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. Therefore, excellent breast reconstruction is particularly important.
Our patients have undergone radiotherapy and chemotherapy for their cancer and now wish to recover 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 our 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. We published a report of this technique in Annals of Plastic Surgery.
In the secondary 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 the aesthetic procedure required) in 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 operating theater with a symmetrical reconstruction. Two or three months later we replace the expander with a cohesive silicone prosthesis, inject fat throughout the subcutaneous area and reconstruct the nipple-areola complex. We published a report of this technique in Annals of Plastic Surgery.
With this protocol the patient obtains a highly satisfactory breast reconstruction, thanks to the great capacity of the fat tissue and the preadipocytes for tissue regeneration. 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.
Tumorectomy and Platelet Autoprosthesis
In tumors in which it is not necessary to perform a complete mastectomy, the cancer surgeon removes the tumor. Then we create a platelet autoprosthesis, a gel made from the patient’s own platelets, in order to fill the defect. A report of this technique was published in the Annals of Plastic Surgery.
Via the periareolar incision used to remove the tumor, we insert the platelet autoprosthesis. In this way the breast does not lose volume and the nipple areolar complex does not retract. From the oncological point of view the patient is cured, and from the aesthetic point of view the breast is not deformed – a very important consideration in terms of the patient’s body image.
Tumorectomy and latissimus dorsi flap with endoscopy
It may be necessary to perform a quadrantectomy. To do so, we use two incisions, one semicircular above the areola and the other axillary. Then, through the axillary incision (which may already have been used for lymph node dissection) and with the aid of endoscopy, we raise the whole of the outer rim of the latissimus dorsi and use this part of the muscle to fill the entire defect in the breast. In this way, the breast is not deformed: there is a single periareolar scar used to remove the tumor, and another in the armpit used for the quadrantectomy and to dissect the portion of latissimus dorsi muscle needed to cover the defect caused by the tumerectomy.
Our technique does not involve any scarring in the back and achieves highly satisfactory breast reconstruction.
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 Spain. 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 –