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Breast Reconstruction

Breast Reconstruction

Breast Reconstruction

The breast deformities can be congenital, which are related to the development, or acquired, which is present throughout life. Breast tumors and their withdrawals, especially in cases of cancer are the most prevalent deformities. Cancers sometimes require the performance of mastectomy (complete removal of the breast) and breast deformities are treated more in breast reconstruction. Trauma, such as burns, and currently the major weight loss of morbidly obese patients undergoing gastric reduction surgery are other causes important indication for repair of the breasts.

The preventive resection of the mammary glands to prevent breast cancer is a reality today, emerging as a new cause of acquired deformity. This withdrawal of the breasts (adenomastectomy) is indicated by mastologists in patients who have had cancer in the other breast or have a family history and mutations related to cancer. This new indication for surgery have also increased the number of breast reconstructions.

The increased number of mammary deformities promoted the development of new surgical techniques and tactics to repair these changes. The use of tissue expanders and the availability of silicone implants anatomically allow quite a satisfactory result as the natural contour of the breast volume and texture. The scars are minimized by the current techniques of plastic surgery and intensive care during the healing period reduces the stigmas of the surgery.

In cases requiring the partial reconstruction of the breast, the breast tissue repair sites,’s own cancer, are possible and aesthetic breast surgery techniques can be used. The use of mammary prosthesis may be associated, providing similar results with connotation cosmetic surgery.

In case of full reconstruction of the breast, the use of tissue expanders is often necessary prior to placement of a permanent prosthesis. The tissue expanders are classically used for the treatment of sequelae of burns. These devices are placed under the skin, in muscle or fat in order to increase the size of the body tissues. Traditionally, the expanders were used to increase the dimensions of healthy skin around the burn scars, allowing the removal of the burns and their substitição normal skin nearby areas. In breast reconstruction, tissue expanders are used to increase the dimensions of the skin of the breast tumor as the resection is carried out extensive removal of breast tissue. Through this expansion, the skin takes dimensions that allow, after a few months, the placement of a breast implant with a volume compatible with the original breast.

Often, the tissue expander is placed under the pectoral muscles in order to expand not only the skin but also muscle, which ensures more patient’s own tissue to cover the prosthesis mammary final. The use of tissue expanders revolutionized breast reconstruction. The gain in size of muscles and skin to ensure good coverage and texture to the new breast built with permanent prosthesis, offering the most natural result. This combination of techniques for tissue replacement sites and inclusion of silicone prosthesis provides satisfactory result for reconstructions, reducing trauma related to other repair surgeries breast.

The use of other tissues transfer body regions, such as the abdominal or the back, is a treatment option. These regions provide portions of muscle, fat and skin capable of breast tissue repair or fabricate the new form of cancer. The techniques used are consecrated by the Plastic Surgery and are effective, resulting, however, in scars covering other body areas. In certain cases, especially when radiotherapy is used aggressively tissues other body parts are necessary to couple reconstruction.

Radiotherapy can cause local damage interfering in vascularity and texture of the breast tissue.

The use of patient’s own fat is a very interesting possibility for the correction of minor defects in breast contour and refinements of the reconstruction techniques described above. Through conventional liposuction, fat cells are taken from other areas of the body and can be transferred to the breast in order to restore breast volume lost. In the near future, according to preliminary studies, the possibility of breast repararmos completely by performing repeated transfers of amounts of body fat. Thus, we could reconstruct the breast tissue with the patient herself if she had enough body fat to make up the desired breast volume. Sequential transfers distenderiam the skin and carefully applied with volumes, would draw the desired contour.

Importantly what was previously mentioned in relation to patients who are at increased risk of developing breast cancer. Many patients who have had cancer of the breasts or who has a family history and genetic studies showing mutations that predispose to cancer, have chosen to remove the breasts. What encourages these patients to do such a procedure, and from the perspective of reducing the risk of developing cancer, is the technology and techniques that we have available today to reconstruct the breasts. The current reconstruction techniques allow patients to live without stigma and negative effects that the removal of the breasts can cause, which has a big psychological impact on these patients.

Deformities areola complex papillary (nipple-areola)

Changes in the shape of the areola and nipple can be congenital, developmental disorders by, or acquired causes burns, tumors and breast surgeries.

The use of tissue from the breast itself for making the nipple is the most used in nipple reconstruction. The transfer of the nipple portion of the breast adjacent is another possibility. The repair can be performed with the areola tissue of the breast itself, as described in the article cited above, or by transferring skin from other body regions, such as the groin. The skin of the groin has characteristics of color and texture, as time, resemble much to the characteristics of natural areola. The dermopigmentation (tattoos) areola is a technique that can be used to refine the areal reconstruction or even as unique method of treatment.

SCARS
The scars resulting from Surgery are designed to be unobtrusive, and go through several stages of evolution until they reach their final appearance.

Immediate Period: until the 30th postoperative day. The scar presents with little visible aspect. Some cases have a mild reaction to the stitches or bandages.

Mediato period: the 30th day until the 12th month postoperatively. In this period, there is thickening of the scar, as well as changes in its color. The coloration develops a reddish tint to brownish tone which intensdidade decreases with the passage of time. This period is the least unfavorable stage, is what most worries the patients. During this period, treatments can be performed to improve the appearance of scars, such as the use of silicone gel, silicone plates, topical corticosteroids and corticosteroid infiltration in the scar itself, as well as the application of laser.

Late Period: from 12th to 18th month postoperatively. In this period, it becomes clearer and less consistent, reaching its final appearance. Any assessment of the outcome of definiitivo  Surgery should be made after this period.

Unsightly scars, Hypertrophic and keloid.The unsightly scars, hypertrophic and keloid scars are changes that usually occur by genetic causes, inflammation or postoperative infections. The correction can be done through a minor surgery under local anesthesia, after a few months of evolution. The keloid scars can be treated with injections of corticoids and betatherapy can minimize risks recurrence.

Through the Site BRAZILIAN SOCIETY OF PLASTIC SURGERY (www.cirurgiaplastica.org.br), you can get more information about Plastic Surgery.




Cirurgia Plástica - Cirurgião Dr. André Ferrão Vargas
Visconde de Pirajá 595, Ipanema Rio de Janeiro
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