Breast teconstruction after breast cancer (Mastectomy)
In some breast cancer patients, the complete removal of the breast (mastectomy) is a necessary part of the treatment. Today, various surgical methods help us reconstruct the breast, including gel-filled silicone implants, tissue flap procedures (own body tissue), or a combination of those two.
Which method we will choose depends on the patient’s needs and wishes and the surgical options in individual cases. Medical decisioncriteria include the patient’s general state of health, breast size, consistency of the breast tissue, scarring, and other treatment plans. Chemotherapy, for instance, affects the skin quality and thus the choice of surgery technique. If radiation therapy is needed, it is advisable to delay the reconstruction.
The timing of breast reconstruction varies greatly. It can be performed during a mastectomy or later, after the surgical wounds have healed and the necessary adjuvant treatment is completed. Some women prefer to wait between breast amputation and reconstruction, because they are not emotionally or medically able to undergo additional surgery or they want to be fully informed about the variety of options. We will be happy to offer you professional support during this process.
Breast reconstruction with implants
Breast reconstruction with implants is the most frequently applied method worldwide. Implants can be filled with silicone gel or saline solution (salt water). In most cases, they are inserted behind the pectoral muscle through pre-existing scars. After mastectomy, the overlying skin is too tight to allow a full-size implant to be inserted immediately, so a tissue expander is often needed. The tissue expander is stretched to the desired volume by gradually injecting additional saline, usually over several weeks or months. In this time, the overlying skin gently expands, providing enough space for the final implant. In a further operation, the saline-filled expander is replaced by a permanent silicone implant.
According to current information, modern, high-quality silicone implants pose no risk to health. However, complications such as capsular fibrosis or capsular contracture (implant hardening) may occur. In such cases, the implants must be replaced or removed. Young women in particular should be aware that removal or replacement of their breast implants may be necessary at a later point in time.
Breast reconstruction with implants is a relatively short surgical procedure which involves only few risks and has the benefit of no scars, except the amputation scar. We usually perform breast reconstruction with silicone implants in the nearby » Steigerwaldclinic.
Tissue flap surgery for breast reconstruction
Tissue flap procedures are an alternative to silicone implants. Flap procedures use tissue from the patient’s abdomen or back (rarely from other body areas) to create a new breast mound after a mastectomy. This technique involves transplanting skin and fatty tissue (with or without muscle) to the breast area, where the new breast is formed. Breast reconstruction with own tissue, especially free flap microsurgery is a challenging task and should be performed only by highly-qualified plastic surgeon teams at specialized centers.
The most common methods for breast reconstruction with tissue taken from the patient’s abdomen area are the TRAM flap (Transverse Rectus Abdominis muscle), which uses muscle, fat and skin), the DIEP flap (Deep Inferior Epigastric Perforator) which uses only skin and fat, no muscle is sacrificed), and the SIEA flap (Superficial Inferior Epigastric Artery) that uses fat, skin, and blood vessels. Tissue removal from the abdominal area could cause abdominal wall weakness.
In very slim women with insufficient abdominal fat, a GAP flap is a possible alternative. Both the I-GAP (Inferior Gluteal Artery Perforator) and the S-GAP (Superior Artery Perforator) involve transplanting skin and fatty tissue from the gluteal region (buttock) to the breast area. However, buttock tissue is less soft and pliable than the lower abdominal tissue, making the shaping of the breast more difficult.
Depending on the size of the breast to be reconstructed, the tissue transplant could lead to asymmetric buttocks and long-lasting problems when sitting. In exceptional cases, skin, fat, and muscle transplant from the hips or thighs is also possible (Transverse Musculocutanaeus Gracilis Flap, also known asTMG flap). A LADO procedure or the LD flap (Musculus Latissimus Dorsi) uses muscle and skin from the upper back, but the amount is normally not sufficient to form a reasonably large breast. In most cases, to match the other breast, an additional breast implant is required.
In summary, own-tissue breast reconstruction is generally much more complex and stressful for the patient than breast reconstruction with implants. Tissue transplant from the lower abdomen and back results in additional long scars in these areas. Moreover, surgery takes longer, the risk of bleeding is much higher, and further complications such as partial or total skin necrosis (tissue death due to poor blood flow) may occur, making follow-up surgery necessary. However, own-tissue breast reconstruction offers a big advantage over breast reconstruction with implants: the breast feels more natural and the risk of capsular contracture is very low. Ideally, breast reconstruction should be done by removing abdominal skin and fat, which will have the additional benefit of a tummy tuck (abdominoplasty). We do not offer tissue flap breast reconstruction in our clinic, but would be happy to provide professional advice and recommendations.
Own-fat breast reconstruction (lipomodelling)
Breast reconstruction with fat alone (without skin and muscles) is not yet a mature surgical procedure, but still subject of research. Lipomodelling involves removing fat and the body’s own cells from the abdomen, back or thighs and injecting it into the breast. In Germany, this procedure has rarely been used, and when it has, then only under research conditions.
In most cases, a few months after breast reconstruction, the nipple can also be reconstructed. One technique includes transplanting a piece of the nipple from the opposite breast to create the new nipple mound. If the new nipple is too small, a small abdominal flap can be additionally used. The areola (the darker area surrounding the nipple) can be reconstructed either using a stronger pigmented skin flap (from the inner thigh, for instance) or it can be achieved with medical tattooing in a specialized practice or outpatient clinic.
Surgery cost for breast reconstruction
Normally, the costs for conventional and established breast reconstruction surgery are covered by public or private health insurance programs. This also applies for surgery on the healthy breast to reduce breast asymmetry.
Do you need more information? Please call 0951 – 208 77 890 to arrange an appointment for a non-binding consultation. We are happy to clarify your individual needs in a detailed conversation and you can enjoy the benefit of our expert advice at any time.
If you have to drive some distance to reach us, for instance from Schweinfurt, Coburg, Bayreuth, Hof, Erlangen, or Nuremberg, you should definitely combine your visit to our clinic with a short excursion to Bamberg’s beautiful medieval Old City, only minutes on foot from us. » Bamberg UNESCO World Heritage Site since 1993.