Mammology: Breast cancer — Diep-flap plastic reconstruction with own tissues. Treatment
According to statistics, more than 300 thousand women annually undergo surgery to remove the breast cancer. The resulting physical defect causes deep psychological trauma, leads to the development of depression and deterioration of the quality of life. Therefore, to date, breast reconstruction is an important step in rehabilitation of these patients.
Indications and Contraindications
Breast restoration is indicated to women who have had a mastectomy for cancer, fibroadenomatosis, purulent mastitis and other diseases.
The surgery is not performed when the general condition of the patient is grave, she suffers from severe diabetes or chronic cardiovascular pathologies.
For cancer patients, the contraindications are as follows:
- appearance of metastasis,
- tumor invasion in the chest wall,
- breast cancer recurrence.
For women who are obese or long-term smokers, the possibility of breast reconstruction is considered individually.
Plastic surgery can be performed simultaneously with mastectomy or some time afterwards. The latter option is considered preferable if the woman needs postoperative radiation therapy, has an overweight or mild form of diabetes.
The breast reconstruction options are as follows:
- arthroplasty (installation of silicone implants)
- autoplasty (lost organ reconstruction with own tissues).
There is no "Gold Standard" of reduction mammoplasty. For each patient the technique of intervention is determined individually, taking into account the scope of mastectomy performed, original breast size and overall picture of health.
Upon arthroplasty, the graft is installed under the pectoralis major muscle. In some cases, the breast skin is stretched by pre-installation of temporary expander. After 2 to 6 months, it is replaced by a permanent prosthesis.
Upon autoplasty, the donor tissues (skin-muscle and skin-fat grafts) are taken from the back, abdomen, or buttocks of a woman. This type of surgery is characterized by a more aesthetic result, but requires a high skill of the surgeon.
The last stage of the gland reconstruction is recreation of the nipple-areola complex. This procedure is performed under local anesthesia 3 to 4 months after mammoplasty, when the "shrinkage" of the transplanted tissue is over. For nipple reconstruction, the implants, patient's own skin tissue or medical tattoo is used.
The final evaluation is done 6 to 8 months after the plastics. Some patients may need additional correction to restore the symmetry and improve the appearance of the breast.
The externally reconstructed breast virtually does not differ from the anatomical one. There are scars at the site of skin flap stitching, but they become less noticeable over the next two years.
Reduction mammoplasty doesn’t affect the development of recurrence or worsening of disease prognosis.Hide
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