Breast reconstruction

Breast reconstruction looks for recreating the shape of the breast after a complete or partial removal of the breast (mastectomy or lumpectomy). The creation of a natural, symmetrical and durable breast helps recovery and physical and mental well-being, increasing self-esteem after breast cancer treatment.

Breast reconstruction can be performed immediately or delayed:

1. Immediate reconstruction is performed at the time of the breast removal surgery.
2. Delayed reconstruction is performed after breast removal surgery (months or years later).

There are mainly two techniques to perform breast reconstruction, which can be used whether the reconstruction is immediate or delayed:

1. Reconstruction with autologous tissues (flaps): it consists of transplanting the patient’s own tissues from another area of the body to reconstruct the breast. The first choice is usually the abdominal tissue (skin and fat), called the DIEP flap, although there are other options. This technique offers fewer complications by avoiding the use of implants, has a more natural result than implant reconstruction, and allows a “life-long” reconstruction without the need for future surgery. This type of reconstruction is usually required when the patient underwent previous radiotherapy.
2. Reconstruction with implants (expanders and prostheses): it is generally carried out in two surgical stages. In the first intervention an expander or empty prosthesis is placed, which is subsequently filled (expanding) with saline solution until reaching the desired volume. Once this volume is achieved, a second surgery is performed in which the expander is exchanged for a definitive prosthesis. We recommend this option when a reconstruction with your own tissues is not possible.

It usually requires from one to four nights of admission, depending on the type of reconstruction.

The surgery requires placement of drains in the operated areas. These drains collect blood and fluids to prevent them from accumulating, and are removed when the amount of liquid collected is minimal.

At discharge, you will be able to walk and live a relatively normal life without exercising during the first 6 weeks. It is recommended to wear a bra without underwire for 6 months. In cases where abdominal tissue reconstruction is performed, an abdominal elastic belt will be used for 6 weeks. Sun protection is essential at least for the first year.

Breast reconstruction does not prevent oncological follow-up and this should be done according to the guidelines established by your oncologist.

Reconstruction of the nipple-areola complex is usually performed in a last time, a few months after the breast has been reconstructed and the scars are stable.

There are different methods to reconstruct the areola-nipple complex, and all of them can be performed under local anesthesia and on an outpatient basis (without admission).

Micropigmentation allows to recreate the nipple using an optical effect, as well as providing the corresponding color.

Surgery allows the nipple to be reconstructed by providing adequate volume, projection, and shape using a nipple graft from the non-
cancer breast, or by using local flaps obtained from the reconstructed breast itself. In these cases, the areola can be recreated using micropigmentation or with a skin graft obtained from another body area.