume and shape changes naturally with age, just like the shape of the second, healthy breast. The consistency of such breasts is more natural. In addition, over time, the result only gets better, while breasts restored with an implant will sooner or later need to be operated on again. The consistency of breasts with an implant is denser and does not change over time; capsular contracture increases.

- Is lipofilling used for breast reconstruction in Russia?

Yes. But not as an independent method of reconstruction. I am almost sure that no one except Roger Kouri uses it as a mono-method for reconstruction. But almost everyone uses lipofilling as a method of correction after reconstruction in those places where there is not enough adipose tissue. The procedure is performed on an outpatient basis under local anesthesia, it is safe and gives a good result.

- Tell us about the methods for reconstructing the SAH.

There are different methods, the choice depends on how the gland itself is reconstructed. If using your own tissues, then usually the nipple is made from the same flap according to certain patterns, and the areola, as a rule, is tattooed later. The naturalness of a tattooed areola depends on the tattoo artist. Of course, if the areola is blurry and has unclear pigmentation contours, it is more difficult to recreate it, and in this case it is recommended to tattoo the second areola.

Just as there is no one-size-fits-all method of breast reconstruction, there is no one-size-fits-all method of nipple reconstruction. In each specific case this is done differently. When reconstructing with one’s own tissues, for example, a flap of a special shape is cut out and stitched in a certain way. During a two-stage reconstruction using an expander, the skin is stretched and it is not possible to cut exactly such a flap; then a piece of synthetic material is placed inside the future nipple instead of its own tissue.

- What are the features of mastectomy with preservation of SAH and further reconstruction? Is the result in this case the most natural?

The result depends on the shape of the gland and the severity of ptosis. If ptosis is not expressed, the projection of the nipple is above the inframammary fold, the skin is not stretched, the tumor is located far from the nipple and areola, then in the initial stage of the disease we can make an incision in the inframammary fold, remove all glandular tissue under the skin and replace it with an implant or our own tissues. If the ptosis is severe, preserving the nipple and areola will most likely lead to necrosis of the nipple, and there is no aesthetic sense in this. It is not difficult to get a new nipple and areola tattooed, it will look better.

But in Russia there are rare situations when mastectomy with preservation of SAH is possible - we have few patients with the initial stage of the disease. There is no medical examination, people are examined very irregularly. Cancer can be detected at an early stage only through regular examination of healthy people. The tumor never hurts; it develops from its own tissues. The slightest mastitis after childbirth gives terrible pain and the patient immediately runs to the doctor, but the rather large tumor does not bother her at all, does not manifest itself and the woman does not see a doctor. We have very little literature for patients; people are afraid to go for examination: “What if they find cancer on me? I’d rather not go.” The task of the state and the media is to convey to people that today breast cancer in the initial stages can be cured in 95%. Previously, after treatment, patients lived for 2-3 years, so the issue of reconstruction was practically not raised. Now, after recovery, patients live a full life, for a long time, reconstruction is relevant and gives an excellent aesthetic result.

Examples of breast reconstruction after mastectomy

Patient 1 (40 years old)

Delayed reconstruction of the right breast with a Becker expander endoprosthesis 2 years after RME. Photos before and 1 year after reconstruction.

Patient 2 (49 years old)

Bilateral delayed breast reconstruction with thoracodorsal flaps and Spectra implants was performed.

Patient 3 (40 years old)

Radical skin-sparing mastectomy with simultaneous reconstruction with a displaced TRAM flap. Photos before and 3 years after reconstruction.

Patient 4 (34 years old)

A subcutaneous radical mastectomy was performed preserving the pectoral muscles with simultaneous reconstruction using a Becker expander endoprosthesis and a thoracodorsal flap.

Patient 5 (38 years old)

A delayed reconstruction of the left breast with an expander was performed (stage 1), then the expander was replaced with an implant on the left and augmentation on the right.

Patient 6 (43 years old)

In 1995, subglandular augmentation of the mammary glands was performed. In 2013, left breast cancer was diagnosed. Left radical mastectomy was performed with partial skin sparing with simultaneous reconstruction of the left breast with an implant and thoracodorsal flap. Repeated subpectoral augmentation on the right. Then 4 courses of chemotherapy were administered and endocrine therapy was prescribed.
Photos before the start of treatment and 3 months after.

Patient 7 (40 years old)

A delayed reconstruction of the right breast and a prophylactic mastectomy on the left with simultaneous reconstruction were performed. Stage 1 – installation of the expander on the left. Stage 2 – prophylactic mastectomy on the left and reconstruction of both mammary glands with a split TRAM flap. Then the formation of the nipple-areolar complex on the right.
In the photo: before the start of treatment, after the second stage, 3 months later, a year after reconstruction.

All operations, the results of which are presented in the photo, were performed by V. A. Sobolevsky.

Breast cancer pathologies are one of the most frequently diagnosed diseases among women. Often, for effective surgical treatment of breast cancer, a mastectomy, an operation to remove the mammary gland, is inevitable.

Today, thanks to the possibilities of reconstructive plastic surgery, it is possible to restore the lost shape and volume of the breast even after a radical mastectomy. A “new”, aesthetically attractive body helps improve the quality of life and significantly speed up the process of social and psychological adaptation after cancer.

