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Reconstructive surgery

Breast reconstruction after mastectomy can be performed immediately or at a later date. The decision depends on the patient’s own preferences, the presentation of the underlying disease, skin trophicity and whether adjuvant radiotherapy is indicated. 

Generally speaking, conventional external radiotherapy does not exclude immediate reconstruction. In the case of reconstruction with a prosthesis, the risk of adhesive capsulitis around the prosthesis is increased. In the case of a flap reconstruction, the vascularisation of the flap can be reduced, with an increased risk of necrosis of the transplanted tissue. 

Prosthesis reconstruction is now widely used. The implants are placed under the pectoral muscle and fill the tissue gap left by mastectomy. Silicone implants are anatomically shaped to match the contralateral breast, which also determines their projection. 

Flap reconstruction fills the gap with autologous (i.e. the patient’s own) tissue, which is used to reconstruct a curve in the pre-thoracic area. The choice of the flap used will depend on the patient’s own preferences, her anatomy and the quality of the residual tissues. The flaps can consist of muscle or fasciocutaneous tissue, pedicled (i.e. attached) or free. In the latter case, a mastery of microsurgery techniques is essential. 

Flap reconstruction is particularly indicated in the case of poor skin trophicity, e.g. after radiotherapy. One advantage of this technique is that the reconstructed breast will develop over time isometrically with the other breast (weight loss or gain, for example).