Table of Contents: 1. Overview of Breast Reconstruction Project, 2. Preoperative Preparation for Breast Reconstruction, 3. Surgical Methods for Breast Reconstruction, 4. Postoperative Characteristics of Breast Reconstruction, 5. Postoperative Care for Breast Reconstruction, 6. Precautions for Breast Reconstruction.
1. Overview of Breast Reconstruction Project
Patients with breast tumors who have already undergone or will undergo oncological surgery often experience partial or complete breast defects, which can cause significant physical and psychological trauma. For example, radical mastectomy, modified radical mastectomy, partial mastectomy, skin-sparing mastectomy, and prophylactic mastectomy. Additionally, patients with benign breast tumors may also face the distress of partial or even total mastectomy, which can be resolved through breast reconstruction. Generally, there is no age limit for breast reconstruction as long as the patient's health condition permits it.
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2. Preoperative Preparation for Breast Reconstruction
Routine examinations are required.
3. Surgical Methods for Breast Reconstruction
Autologous tissue transplantation is used to reconstruct chest wall deformities and breast defects, including latissimus dorsi myocutaneous flap, rectus abdominis myocutaneous flap, or transverse rectus abdominis myocutaneous (TRAM) flap for repairing chest wall defects and performing breast reconstruction. Alternatively, a tissue expander and silicone gel breast implant can be used for breast reconstruction by placing the tissue expander under the pectoralis major muscle. After the incision has healed stably, physiological saline is injected into the expander regularly every 1-2 weeks. After 4-8 weeks of expansion of the chest tissue, the expander is maintained for 2-4 weeks before replacing it with a silicone gel breast implant.
1. The timing of surgery can be chosen based on different causes of breast loss. If the patient has undergone a simple mastectomy due to benign breast tumors, breast reconstruction can be performed simultaneously. If breast hypoplasia or breast loss due to trauma or burns occurred during childhood, elective surgery can be performed after adulthood. If the patient has undergone a radical mastectomy due to malignant breast tumors, observation for 3-5 years is required to confirm no metastatic lesions before proceeding with breast reconstruction.
2. Breast reconstruction methods can be categorized into two main types:
(1) Breast Implants: Including silicone gel/saline implants and expanders. This method is suitable for younger patients who do not wish to sacrifice autologous tissue from other parts of their body and have good local soft tissue coverage. The procedure involves placing a silicone gel, silicone elastomer, or saline-filled implant under the skin flaps or beneath the pectoralis major muscle following mastectomy. If the local tissues cannot provide sufficient space to accommodate the required size of the implant, a tissue expander can be placed first, followed by regular water injections postoperatively until enough space is formed, then a second operation replaces the expander with the breast implant.
(2) Autologous Tissue: Autologous tissue breast reconstruction uses the patient’s own tissue as the donor site and employs tissue transplantation methods for breast reconstruction. The tissue sources can include the abdomen, buttocks, back, thighs, etc., and the transfer methods can be pedicled transfer or free grafting.
4. Postoperative Characteristics of Breast Reconstruction
The reconstructed breast has a lasting and realistic appearance. When performing flap transplantation, simultaneous nerve anastomosis can help restore sensation to the reconstructed breast within about one year postoperatively.
Additionally, autologous tissue transplantation offers the following advantages:
1) It makes full use of the patient's own tissues;
2) It avoids potential complications associated with implants;
3) It has good texture, is easy to shape, and provides a natural drooping sensation while correcting clavicle depression and axillary anterior wall defect deformities;
4) It can withstand postoperative radiotherapy and is applicable to patients who have previously received radiotherapy and require extensive resection due to recurrence;
5) Well-vascularized autologous tissue can promote the healing of poor wounds and ulcers.
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5. Postoperative Care for Breast Reconstruction
Pay attention to anti-inflammatory treatment and take antibiotics on time.
6. Precautions for Breast Reconstruction
1. Patients with organic diseases of important organs or systemic diseases that cannot tolerate surgery.
2. Patients with coagulation mechanism disorders.
3. Patients with severe diabetes.
4. Minor patients.
5. Patients with signs of tumor recurrence or metastasis.
6. Patients with unrealistic expectations of surgical outcomes.
7. Psychiatric patients or emotionally unstable individuals.