Breast Reconstruction Surgery

There are a multitude of mastectomy techniques. The choice of the right one is primarily defined by the nature of the tumor and hence the extent of breast amputation (e.g. skin-sparing or nipple-sparing mastectomy, lumpectomy etc). Furthermore, the patient’s preferences play a crucial part as well as availability of own tissue, planned radiation etc.

Autologous breast reconstruction: 
Your breasts can be reconstructed by your own body tissue, which are so called flaps from surrounding or more distant parts of the body. One classic local, i.e. pedunculated flap, is the large dorsal muscle which can be commonly combined with a silicone implant. Free distant flaps from other parts of the body, which necessitate the microsurgical anastomosis of the vessels, can be DIEP flap (tissue transfer from lower part of the belly), the PAP flap or gracilis muscle (from upper thigh) and other procedures. 

Reconstruction with an implant: 
Still commonly performed and a popular choice as it does not imply surgical procedures on other parts of your body in order to reconstruct the breast. It may be combined with the implantation of a cellular matrix (ADM), which is a tissue envelope acting as an internal bra for additional support. Furthermore, with an enormous selection of size, shape and consistence of various implants, a careful choice can result in a good, natural and symmetric result. 

Additional fat grafting:
In certain cases, it may be good option for optimizing the contour, volume, shape and coverage.   
Nipple reconstruction:
Nipple reconstruction represents a final but essential step in breast reconstruction. It can be performed by means of local skin flap or grafting from the other nipple, resulting in a natural and proportional nipple. The areola itself can be tattooed by a professional medical tattooist. Lately, the 3-D tattoo of the nipple itself gained in worldwide popularity. 

Breast implants:
Often first choice is the so called skin-sparing mastectomy (removal of glandular tissue only without excessive skin resection). If more excessive excision of skin is performed, an expander may have to be used first (see below). The advantage of breast reconstruction by silicone implants include the simplicity of procedure compared to autologous flaps, a shortet operation and hospitalization time and quicker recovery. Furthermore, if patients should change her mind in the future, the implants can always be removed and replaced by autologous tissue. 

Autologous breast reconstruction:
Being made from your own tissue, complications related to foreign body reactions like capsular contraction do not occur, and the breast are more natural in touch and appearance. However, it often requires multiple surgeries until a final and symmetric outcome can be achieved. Furthermore, it necessitates a surgical procedure on another part of your body, such as tummy or upper thigh, resulting in additional scars. It is often a prolonged surgery with prolonged hospitalization.

The scars of previous mastectomy maybe used or, if it is a single-stage procedure, the implant can be inserted via the same access as the one performed for mastectomy. In case that the skin envelope is not sufficient, the expander, which is a kind of inflatable temporary implant, is implanted in a first small procedure. After the scarring is firm enough (about 3 weeks), the expander will be periodically inflated with saline solution until the desired size is achieved. By filling the expander, the overlying skin will grow accordingly as well. Once the desired size for the final implant is achieved, the expander will be exchanged for the silicone implant. For additional support, a acellular matrix (ADM) or a artificiall mesh might be implanted within the same procedure. The selection of the appropriate implant is crucial, and the considerations are similar to aesthetic breast augmentation.