Mammary reconstruction is a surgical procedure which reconstructs part or all of a woman’s breast affected by breast cancer.
Breast cancer is the most frequent type of cancer, thus many women undergo breast surgery because of this disease. It is very important for a woman who undergoes a mastectomy (surgical removal of the breast) to return to her normal life and not see signs of the handicap on her body. This is why surgical oncologists work in close collaboration with plastic surgeons with increasing frequency in order to obtain the best results in the shortest amount of time possible after the illness.
Candidates for breast reconstruction surgery are women who have undergone a partial removal (tumourectomy or quadrantectomy) or a complete removal (simple mastectomy, skin sparing mastectomy, nipple sparing mastectomy), unilaterally or bilaterally, of the breast.
"Immediate" breast reconstruction is performed at the same time that the tumor is removed. "Delayed" breast reconstruction takes place at a later time, up to one year after the initial cancer surgery. In both cases, the aesthetic results that are achieved are the same and are usually very satisfying.
The visit to the plastic surgeon is frequently done before the removal surgery to decide which reconstructive technique is more appropriate for the patient and better corresponds to her needs.
There are women who want to leave the operating room with full breasts and others who postpone the breast reconstruction stage as a personal choice or because, after a total mastectomy, they do not have enough mammary tissue for immediate reconstruction and require an expander that can extend the remaining tissue over a period of a few months so that implants can be inserted.
The Professor will examine the patient, gather her medical history from the illness, the surgical procedures that have been done up to that point, and any additional information on medical therapies like chemotherapy and radiotherapy. He will also explain the various surgical techniques that can be used to attain the best possible results.
Prof. Dini will also evaluate the patient’s overall health to exclude any allergies or other illnesses that can alter the positive outcome of a reconstructive procedure.
Breast reconstruction surgery can vary widely from patient to patient. This depends on multiple factors: first of all, on the type and extent of the tumour; on the patient’s age; on the shape and size of the contralateral breast; but also on the structure of the operated tissues, which can be thick or thin, radio-treated or ulcerated; on pathologies like diabetes and hypertension; on whether the patient is thin or fat, a heavy smoker, etc.
In the case of small tumour removal, the Doctor usually resorts to very simple, minimally invasive techniques like local flaps and reshaping the breast tissue itself.
For more extensive tumours, the techniques can vary greatly and several surgical procedures are often performed together. An extended reconstruction can be done with simple lipofilling, with a local flap, or by inserting a breast implant. An initial surgical procedure might be necessary to implant a mammary expander, followed by a second procedure to put in the breast implant. More complex flaps might be necessary like the Tram flap or the Latissimus Dorsi flap, or more refined reconstructive microsurgical procedures like the Diep flap, etc.
Depending on the technique used, breast reconstruction can be done under local anaesthesia with sedation or under general anaesthesia, as an outpatient procedure or with a few nights at the health care centre.
Prof. Dini, having performed all the different reconstructive techniques in his surgical experience, from the simplest to the most complex, both in terms of breast reconstruction and nipple-areola reconstruction, will be able to recommend the best method and technique for the best possible result.
Post-operative recovery also differs based on the type of procedure.
For simpler reconstructions and those where the breast implants will be put in immediately, Prof. Dini recommends that his patients stay on bed rest for the first 48 hours and to move their arms right away so as to facilitate muscle tissue recovery. After that, patients will gradually be able to go back to their normal routines, avoiding lifting weights or strenuous activities. After a week, they can go back to work, although it is advisable to wait at least a month before exercising again.
In reconstructions that require using a mammary expander, patients must undergo a session to fill the expander with saline solution every month in order to gradually reach the necessary and sufficient expansion so that the final implant can be put in. Once the desired expansion is reached, Prof. Mario Dini will perform a second operation to replace the expander with the breast implant and the post-operative recovery will be the same as for simpler procedures.
Finally, in the case of breast reconstruction using free flaps, recovery will be more difficult and relatively longer.