Reconstructive mammoplasty: advantages and indications

As a rule, breast reconstruction is performed for aesthetic reasons. However, it is worth noting that reconstruction after mastectomy is carried out not only for the sake of improving appearance. Breast removal is also fraught with a number of problems associated with the psycho-emotional state of the patient, such as the development of stable complexes associated with appearance, self-doubt, feelings of inferiority, aversion to one’s own reflection in the mirror, fear of communication, isolation, a tendency to reduce social contacts, problems in family and sexual life.

As for relative medical indications, the following should be noted:

• improper load on the spine (where the mammary gland is removed due to mastectomy, the load will be less, which leads to spinal deformation);
• drooping shoulders and the formation of the habit of slouching;
• malfunctions in the functioning of the chest organs caused by curvature of the spine.

Contraindications

An oncologist surgeon may not consent to breast reconstruction in the following cases:

• late stage of breast cancer (stage IIIb and above);
• unfinished course of treatment for oncological pathologies;
• combined breast cancer and ovarian cancer;
• severe pathologies of internal organs and systems;
• diabetes;
• infectious diseases;
• diseases in the acute stage;
• poor blood clotting;
• pregnancy;
• age up to 18 years.

Breast reconstruction does not limit further examinations and routine monitoring of breast condition.

As a rule, the most informative research methods are computed and magnetic resonance imaging, as well as PET-CT (positron emission tomography combined with computed tomography).

The patient himself can partly minimize the risk of complications: to do this, it is enough to approach the choice of a plastic surgeon and clinic with maximum responsibility and strictly follow the doctor’s instructions. To have an idea of ​​the dynamics of the condition of the breast after mammoplasty, it is advisable to be observed by one specialist - a highly qualified reconstructive oncologist surgeon with extensive experience in breast oncology.

How long after reconstructive plastic surgery should be performed?

The need and duration of the “pause” between breast removal and reconstruction is determined by the stage of cancer, the nature and size of the tumor, as well as whether the patient has undergone chemotherapy and/or radiation therapy.

It is impossible to answer unequivocally after what period it is better to carry out such an operation. Reconstruction after cancer can be performed weeks, months and even years after a mastectomy.

Often, mammoplasty is performed immediately after removal of a malignant tumor - such reconstruction is called emergency. The timing of the operation must be determined by the doctor. This takes into account the indications for surgery, the patient’s current condition and medical history, the results of preoperative examinations, as well as the patient’s wishes.

Breast reconstruction: what? When? How?

There is a so-called “gold standard” of reconstructive mammoplasty. In this case we are talking about a two- or three-stage operation.

• Stage 1 - mastectomy with one-time or delayed until the next operation installation of a tissue expander. Over the course of 1–2 months, a special physiological solution is pumped into the expander, causing its volume to increase. This creates excess tissue necessary for repair.
• Stage 2 – the process of replacing the expander with a permanent implant. The implant is selected according to the individual characteristics and proportions of the patient’s body, taking into account her personal wishes. At this stage, as a rule, correction of healthy breasts is carried out - enlargement, reduction or lifting to eliminate asymmetry.
• Stage 3 – restoration of the nipple and areola removed as a result of mastectomy. The repaired area can later be tattooed to achieve the most realistic color, shape and size possible, as well as to disguise the suture that joins the edges of the excised tissue. To even out the relief and eliminate unevenness, you can perform a lipofilling procedure.

In the absence of contraindications, it is advisable to carry out the first stage of breast reconstruction simultaneously with mastectomy. If breast reconstruction is not started immediately, the patient must first undergo a full course of treatment, in particular chemotherapy, radiation and/or targeted therapy.

Reconstructive mammoplasty can also be performed using the patient’s own tissue transplant:

• latissimus dorsi flap (LD flap);
• rectus abdominis flap (TRAM flap);
• DIEP or SIEA flaps (skin and fat grafting from the abdomen);
• buttock flap (I-GAP, S-GAP or FCI flap).

Rehabilitation

After mammoplasty, the patient is in the hospital under the supervision of a doctor. In the early stages, rehabilitation is accompanied by discomfort, pain, and swelling.

To speed up and facilitate the recovery process after surgery, doctors recommend wearing special underwear, eliminating physical activity that involves the muscles of the shoulder girdle to one degree or another, giving up hot baths, bad habits, visiting the sauna and bathhouse, tanning in the open sun and in the solarium. .

You should also not sleep on your stomach and neglect the use of medications prescribed by a specialist.

During the rehabilitation period, the patient should come to her doctor for regular dressing changes and inform him of all symptoms and sensations that cause concern and cause discomfort.

A conscientious doctor will definitely warn the patient that scars and cicatrices will not go away without a trace even after several years - they will only become less noticeable. It is also impossible to fully restore breast sensitivity. The final result of the operation can be assessed on average six months after the operation.

Risk of relapse

Reconstructive mammoplasty really allows women to return to their normal lives and regain aesthetically attractive body shapes. However, in this matter, in no case should you put your own health in the background.

