One-stage Breast Reconstruction with Implant

ONE-STAGE BREAST RECONSTRUCTION WITH IMPLANT

In several cases the removal of the tumor from the breast is not enough and patients are indicated to undergo a larger operation to remove the entire breast. This operation is called a mastectomy and we distinguish several types of operation depending on the structures that can be preserved. The surgery usually extends to the lymph nodes of the ipsilateral armpit. The indication for mastectomy and its type is entered by the Breast Oncologist. The type of restoration and when it will take place is the subject of Plastic Surgery and is determined by many factors, taking into account the wishes and needs of the patient.

As already mentioned, the treatment of breast cancer has spectacular results in the life expectancy of patients and the number of women who, after the completion of their treatments or at the same time as their oncological surgery, request breast reconstruction surgery is constantly increasing. Nowadays no patient should undergo a mastectomy before being explained her options for immediate or delayed reconstruction.

Here, we will analyze the immediate (simultaneous with oncological surgery) in one year (without the use of expanders) reconstruction with an insert.

TO WHOM IS THE OPERATION ADDRESSED?

The operation is aimed at all patients who will undergo a subcutaneous mastectomy with skin preservation (+/- the nipple and areola) regardless of age, and who wish to restore the deficit left by the mastectomy.

Although the operation belongs to the restorative operations of Plastic Surgery, it has a strongly aesthetic character and significantly improves the quality of life and functionality of the patients.

HOW IS THE OPERATION DONE?

The type of mastectomy (subcutaneous mastectomy with skin and nipple preservation or subcutaneous mastectomy with skin preservation only) is chosen by the Breast Oncologist and the patient. Important in decision-making are the size and number of tumors, their location, the size of the breasts, previous breast surgeries, age and the plan of post-operative treatments.

As a general principle, the breast is removed by the Oncological Surgeon while preserving the overlying skin and fat. The location of the incision is selected on a case-by-case basis. The breast is then reconstructed with an insert suitable for the dimensions of the patient. The insert is inserted subcutaneously, fully or partially under the pectoralis major muscle and its lower pole is protected and supported with special meshes or biological skins. The wound is closed in layers after drains are first placed.

WHAT IS THE TYPE OF ANESTHESIA?

The mastectomy and its immediate restoration with an insert is done under general anesthesia in an organized clinic. The duration of the surgery is from 2 to 4 hours, while due to the nature and duration of the surgery, it is considered advisable to stay in the clinic for two days.

WHAT WILL THE SCARS BE LIKE AFTER THE SURGERY?

The type of scars depends on the surgery that will be chosen. The incisions are planned together with the Oncological Surgeon before the surgery, following the basic principles of Surgical Oncology and Plastic Surgery. The incisions heal and mature over several months and the scar they leave behind is always covered by the bra. The majority of women will undergo post-operative radiotherapy and chemotherapy, treatments which affect the rate of healing.

During this period you will be given instructions to avoid deformed scars, while you will enter a follow-up program to ensure the aesthetic result of your breast(s).

HOW LONG WILL THE RESULTS LAST?

The results are permanent and will remain stable. At the same time, the other (non-operated) breast is subject to the changes brought about by gravity and time, as a result of which a second symmetry surgery is often deemed necessary. Often the operated breast needs to undergo post-operative radiation, which in the majority of cases is completed without problems and complications.

WHAT ARE THE LIMITATIONS OF THE SURGERY?

There are no absolute contraindications beyond the stage of the disease. Related contraindications for immediate breast reconstruction with an insert are smokers, obese women, who have undergone radiation in the past.

WHAT ARE THE RISKS OF THE OPERATION?

Together, the doctors will assess your general condition and history and decide if you are suitable for immediate reconstructive surgery. You will be informed about the possible complications and what needs to be done to reduce the possibility of their occurrence. You will also be asked to stop using supplements and medications that affect blood clotting and to refrain from smoking. The anesthesiologist will then talk to you about the type of anesthesia you will receive and the possible complications.

WHAT YOU SHOULD DO BEFORE SURGERY?

Depending on your age you will be given instructions on which medicines you may be taking and which should be stopped or replaced. One week before surgery you will need to take measurements to order a special bra, have your photo taken and sign the consent form.

WHAT TO WATCHOUT FOR AFTER THE OPERATION?

You stay at the clinic for at least two 24 hours. Your time off work must be calculated in two weeks. Leaving the surgery you will wear a special bra which you will keep for 6 weeks. You will have a drain which will remain for several 24 hours, while you will need to mobilize in a controlled manner for the first 24 hours. Pain is easily treated. Because the sutures are intradermal, no stitches need to be removed.

WHAT IS THE COST OF IMMEDIATE BREAST RECONSTRUCTION WITH AN INSERT?

The cost of immediate breast reconstruction is calculated by adding up the fee of the clinic, in which the patient is operated and hospitalized, of the Oncologist General Surgeon, the Plastic Surgeon and the Anesthesiologist. The purchase of the insert and the special bra must be included in the costs. Part of the costs are covered by the patients' fund.