Rebuilding of the bosom

A patient, operated of a breast cancer, underwent an ablation of this bosom . The role of the surgeon plastics technician is to intervene then to restore mammary morphology and to rebuild the bosom.

Important progress was made in this field and various techniques exist which make it possible to obtain a satisfactory result.

The choice of the technique more adapted is business of particular cases and will be explained as well as possible by the surgeon plastics technician with his patient.

The rebuilding can generally be considered little time after the (on average a year).

The purpose of surgical operation is to reconstitute the volume of the missing bosom and to symmetrize the opposite bosom.

Obviously, this intervention could be considered only after one common agreement with the surgeon gynecologist and the cancer specialist.

Various techniques exist whose principle is function of the cutaneous elasticity on the side where the was carried out.

If there exists a flexible cutaneous coating, surplus and to good quality, the installation of a mammary prosthesis is enough to restore a satisfactory mammary contour.

If, on the other hand, the skin is tended, not very elastic, it is initially advisable to bring to the level of the bosom of the surplus tissues which will be used for the later rebuilding.

The first consultation is fundamental, because it makes it possible to determine the motivations well and to target the precise objectives.

The medical history and surgical is referred to (allergy and medicamentous capture…). The gynaecological and obstetrical past is specified.

The clinical exam makes it possible to quantify the by measurements and to specify the quality of the skin in order to determine the procedure used.

The bosom not operated is also examined. In particular, it is noted if there exists a degree of hypertrophy, or of ptosis associated.
The consultation ends in the capture of photographs, useful for the technical analysis and the postoperative evaluation.

A consultation with an doctor-anesthetist is programmed before the intervention to practice a complete physical exam and to prescribe the complementary examinations necessary.

This consultation makes it possible to refer to the various types of anesthesia, to take all the safety measures necessary.

The doctor-anesthetist then specifies you all the measures to be taken before the intervention concerning the fuel supply, drinks, the tobacco and the medicamentous captures.

A mammography or an echography is carried out according to the antecedents, of the quality of gland and the age, and to detect a possible associated cyst which in same time.

Which type of anesthesia will be practiced?
The general anesthesia is indicated. Usually practiced with the Private clinic Elysium , she answers criteria of maximum security.

Which is the duration of the intervention?
The intervention lasts on average between one and two hours according to the technique used. Obviously and if it is necessary the contralateral bosom will be symmetrized.

Will there be visible cicatrices?
This intervention leaves cicatrices to the level of the rebuilt bosom. In general, it is about the cicatrice of the which is taken again.

This cicatrice will be attenuated later on since the areola will be rebuilt and a party will mask some.

As for the contralateral bosom, he obeys the various techniques and mammary requirements of the plastic surgeon, according to whether there exists an hypoplasia, a hypertrophy or a ptosis.

Obviously, any cicatrice will be the subject of careful care and a rigorous regular monitoring as well as possible to improve the specific cicatricial potential to each patient.

How is held the intervention?
The drawing is carried out before the intervention on a patient upright in whom precise measurements are taken.
The intervention is made under general anesthesia and the technique used depends on the cutaneous coating.

If this coating is flexible and surplus, if it is of good quality, the simple installation of a mammary prosthesis is enough to restore a sufficient mammary contour.

If, on the other hand, this skin not very elastic and is tended, it is advisable to bring surplus skin and for this reason three techniques are possible:

• contribution of a muscular and cutaneous scrap starting from the back
  
  
• contribution of a muscular and cutaneous scrap starting from the abdomen
  
  
• distension of the thoracic skin by the technique of the tissue expansion (this more recent and simpler technique is used in priority if there is no counter-indication).

When the surplus of skin is obtained by the first technique, the purpose of the second operational time is to generally restore mammary volume by including a prosthesis there.

If necessary, the volume and the form of the other bosom are symmetrized.

In the same way, later on, the areola and the nipple will be rebuilt, according to various techniques.

A bandage in the form of support gorges, slightly compressive and grinding is implemented.

Which type of bandage will be used?
A bandage is carried out in the form of slightly compressive bra.

This modelling bandage is used the first day.
According to the cases, according to the intervention and the skin type, the later mode of application will be advised.

Which is the duration of the hospitalization?
It is in general three days.

The continuations are not very painful in general and of analgesics are prescribed in a systematic way. The wire used are in general and there exists an edema which regresses into 2 to 3 weeks.
Some care are of course with advising, like avoiding the significant efforts, or a too physical sport during a fifteen or so days.

Like any surgical operation, the rebuilding of a bosom can have some rare complications such as: infection, hematoma or an anesthetic complication.

It can obviously exist specific complications with this intervention especially related to the quality of the skin.

If the skin is flexible and special medication did not undergo, the complications are in general extremely rare.

On the other hand, if the skin is tended and in particular if there were a type treatment of radiotherapy, it can occur cicatricial problems (disunion, infection, skin necrosis).

If these complications are not very important, it is possible to discuss them by regular care.

If, on the other hand, if the skin necrosis or the cutaneous disunion is important, it can be necessary to stop the phase of rebuilding to await a better revitalization of tissues and possibly a later reintervention.

If a radiotherapy were carried out, the possibility of repair is more difficult.

As for the rebuilding of the areal plate, it is in general carried out by a contralateral skin graft or techniques of dermo-pigmentation.

It will obviously be advisable to supervise the cicatricial development and to ensure the postoperative consultings as well as possible to reduce the risk of hypertrophic scar or .

Any increase in a rebuilt bosom generally contains the installation of a mammary prosthesis. This prosthesis is in rule general filled with the saline, and like any implant, it involves the risk of “rejection” with possibility of hull (induration). This hull can be the subject of regular massages which attenuate its consistency.

In addition, a deflation of this prosthesis is possible leading to a reintervention.

Regular controls will be established obviously, by the plastics technician certainly but also by the gynecologist and the cancer specialist to make it possible to follow the development of the initial disease.

The contralateral bosom will be also in particular well followed.

As for the cicatrices, they will be normally supervised and will be the subject of careful and personalized care.

It is advisable to avoid an exposure to sun of the cicatrices during one year.

The processing of a mammary rebuilding allows the restoration of the contour and the morphology of the bosom.

Generally, the increase in volume is ensured by the installation of a prosthesis and the complications are those of a mammary prosthesis.

Thus, a hull can appear or a deflation of the mammary prosthesis can occur (saline).

Apart from these complications, which require a medical monitoring and surgical, the duration of effectiveness of this intervention is long and its quality remains related to regular medical controls.

In conclusion, the mammary intervention of rebuilding brings an unquestionable benefit as well physical as psychological and the result obtained is satisfactory on the morphological level.

These explanations are certainly diagrammatic, because each case is specific and each technique must be lengthily and personally explained to the patient.