Breast Reconstruction -
Different possibilities / techniques
For many breast cancer patients, it is extremely important for many breast cancer patients to have their amputated breast rebuilt, especially as younger women are affected every year, for self-esteem, in order to feel safe and comfortable again as a "full-fledged" woman and in everyday life. Many women have additional surgery to have a breast again and to feel more mentally stable. There are many recovery options available today. We have listed the most common options for you here.
Restoration with silicone prosthesis:
After the tumor has been removed, the silicone prosthesis is placed under the
Pectoral muscle laid. We often use a smaller prosthesis for the opposite side if the patient agrees. The prosthesis on the opposite side helps maintain symmetry and statics.
• Advantage of this method: The operation only takes about 1 additional hour. There will be no additional scar.
• Disadvantage: It doesn't feel as natural as your own tissue. It is a foreign tissue that can make a reaction; in rare cases capsular contracture occurs.
Breast restoration with autologous tissue:
Latissimus dorsi flap - build up the chest with tissue from the back
The latissimus dorsi flap was and is an important breast repair flap. It is the most frequently performed flap surgery in the world to restore the female breast. Here, the whole or part of the latissimus dorsi (the long back muscle) is severed on one side or just a part of it, carried under the armpit and brought to the chest and shaped. The blood supply to the muscle is retained during the shift. The underbust crease is retained in an immediate reconstruction. The results can be optically very good, as the fit and size in this case is determined by the skin-saving mastectomy.
The extraction point on the back is closed directly. The remaining scar is usually positioned before the operation so that it is well covered under the bra.
A shapely breast can be restored in this way up to medium-sized breasts with sufficient excess skin and soft tissue. The latissimus dorsi flap can be combined with an implant if the volume is not sufficient.
Advantages: The latissimus dorsi flap is a stable and therefore low-risk flap. The flap is usually performed on a pedunculate basis (it is not necessary to relocate and reconnect the blood vessels), which means that the operation time is relatively short.
Disadvantages: The cloth can only be used if there is enough tissue on the back. A scar is created on the back (from the underbust crease of the affected breast to the middle of the back). A muscle must be sacrificed for this operation. However, the function is usually not restricted as the tasks of the latissimus dorsi are taken over by other muscle groups.
Unsuitable for: Very slim patients on the back, athletes. Suitable for: Patients with sufficient soft tissues who are no longer very active in sports.
Operation time: 4 hours
Inpatient stay: 3-5 days
Breast augmentation with tissue from the lower abdomen: DIEP flap
The second standard procedure for breast reconstruction with autologous tissue is the DIEP flap. When building up the breast with the DIEP flap - as a frequently desired side effect in the course of a tummy tuck - the freely prepared main vascular pedicle is used to build the breast. With this method, only the lower abdominal fat tissue with the skin and fat portion is shifted to the breast region and connected to the new vascular supply in the breast area microsurgically (under the microscope with very fine instruments). The flap is then shaped and sewn in according to the healthy breast. At the same time the abdominal wall is closed. By removing tissue from the abdominal wall, the abdominal wall is tightened in a manner similar to a tummy tuck.
Advantages: Depending on the excess soft tissue on the abdominal wall, up to very large breasts can be restored. The method is well established and is one of the standard breast restoration procedures. Simultaneously with the breast restoration, the abdominal wall is tightened. The advantage over the TRAM and latissimus flaps is that no muscles are sacrificed.
Disadvantages: Relatively complex method (because of the vessel connection) with an approx. 3-5% risk of failure.
Unsuitable for: Patients who do not have sufficient excess soft tissue in the area of the lower abdominal wall. Patients with extensive scars in the lower abdomen.
Suitable for: All patients with sufficient soft tissue on the abdominal wall who do not want to do without parts of the back muscles or who do not want to accept scars on the back.
Operation time: 4-6 hours
Inpatient stay: 5-7 days
Breast build-up with tissue from the inside of the thigh - Gracillis flap (TMG flap)
When augmenting the breast with the TMG flap, the freely prepared main vascular pedicle is used to augment the breast, as a frequently desired side effect in the course of a thigh lift. The elongated piece of fabric is twisted into a cone and a breast shape is reproduced. The TMG flap (= transverse myocutaneous gracilis flap) is a flap from the area of the inner thigh and consists of the eponymous muscle, the gracilis muscle as well as the subcutaneous fatty tissue and the corresponding (transverse = transverse) skin spindle. The scar after the removal point of a dorso-medial thigh flap is hidden in the natural flexion fold of the inner thigh, with outflows in the infragluteal fold.
The TMG flap is one of the standard breast restoration flaps. The main problem is often the small volume that can be removed for breast restoration.
Advantages: Compared to the DIEP and FCI rags, none. Relatively simple method with low microsurgical risk in relation to the vessels to be transferred in relation to other flap plasties.
Disadvantages: Only small to medium-sized breasts can be restored using this method. Unsuitable for: Patients with scars on the inner thighs (e.g. after liposuction on the inner thigh).
Suitable for: Patients for whom no tissue is available in the area of the lower abdomen.
Operation time 4-6 hours
Inpatient stay: 5 - 7 days
sGAP and iGAP - flaps (breast structure through tissue from the buttocks)
sGAP stands for Superior Gluteal Artery Perforator Flap, iGAP Inferior Gluteal Artery Perforator Flap.
There are tissue displacements from the upper and lower buttock region. These are flaps which are made up of skin and subcutaneous fat without any muscle. In addition to the sGAP flap on the buttocks, there is also the iGAP flap. Both procedures are rarely used due to the significant buttock deformity, but they are an option.
Operation time: 5-7 hours
Inpatient stay: 5-7 days