Breast Reconstruction

After a mastectomy

The Breast Reconstruction can start either simultaneously with the initial mastectomy operation, placing a tissue dilator under the chest muscles, or later, with a technique that can be chosen according the topical conditions of the skin area.

In order to make the process more comprehensive, we would say that the immediate position of a tissue dilator under the chest muscles in the initial operation, gives the ability to complete the process in a few weeks with a silicone implant. This process does not annul the tumour treatment of the patient (chemo-therapy, radiotherapy), it just delays it for a short term (6-8 weeks), which is not critical for the prognosis of the disease. Thus, the silicone implant placement becomes a light operation. Moreover, the observation of the topical recurrence of the tumour is not hindered by the implant. On the contrary, the treatment of the area after the radiation therapy demands surgical techniques far heavier, which could hinder the observation of the topical recurrence of the disease.

The Breast Reconstruction can start either simultaneously with the initial mastectomy operation or later

The Breast Reconstruction after a mastectomy without radiation treatment follows the previous procedure. Thus, a tissue dilator is placed to gain skin and then its replacement with silicone implant. There are two operations: one for the dilator placement and another for its replacement with a permanent implant. Both operations are easy and the patient gets out of the hospital at the same day.

When the patient has been treated with radiation, the skin has lost its elasticity and has limited aematosis. The surgical incisions are not healed easily. In this case, the doctor transports a blood flooded tissue. The TRAM flap is the most commonly used and includes the lower part of the abdomen area. The result is excellent, where the skin texture is compatible with the breast, and a simultaneous abdomenplasty is almost necessary in most patients. This operation is heavier and the patient must stay in the hospital for a few days. The second most-used flap is that of the wide dorsal muscle, which needs the use of a silicone implant. There is a disadvantage though; the back armpit angle needs to be modified, since this muscle creates it.

Tubal Breasts

The tubal breasts come as a result of an irregular growth of the breast’s volume and shape during adolescence, due to congenital skin inelasticity around the areolae. The degree of the skin inelasticity varies from patient to patient; the patient’s breast may have a different degree of inelasticity, having as a result the variation of the malformation degree. The massive gland tries to grow through the areolae, making the malformation obvious: a small breast, in the shape of a tube with big areolae.

Usually, the breast augmentation with silicone implants and the alleviative incisions are enough to reinstate the shape, the size and the analogy of breast – areolae

To correct this problem surgically, the plastic surgeon places a silicone implant, making a 3-4 cm incision on the verge of the areolae. The operation must include alleviative incisions, placed around the areolae, allowing the skin to expand around the areolae. Usually, the breast augmentation with silicone implants and the alleviative incisions are enough to reinstate the shape, the size and the analogy of breast – areolae.

Sometimes, the areolae must be decreased and in rare cases it should be moved, to provide symmetry at the repaired breasts. Surgical incisions will be needed in this case, that may resemble the ones of the breast lifting, when the breast has a small fall.

There may be an important problem in rare cases, where the inelastic skin around the areolae might lead the breast’s growth to aplasia. It is possible in such cases that the surgeon will have to use a tissue dilator, and replaces it later with a permanent silicone implant, as described.

If the problem is known to the parents when the puberty commences, the natural growth of the breast could be allowed with alleviative incisions around the areolae.

The post-operational course of the tubal Breast Reconstruction operation is no different from that of the breast augmentation.

Retraction of the nipple

The retraction of the nipple is a congenital anomaly, caused by short and atrophic milk ducts. The nipple is not projective; it immerses, due to the inward attraction by the milk ducts. Apart from cosmetical, this is also a functional problem. The patient cannot nurse properly, or she cannot even provide any milk.

The degree of the retraction varies, depending on the genital malfunction.

There is a plethora of techniques that have been described and applied so far. They are all small operations, being made under topical anesthesia.

There is a plethora of techniques that have been described and applied so far. They are all small operations, being made under topical anesthesia. Only in cases of regressing retraction and not in permanent retractions, do the techniques keep the continuity of the milk ducts. When there are short and atrophic milk ducts, the preservation of their continuity does not help either when nursing, neither to the repair of the retraction. All techniques involve a small incision at the edges of the “crater”, so within it, the cross-section of the fibroid milk duct complex could be achieved and the reverse of the nipple could be allowed. There are other topical surgical “tricks” that can maintain the immediate surgical result. The post-operational course is as simple as the beauty spot removal with topical anesthesia.

 

 Hot Tips

The use of special belt is obligatory for one month after abdominoplasty and can only be removed during sleep.

Sunbathing is forbidden after laser operation.

The patient must go to the hospital without having eaten anything or having dunk water for the past 6 hours.

The coherent silicone for breast augmentation is of high technology, an inert substance that needs no change at all.

Rhinoplasty can have girls after the age of 6 and boys after the age of 18.