Each person’s body is individual, and the risk of developing a relapse depends not on the fact of reconstruction, but on the stage of cancer - a relapse can occur both after reconstructive mammoplasty and without it.

This has been confirmed by many authoritative studies: at the same stage of the disease, relapse developed equally often both in patients with reconstruction and after mastectomy without breast reconstruction surgery. Accordingly, reconstruction does not pose a risk from an oncological point of view.

It should always be remembered that if further treatment and surgical intervention are necessary, the aesthetics may be lost, since the relapse must be treated, even if this requires radical measures, including removal of the implant.

To avoid such a scenario, you should trust your health only to experienced professionals who can make an accurate prognosis and reduce the risk of relapse.

‒ oncologist surgeon, plastic surgeon at the “Correct” clinic, winner of the prestigious “Crystal Lotus” award in the category “Best plastic surgeon for mastopexy.”

Author of the “Bello Busto” method, full member of RAMA (Russian-American Medical Academy), Bundesärztekammer (German Medical Association), Sächsische Landesärztekammer (Association of Doctors of Saxony), RUSSCO (Russian Society of Clinical Oncology).

Breast cancer occupies a leading position among diseases of the mammary glands. With this disease, the entire affected breast is often removed, that is, a mastectomy is performed. Mastectomy is not used for mastitis, but it can be used in case of purulent inflammation of the mammary gland, as well as for gynecomastia. Sometimes resection of only part of the gland is performed - lumpectomy. After removal of the affected gland, women often resort to reconstructive surgery to restore the volume and shape of the breast. Restoring the shape and volume of the bust is quite possible, because modern plastic surgery has in its arsenal a wide range of effective methods of reconstructive mammoplasty.

Breast surgery after removal

Breast surgery after breast cancer is carried out in several stages and requires the use of special equipment. Breast reconstruction is currently based on two techniques that can be used in combination:

• patchwork
• prosthetic

The flap technique is based on transplanting the patient's own tissue, for example, muscles taken from the abdominal wall or back, into the area of ​​the removed breast. Unfortunately, the flap technique is very traumatic and is based on extensive surgery. When taking part of the muscle from the anterior abdominal wall, there is a risk of complications, such as hernias. When using the flap technique, a significant scar remains at the site of tissue collection, and there is also a risk of rejection of the transplanted flaps.

The prosthetic technique for breast surgery after oncology is based on the use of breast implants in place of the removed mammary glands and is carried out in several stages. Mastectomy and subsequent therapeutic procedures lead to a deterioration in the properties of the skin of the bust: it darkens and thickens. The area of ​​the breast skin is reduced and is not enough to install an implant. To eliminate the lack of skin in the area of ​​the removed mammary gland, an expander is inserted - a special expandable silicone balloon filled with saline solution.

The expander is placed for a period of 3 to 4 months. While wearing it, the plastic surgeon regularly increases the volume of the expander, adding about 100 ml of saline solution in one session. Replenishment of the expander volume is carried out on an outpatient basis and does not create significant discomfort. This approach allows for gradual stretching of the skin. Once the expander has created a sufficient pocket for the implant and stretched the skin, the prosthesis can be installed to achieve breast enlargement after mastectomy and restore the natural shape of the mammary glands.

Placing a breast implant after a mastectomy is similar to standard breast augmentation surgery using endoprostheses. Installing an implant allows you to achieve symmetry of the mammary glands and restore the natural shape of the bust. For breast plastic surgery after oncology, that is, after partial or complete removal of the glands, both silicone and saline endoprostheses can be used.

At the final stage, reconstruction of the areola and nipple is carried out. For this, various techniques can be used, including tattooing, the use of donor tissue, or transplantation of one's own skin that has pigmentation.

Recovery period after reconstructive breast surgery

The rehabilitation process after breast augmentation after mastectomy must be carried out in strict accordance with the requirements of the attending physician. To combat swelling and support the mammary glands during the recovery period, special bras and elastic bandages are used. Breast surgery after breast cancer is a major operation, so returning to your normal daily schedule is possible only a few weeks after this type of breast surgery. The final result of reconstructive surgery can be seen approximately 2-3 months after surgery.

Combined use of prosthetic techniques and lipofilling

The combined use of lipofilling and prosthetic techniques for breast plastic surgery after oncology allows one to achieve improved results. Mastectomy sometimes even removes muscle, so fat grafting can create a cushion that covers the implant, giving the breast a more natural appearance. Usually, the use of lipofilling is carried out simultaneously with increasing the surface of the skin of the breast using an expander. Lipofilling can be performed in several stages to gradually stretch the breast before installing implants.

When is breast reconstructive surgery necessary?

What is the purpose of endoprosthetics after mastectomy? Breast cancer is extremely common, and its treatment almost always involves partial or complete removal of the breast, which worsens the shape of the bust. After a long and difficult treatment for breast cancer, a woman may face psychological complexes caused by the absence of a breast. The situation is made easier by wearing a bra with special inserts that reconstruct symmetrical breasts. However, this measure is not suitable for everyone; many women are embarrassed by their appearance without clothes. To eliminate such problems, full-fledged reconstructive breast surgery is performed after removal of the mammary gland.