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SURGERY PLASTIC AND RECONSTRUCTIVE
Reconstruction after cancer
Immediate or secondary breast reconstruction is done in collaboration with the team of gynecologistsobstertricians and cancer specialists form the Clinique de L’Union.
Breast reconstruction after mastectomy can be immediate or secondary.
I work at the (Clinique de L’Union) , as a member of a multidisciplinary team specialized in breast cancer (radiology, surgical gynecology, and cancerology).
The choice of whether or not to carry out immediate breast reconstruction is discussed in a multidisciplinary meeting RCP with all team members concerned. Generally, we advise immediate reconstruction when there is no other treatment needed ( carcinomacanalaire in situ and or multifocal or large volume or retro areola). In the other cases, when radiotherapy is foreseen, we prefer to delay the reconstruction so as not to compromise the treatment of the disease and thus to obtain a better esthetic result.
Two types of reconstruction:
– Breast implant
– Autologous tissue using the patient own tissue: muscular flap//fat reinjection
Before the operation
It’s at the first consultation, I will carry out a precise clinical examination, photographs are taken, in order to study the patient’s morphology, the skin quality, and the aspect of the contro- lateral breast (volume, extent of ptosis, the size and the position of the areola). This examination allows me to study the feasibility of various techniques, and to discuss with you and to propose the technique best adapted to your anatomy and life style.
It would be better to stop smoking 45 days before the operation considering the risks of skin damage due to vasoconstriction from the nicotine.
A complete breast imaging is prescribed systematically for the controlateral breast (breast X ray, echography)
Mammary reconstruction using implants
Reconstruction by breast implants is the quickest and simplest technique, but it needsthe skin to be of excellent quality .The prosthesis is placed under the pectoral muscle which is desinserted to completely protect the implant.An inconvenience however can be that as the reconstructed side will age differently from the side not affected. An other factor is that as the years advance, the prosthesis will need to be changed.
Musculo-cutanéous flap reconstruction
When the skin quality is insufficient after radiation treatment, it’s the only option available.
– Reconstruction by latissimus dorsimusculo-cutaneous flap is an excellent technique which gives good muscle and skin quality with a dorsal scar.
– TRAM reconstruction uses the rectissimus with abdominal skin. It gives excellent esthetic result with a large muscular aftereffects at abdominal level, but allows in the same operation the removal of excess skin and abdominal fat.
– Le DIEP , branched by microsurgery allows the skin and the fat from the abdomen to be used without any muscle damage.
Lipostructure by reinjection of autologous fat allows an increase in the volume of the breast and an overall improvement of the quality of the tissues.It can be combined with others techniques before the implant is placed, to correct imperfections after the implant has been placed or after flap surgery. It can be used alone or with the Brava technique which uses a specific apparatus which is worn several hours a day for one month before and after each operation and which allows the skin to expand, increases the breast volume, and creates a good environment for the fat cells to take. The number of operations needed, will depend on the quality of the skin and the volume desired.
Breast reconstruction requires several operations. These can be symmetrisationof the contrrolateralbreast , some lipostructure, reconstruction of the areola, and dermopigmentation to perfect the result. The motivation of the patient to go through to the end and to get a perfect result must be discussed from the outset.