BREAST RECONSTRUCTION

Breast reconstruction after mastectomy
At Breast Pathology Units in Europe and the United States, a patient is only considered cured when her breast has been satisfactorily reconstructed. We believe that a patient can be considered completely cured when she no longer thinks about the disease. In this regard, excellent breast reconstruction is particularly important.

Our patients have undergone radiotherapy and chemotherapy for their cancer and now wish to regain a positive body image, with as few scars as possible. To help them achieve this, we have designed a breast reconstruction protocol with expanders, prosthesis, and fat grafting which capitalizes on the regenerative capacity of preadipocytes, or stem cells, and produces excellent results. We have described this protocol in the world’s two most important plastic surgery journals, Plastic and Reconstructive Surgery and Annals of Plastic Surgery.

In the primary reconstruction, which we perform during the mastectomy, we insert the expander, and detach the pectoralis major muscle slightly to obtain a good definition of the lower quadrants of the new breast. We then partially fill the expander. During this first stage we also perform the aesthetic treatment of the other breast, if necessary, and in accordance with the patient’s wishes. Two or three months later, we replace the expander with a cohesive silicone prosthesis and inject fat throughout the subcutaneous area to obtain a good subcutaneous plane and add elasticity, and we reconstruct the nipple-areola complex.

In the secondary breast reconstruction, we insert the expander endoscopically via a minimal incision at the end of the mastectomy scar. In the first stage, we perform the reduction or pexia or the aesthetic procedure required for the healthy breast, in accordance with the patient’s wishes, and we fill the expander until the breasts are the same size. Fat is injected into the upper quadrants between the skin and the pectoral muscle. The patient leaves the surgical theatre with a symmetrical reconstruction. Two or three months later we replace the expander with a cohesive silicone prosthesis and inject fat throughout the subcutaneous area and reconstruct the nipple-areola complex.

With this protocol the patient obtains a highly satisfactory breast reconstruction thanks to the great capacity for tissue regeneration of the fat tissue and of the preadipocytes. The procedure is relatively short and is not painful; the number of scars is kept to a minimum. This is particularly important, bearing in mind that the patient has already undergone chemo- and radiotherapy to treat her cancer.

In cases of conservative surgery (tumorectomy), we insert a coagulum  enriched with Platelet Growth Factor which fills the space and prevents retraction. Several months later, if necessary, we inject treated fat. This technique ensures that the shape of the breast is not altered. 

In the few cases in which these techniques cannot be applied, we use the classical techniques with latissimus dorsi or rectus abdominis muscle flaps, or a range of microsurgical techniques which we were the first to use in this country. In all cases, we inform the patient of the advantages and disadvantages of each technique.

Author’s publications - Mammary reconstruction using tissue expander and partial detachment of the pectoralis major muscle to expand inferior breast quadrants. Serra Renom JM. Ann. Plast. Surg. -Treatment of facial fat atrophy in HIV+ patient by means of autologous fat injections. Serra-Renom JM,. Plast. Reconstr. Surg. - Endoscopic breast reconstruction with intraoperative complete tissue expansion and partial detachment of the pectoralis muscle. Serra-Renom JM, Ann Plast Surg. -Fat grafting in post mastectomy breast reconstruction with expanders and prosthesis in patients who have received radiotherapy. Formation of new subcutaneous tissue. Serra-Renom, JM. Plast. Reconstr Surg –