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Breast reconstruction is a surgical recreation of the removed breast tissue, its nipple and areola.

In Russia, as in most economically developed countries in Europe and North America, an increase of morbidity and mortality from hormone-dependent tumors of women’s reproductive system.

Only in the last 10-15 years, the incidence of breast cancer (BC) has increased more than 2 times. This is attributable to increasing popularity of so-called “civilization diseases”: anovulation, chronic hyperestrogenemia, endocrine infertility, obesity, hyperlipidemia, diabetes. As a result of the mammography and ultrasound use the number of patients with early forms of breast cancer, revealed after the examination, increased. This determines the relevance and practical meaning of new ways of treatment like, for example, organ-sparing treatment.

It should be noted that the implementation of even preserving therapy of breast cancer in the form of a sectoral or segmental resection with axillary dissection followed by radiation therapy is a severe psychological trauma for a significant proportion of patients (35 - 40%). When conducting a "classical" radical treatment (mastectomy, postoperative radiation therapy, and adjuvant chemotherapy) it is typical for the vast majority of patients to have adverse neuropsychiatric reactions of various trace, extent and duration. The two trigger factors like the presence of a malignant tumor and the loss of an attribute of femininity (mammal gland) are the dominant fundamental in the development of neuropsychiatric symptoms of breast cancer patients.

The lack of breast cancer as a physical defect can be easily veiled with special underwear, but the desire or the need to get naked may cause certain difficulties for many patients. Wearing the external prosthesis especially for young women can hardly be called rehabilitation. An alternative is surgical reconstruction of the breast. But not all the patients who had undergone treatment and still have fresh memories about their previous operation want to come back to the clinic. As a rule, elderly women and women who have different life values (like career and child-rearing) rarely think about this operation. Besides there is still a large group of women who either lack information about the possibility of breast reconstruction, or frightened by warning about the dangers of cancer reconstructive surgery said to be the threat of the disease recurrence.

Operations for breast reconstruction are conducted by at least from the mid 70s. Under certain conditions (low recurrence threat) they may be performed simultaneously with mastectomy.

In our country, such operations haven’t gained popularity yet due to the low interest from the side of  patients. The experience of using the existing methods of breast reconstruction operations has been accumulated only in specialized departments with highly qualified plastic surgeons.

When you restore a breast, the primary objective is to obtain a natural convexity and, subsequently, to recreate the nipple and areola. To achieve this goal one needs to find the missing skin and soft tissue to create necessary volume.

A relatively simple situation is when a sufficient thickness and mobility of the chest skin and subcutaneous tissue has remained, as well as the pectoral muscle. In this case, the required increase in tissue expander can be obtained by dermotension. The expander is selected according to the volume and area of the healthy breast base and is implanted in the chest area according to the level of inframammary folds and to the center line position.

The gradual introduction of the liquid increases the expander volume and the tissues stretch over it. Depending on the type of the expander the operation may consist of one or two stages. In first case a so-called expander prosthesis is used. After reaching the required volume the expander performs the role of the prosthesis. As far as the two-stage version in concerned, the stretched expander is removed and an endoprosthesis is installed in its place. Technically, these are the simplest types of operations, that give a good cosmetic result with minimal additional trauma and with a short postoperative period.

In case the thickness of skin and subcutaneous fat are not enough and they are tightly fused with the underlying tissues or the healthy breast has a large volume, a surgeon has to use additional skin grafting. In order to eliminate the deficit of the skin the thoracodorsal skin-muscle flap and skin-muscle flap of the rectus abdominis muscle are used. Each of them has its advantages and disadvantages, so depending on the particular situation the most appropriate operation type can be chosen.

One of the first methods of breast reconstruction was the use of thoracodorsal flap. Its basis is the latissimus dorsi with the permanent vessels around it. The flap is mobilized to the armpit and moves anteriorly with preservation only vascular or vascular and muscular legs. After moving the extra skin the prosthesis is placed under it. The volume of the endoprosthesis is selected to obtain a symmetry with the healthy breast. The donor area on the back is sutured so that postoperative scar is located under the bra straps. In the future the ptosis (drooping) of healthy breast can be removed and areola as well as the convexity of the nipple can be restored. However, this method has certain disadvantages. If radiation therapy was performed, the latissimus muscle often suffers from atrophy and isn’t suitable for the base of the flap. In addition, some women are afraid to get another scar, even taking into account that it will be hidden.

With sufficient supply of tissues on the anterior abdominal wall, the rectus abdominis can be used. It is supplied with blood through a system of anastomoses upper and lower epigastric vessels. Dermal-fat portion of the flap can be positioned both longitudinally and transversely with respect to the muscle. Moved flap brings necessary tissue mass to the chest, which is sufficient to model the breast without additional endoprosthesis. In this case the donor area is sutured, as in surgery for 'drooping' belly, and the postoperative scar in the abdomen is easily veiled with the underwear.

In the future corrective surgery to address ptosis on a healthy prostate and restore the nipple-areola complex can also be performed. Currently, the variant of microsurgery transplanting the rectus abdominis muscle flap for reconstructing the shape of the breast has become more popular. In this case, only part of the rectus abdominis muscle is taken, and the blood supply is conducted through the anastomosis inferior epigastric artery and vein with blood vessels in the underarm area. This method is less weakening for the abdominal wall and allows to form the inframammary fold, but if there is a threat of insolvency anastomoses necrosis of the flap.

The question about the timing of the recovery period remains open. Ideally, the reconstruction can be carried out and performed simultaneously with the mastectomy. Immediate reconstruction is performed in diffuse mastopathy, when immediately after subcutaneous mastectomy the breast volume is restored with the endoprosthesis. At the relatively early stages of breast cancer when postoperative radiation therapy isn’t planned a radical mastectomy and reconstructive surgery may be performed simultaneously.

In delayed reconstruction the optimal term for this surgery is usually considered to be a period not less than one year after the initial treatment. This period is determined by the evolution of the scar tissue.

A brief examination is carried out before the operation.

Sometimes a long and difficult road to after-cancer breast recovery eventually gives a woman a great positive emotional charge that returns her to the active life.

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