Breast reconstruction after cancer

Overview
Duration: about 1 hour
Anesthesia: general anesthesia
Duration of stay: inpatient, at least 2 nights
Suture removal: after 14 days
Healing time: 2 weeks

Breast cancer is one of the most common types of cancer in women: one in eight women will develop some form of breast cancer at some point in their lives. In addition to radiation and chemotherapy, the treatment includes surgical removal of the tumor and thus also the removal of breast tissue (BCT = breast-conserving therapy) or even the entire breast (mastectomy). Although the chances of recovery from this therapy are very good nowadays, the operation on the breast is associated with a certain loss of femininity and the feeling of well-being in their own body for many sufferers. Because of this, there are now numerous techniques that can be used to reconstruct the breast. The interventions range from the reconstruction of small defects to the remodeling of the entire breast, whereby both implants and autologous tissue can be used.

When does breast reconstruction after breast cancer make sense?

Surgical breast reconstruction is by no means a must, but is only carried out at the request of the patient and after in-depth consultation. Breast reconstruction is always useful if you are concerned that you will lose physical well-being, femininity and quality of life after the operation. Although there is also the option of compensating for the defect with special bras, this is not really satisfactory for many patients. The reconstructive operation can therefore give patients the opportunity to regain a little of their old self and the state they were in before the cancer diagnosis. When performing the operation, there are basically two options: Either an immediate operation combined with the removal of the tumor or a time-shifted operation as an independent operation. This decision depends, on the one hand, on the patient’s wishes, but also on the necessary accompanying therapies and the general state of health.

What do I have to consider before a breast reconstruction?

Before each treatment, Dr. Matiasek conducts a detailed consultation with his patients, in which he goes into all aspects of breast reconstruction. At the beginning, explain what exactly is bothering you and what wishes and expectations you have for the procedure. Regardless of what type of operation is performed, a precise oncological treatment plan is drawn up beforehand. A histological definition of the tumor is important on the one hand, but also imaging is used in order to know the exact size and extent of the tumor and also to be able to estimate the extent of the tissue removal. Only with this information is it possible to plan further operations. Both the tumor-removing operation and the reconstructive intervention, require a detailed informative discussion to take place in which questions and possible doubts are to be clarified. Medication to be taken regularly and chronic diseases are recorded and blood is drawn for the most important laboratory parameters in order to clarify possible risk factors.

During the consultation, Dr. Matiasek goes over the optimal preventive care for breast reconstruction after breast cancer. This includes, among other things, that you stop taking blood-thinning medication about two weeks before the procedure and that you refrain from alcohol and nicotine during this period. You will also receive information about the correct behavior on the day of the procedure, such as the last food intake.

How does breast reconstruction with implants work?

Reconstruction using implants basically takes place in several steps, the sequence of which differs depending on whether the whole or only part of the breast has to be removed and how much skin is available. If the entire breast is to be removed, several steps are required as the nipple and areola also have to be remodeled.

Even if only little skin is available, the operation must be carried out in several individual steps, as an expander must be used in advance before the actual implant can be inserted. An expander is an empty plastic bag that is initially inserted into the breast instead of the actual implant. This bag is then filled with a saline solution at intervals of several weeks so that it slowly increases in volume. This means that the overlying skin can slowly stretch, so that the implant can subsequently be accommodated. The silicone implant is then inserted after a few months as part of another operation. The implantation takes place through a small skin incision in the underbreast fold, so that a scar that is only minimally visible is created. The anatomically pre-formed, silicone-filled implant is then pushed under the pectoral muscle and the surrounding tissue is sutured again.

How does breast reconstruction with autologous fat work?

In addition to breast reconstructions in which silicone implants are used, own tissue can also be used for reconstruction (autologous reconstruction). Modern plastic surgery has numerous procedures in which both adipose tissue and muscle flaps can be used to shape the breast. An essential advantage of these methods for many patients is the ability to dispense with silicone in the body. However, the interventions are also somewhat more complex and lengthy and always involve tissue removal from a different location. In the case of breast reconstruction with autologous fat, this means that sufficient fat has to be removed beforehand, which in some cases can extend to several sessions. The autologous fat removed as part of liposuction is then specially prepared and can then be used as a filling material for your breast. The physical condition and condition must also be such that liposuction or muscle flap surgery is even possible.

What are the risks of breast reconstruction?

Basically, it should be remembered that every procedure and every anesthetic is a physical strain and can be associated with possible risks and complications. In order to reduce this burden, the possibility of immediate plastic reconstruction was created, in which an intervention is, so to speak, saved. Nevertheless, several surgical interventions can be necessary for reconstruction with implants as well as with autologous fat, for which the patients are always prepared. All methods of breast reconstruction are also associated with general surgical risks such as bleeding, infection or wound healing disorders, which, however, are very rare in the operating theater due to the highest quality and safety standards.

What do I have to consider after a breast reconstruction?

Immediately after the operation, it is common to spend at least one or two nights in the hospital for observation. If there are no complications, major secondary bleeding and if the condition remains stable, any drainage can be removed and further care and necessary controls can be carried out on an outpatient basis. The sutures are removed after two weeks, after which the control intervals increase. If silicone implants are used, a compression bra should also be worn for about six weeks to support the healing process. In addition, as with any major surgical procedure with general anesthesia, it is important to take it easy for the first few days and remain on sick leave for a few days. You should avoid vigorous physical exertion, lifting heavy objects, and exercise for about six weeks. Showering with clear water is possible immediately after discharge from the hospital, but care must be taken to keep the wound as dry as possible. On the other hand, it is advisable not to take a hot bath or sauna for the first two months.

When can I see the results of the breast reconstruction?

Of course, patients cannot wait to admire their newly acquired breasts. Until then, you will have to be patient, but you can already notice the first visible changes after a few weeks. An actual and final result can only be seen after the wounds have healed completely and the swelling has subsided, i.e. after about six months. If further interventions are planned, the assessment of the final result will be postponed accordingly.

Surgical breast reconstruction after cancer is much more than just a cosmetic procedure. After a threatening and frightening diagnosis, it is a step towards normality and a positive feeling in one’s own body and therefore standard in breast cancer therapy today. Dr. Matiasek is looking forward to getting to know you in a personal consultation and creating an individual treatment plan for you.

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