Breast Reconstruction

Breast reconstruction brings together the surgical procedures used to restore the shape, volume and contour of the breast after a mastectomy, after partial surgery for a breast lump, after trauma or in the case of certain malformations. The aim is for the patient to regain a body appearance that is as natural as possible, both clothed and unclothed.

Reconstruction can be carried out with a breast implant, sometimes after a tissue expansion stage, with the patient's own tissue (flaps taken from another area of the body), by fat transfer or by a combination of these methods. It is most often a process carried out in several stages. At Detalii Med, in Baia Mare, the assessment and surgery are performed by the clinic's plastic surgeons.

The procedure is mainly intended for patients who:

• have had a mastectomy, total or partial, and wish to have the breast restored;
• have been left with a breast deformity after surgery or radiotherapy;
• have a congenital malformation of the breast or chest wall;
• are in a general state of health that allows surgery and anaesthesia.

The timing of reconstruction is decided together with the oncologist, where relevant. Reconstruction can be immediate, in the same operation as the mastectomy, or delayed, months or years after the initial treatment.

Breast reconstruction can restore the volume and projection of the breast, can improve symmetry with the opposite breast and can give a natural contour in a bra and in clothing. The areola and nipple can be reconstructed later, and if needed the healthy breast can also be operated on for balance.

Reconstruction cannot restore normal breast sensation, nor create a breast identical to the original. Scars usually remain on the breast and, if the patient's own tissue is used, in the area from which it was taken. Perfect symmetry is not realistic, and the result depends on tissue quality, the treatments received and each patient's healing.

At the consultation, the plastic surgeon discusses the medical history, the cancer treatments already received or planned (chemotherapy, radiotherapy, hormone therapy), any associated conditions and the patient's habits, including smoking. The chest, the opposite breast and the areas that could serve as a source of tissue are examined.

The doctor explains the methods suited to the case, the advantages and limitations of each, the likely number of stages and the recovery period. Blood tests, imaging or the opinion of other specialists may be requested. The patient is given time for questions and for an informed decision.

How the procedure is carried out depends on the chosen technique. In implant reconstruction, the permanent implant may be placed from the outset or, more often, an expander is used, which is gradually filled during outpatient sessions until the desired volume is reached; it is then replaced with the implant in a second operation.

In reconstruction with the patient's own tissue, the surgeon transfers skin, fat and sometimes muscle from another area, such as the abdomen or the back, to create the new breast. Fat transfer can be used alone, for small defects, or to refine the contour.

In the following stages, shape adjustments, symmetrisation of the opposite breast and reconstruction of the areola and nipple may be carried out. As a guide, each operation lasts from one to several hours.

The main reconstruction procedures are usually performed under general anaesthesia, following a prior pre-anaesthetic assessment. Some minor stages, such as filling the expander, nipple reconstruction or small adjustments, can be done under local anaesthesia, depending on the case.

After surgery, the patient may stay in hospital for one or more days, depending on the extent of the procedure. Drains may be needed for a few days, as well as a surgical bra or compression band. Pain and discomfort are controlled with medication.

A return to light activities usually takes place after two to four weeks, and to strenuous physical exertion and sport after about six weeks or as advised by the doctor. After reconstruction with the patient's own tissue, recovery may take longer, as healing occurs in two areas. Regular follow-up appointments are essential.

As with any major surgery, breast reconstruction carries risks, which are discussed in detail at the consultation:

• bleeding, haematoma, fluid collection (seroma) or infection;
• delayed healing, more common in smokers and after radiotherapy;
• partial compromise or, rarely, loss of the transferred tissue;
• with implants: capsular contracture, displacement, rupture or the need for replacement over time, as well as rare implant-associated conditions;
• asymmetry, visible or thickened scars, changes in sensation;
• the general risks of anaesthesia, including blood clots.

Some situations may require additional corrective procedures.

The shape of the breast can be judged gradually, as swelling subsides and the tissues settle, usually over a few months after each stage. The whole reconstruction process can take from a few months to more than a year, depending on the technique and the cancer treatments. Over time, the result may be influenced by changes in weight, by ageing and, with implants, by how the implants themselves evolve.

Breast reconstruction is a personalised process, often in several stages, which can restore the contour of the breast and confidence in one's own body. The choice of method and of the right timing is made at the consultation, with the plastic surgeon and, where relevant, together with the oncologist, with realistic expectations about the result.