Breast reconstruction involves the restoration of the breast by means of surgical measures. Reconstructive breast surgery is used when the breast has previously been damaged or removed due to breast cancer surgery, for example. Breast reconstruction is possible using the body's own material or breast implants. Here you will find further information as well as selected specialists and centers for breast reconstruction.
There are basically two methods of breast reconstruction:
We will go into more detail about both forms of breast reconstruction in the course of this text.
All breast reconstruction operations are performed under general anesthesia.
Patients can generally decide whether the breast is to be reconstructed primarily or secondarily. If the breast is reconstructed in the same operation in which it was removed, this is referred to as primary breast reconstruction. Secondary breast reconstruction is reconstruction at a later date.
Breast cancer is usually the reason for breast removal (mastectomy). However, accidents or burns can also necessitate the removal of one or both breasts.
Reconstructive breast surgery is primarily concerned with psychological and aesthetic aspects. Physically, life without breasts is perfectly possible. For many women, however, their breasts are part of their own feminine body image.
After the removal of one or both breasts, those affected must therefore decide whether they want breast reconstruction or not.
In some circumstances, it can be helpful to talk to a doctor or psychologist about this question. The decision for or against undergoing reconstructive breast surgery is entirely up to the patient.
The decision for or against breast reconstruction should be made calmly. It is not necessary to carry out breast reconstruction during breast cancer surgery. It is always possible to make this decision later.
Woman after masectomy © simona | AdobeStock
Breast reconstruction can be performed as part of the operation in which a breast was removed. In this case, a single operation is sufficient to remove the breast and rebuild it at the same time. This is referred to as primary breast reconstruction.
Primary breast reconstruction has the advantage that
However, it should be borne in mind that radiotherapy may affect the cosmetic result of breast reconstruction. In some cases, it would therefore make more sense to perform breast reconstruction as a secondary procedure once the cancer treatment has been completed. In this case, a second operation is then necessary.
The decision to undergo breast reconstruction is often made at a later stage. Breast reconstruction is possible at any time. The patient undergoes a second operation for this purpose.
In breast reconstruction with autologous tissue, surgeons implant a block of tissue made from
The tissue is taken from another part of the body, for example
Breast augmentation with tissue from the abdomen is most common, provided there is sufficient tissue available.
Breast augmentation with the body's own material usually looks more natural. Rejection reactions are also rarer. However, an additional incision is made in a different part of the body, which leads to additional pain at this site and also leaves scars.
Under certain circumstances, the reconstructed breast may not be symmetrical to the natural breast. In this case, the appearance of the healthy breast can be adjusted by a lift or reduction.
Breast reconstruction also includes the nipple and areola. To reconstruct the nipple, half of the nipple from the healthy breast can be used and transplanted onto the reconstructed breast. If this is not possible, a local skin flap can also be shaped into a nipple and tattooed.
The areola is either replaced by a graft from the opposite side
also by tattooing.
In most cases of breast reconstruction, fatty tissue and skin are removed from the abdomen and reattached to the breast.
In the DIEP technique, no muscles or blood vessels are removed. This has the advantage that the abdominal wall remains undamaged, thus minimizing the risk of abdominal wall weakness.
With the pedicled TRAM method, on the other hand, muscle tissue is removed. With this method, the abdomen is often tightened at the same time as the closure and the belly button is repositioned.
An abdominal belt and a support bra must be worn for some time after the operation.
This breast augmentation uses skin and fatty tissue from the buttocks. This method is particularly suitable if there is not enough tissue on the abdomen.
The operation and aftercare are the same as for breast augmentation with abdominal tissue.
The advantage of this method is that the scar from the donor site is barely visible later on. The incision is made in a natural fold of the thigh crotch.
Breast augmentation using tissue from the thigh is particularly suitable for slim women with small breasts. The procedure is similar to that described for breast augmentation with abdominal tissue.
Here too, the inner thigh can be tightened during surgical closure.
Breast augmentation with tissue from the long back muscle is the oldest method in reconstructive breast surgery.
When removing tissue from the back muscle, the function of the muscle must not be impaired. Furthermore, there is often not enough tissue available.
Therefore, a small silicone pad must sometimes be inserted in addition. Another disadvantage of this breast augmentation method is a relatively long scar on the back.
Breast augmentation using foreign material usually involves the insertion of a silicone cushion(implant). It must first be determined whether the remaining skin is sufficient to cover the breast implant.
If there is not enough of the patient's own skin, the existing skin must first be stretched. A so-called expander is used for this in an initial operation.
If the breast reconstruction is performed as a secondary breast reconstruction, the same skin incisions can usually be used as in the first operation. This results in fewer scars.
The breast implant is placed behind the pectoral muscle. This results in better aesthetics.
If radiotherapy is planned as part of the cancer treatment, breast reconstruction with autologous tissue may be recommended. After implant reconstruction in combination with radiotherapy, there may be an increase in so-called capsular fibrosis.
Capsular fibrosis is a hardening of the shell surrounding the silicone pad. If this happens, it can lead to deformation of the breast and pain. In such cases, the breast implant may even have to be removed.
Such capsular fibrosis can also occur without radiation, but then less frequently.
Breast implants today are very durable and safe © H_Ko | AdobeStock
We are now talking about the fourth and fifth generation of breast implants. Compared to the first and second generation, these have a significantly longer lifespan and guarantee greater safety.
The latest generation of breast implants are filled with cohesive silicone. It is therefore physically almost impossible for them to leak. In the USA, breast implants filled with saline solution are still used. When a breast implant leaks, there is 'only' a loss of volume in the breast. The leaking saline solution cannot cause any further damage to the body.
Implants rarely have to be removed. The reasons for this are dissatisfaction with the cosmetic result and inflammation of the implant.
The implant material is also subject to a normal ageing process. Although this process has been significantly extended, it is sometimes necessary to replace the breast implant to ensure that the cosmetic result remains stable.
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