Reconstructive Surgery restores the form and function of body parts after an accident, illness or congenital defect.

Objects :

• Burns
• Skin tumours
• Traumatic deficits
• Congenital malformations
• Breast reconstruction after mastectomy

Breast reconstruction after mastectomy

1 in 9 women develop up to 85 years of life breast cancer. Breast cancer is the second most common cancer after that of the skin and the second most common cause of cancer death after that of the lung.

Risk factors:

• Genetic
• Age
• Family history
• First pregnancy after 35
• History of menstrual cycle
• Early initiation of menstruation
• Late stoppage of menstruation
• Benign breast tumors
• Individual history
• Exogenous factors
• Dietary factors

Breast Reconstruction

• The reconstruction has no effect on survival
• The symmetry with the other breast is the target
• It can be performed immediately after the mastectomy or at a later time
• It has beneficial effects on the psychology of patients

Techniques

A. By using implants

In the first stage it is placed under muscle a tissue expander with a view to be stretched the overlying skin, that will then host the permanent implant. After that starts the gradual filling with saline, which will be completed within 4 to 6 months.

In the second stage it will be inserted in the place of the tissue expander the permanent implant (of silicone or water) and may take place some kind of procedure (reduction or augmentation or mastopexy) in the other breast. The creation of the nipple-areola complex can be done simultaneously or in a third stage.

1. Indications

• Thin individuals who do not have sufficient autologous fat (e.g. flat tummy)
• When other ways of reconstruction are impossible for technical reasons (existence of incisions)
• Desire of patients
• Older individuals

2. Benefits

• Same color and touch
• Fewer scars
• Better sensitivity of soft tissue

3. Disadvantages

• Procedure in two or three stages
• Many visits for the progressive filling of the tissue expander
• Immediate postoperative complications (hematoma, inflammation, etc.)
• Risk of necrosis of the overlying skin
• Disruption of the tissue expander
  
  

B. By using of autologous tissue

• Flap of the rectus abdominis muscle (T.R.A.M flap)

-pedicled (pedicled T.R.A.M flap)

       -free (free T.R.A.M flap)

       -based on perforators (D.I.E.P)

• Flap of the latissimus dorsi muscle
• Flap of the gluteal muscle
   
  1. Indications

• When using of implants is contraindicated, as in irradiated area
• Healthy and not obese individuals with excess dermatipose tissue in the abdomen (if it is an abdominal flap)
• Previous failure of implants
  
  2. Benefits

• Autologous tissue without the need of foreign body
• Simultaneous dermatolipectomi
• Better long-term results
  
  

C. Breast reconstruction with stem cells

First of all, a device (brava) that exerts negative pressure on the outside of the breast is applied to the breast area in order to stretch the skin. Its application lasts for a few weeks and when the desired skin relaxation is achieved, the fat which is enriched with stem cells is injected into the breast area under shape. It is a new promising method with very good results for creating small or medium sized breasts.

The cost of breast reconstruction is partly covered (cost of breast implants and hospitalization) by the insurance funds, but in any case the recovery of the body’s well-being restores woman’s quality of life.