Breast Restoration - Breast Building

On average, women are 65 years old when they are first diagnosed. However, there are more and more young women who are confronted with this disease, which certainly has to do with early cancer detection and preventive examinations. Accordingly, breast cancer is recognized earlier, more frequently and, above all, at an early stage today. As a result, breast cancer is detected at an early stage and can accordingly be treated better. Thanks to advances in medical check-ups and annual check-ups, patients have a better prognosis. In other words the patient on average will have a better life expectancy. In order to maintain the quality of life after breast cancer therapy and to continue a correspondingly "normal" life, it is important that the patients are informed about all possible ways of restoring the breast. This also gives the patients the hope that they will not feel disturbed in their femininity afterwards.

It is certainly difficult to find out about such a complex topic and to make differentiated decisions in the shock situation of diagnosis. It is precisely for this reason that it is important that sufficient information and a certain level of care is guaranteed by the patient's treating team. With the individual analysis of the patient, the type of cancer and the patient's habitus, a corresponding individual solution can be offered. This can be explained with the patient in several conversations and thereby the patient's fears can be relieved. The fears of "loss of attractiveness" or the feeling of not being fully perceived as a woman can be reduced in advance through the possibilities of reconstructive surgery and appropriate education.

Immediate restoration (primary reconstruction), ie at the time of tumor removal, plays a special role here. This means that the restoration of the breast takes place in the same operation as the tumor removal. The patients accordingly have the great advantage of waking up with two intact breasts after the anesthesia, which corresponds to a primary reconstruction.

There are various breast restoration options available. On the one hand, there is the possibility of restoration with autologous tissue or foreign tissue. Foreign tissue means the silicone prosthesis as a permanent solution or the expander as a temporary solution, a so-called placeholder. The expander can be released after the tumor has been removed in the breast until the final operation is carried out on the patient's own or foreign tissue. Restoring the breast with its own tissue at the time of tumor removal is also possible. Sufficient tissue is required, for example in the abdomen or buttocks area or, in the case of small breasts, in the inner thigh area. This is looked at in the examination of the plastic surgeon together with the breast surgeon. The patient is advised according to the possibilities for a restoration with autologous tissue. In this way, at the time of diagnosis, the person affected can already receive thorough information about the various recovery options.

However, it is also possible that after a complete breast removal and therapy, a patient decides to restore the breast after months or years. There are also various options here. On the one hand, the reconstruction with foreign tissue, i.e. expander prosthesis and later definitive silicone prosthesis, or a restoration with own tissue, most often from the lower abdominal tissue. This is discussed in accordance with the patient's wishes, the possibilities of physique and the situation after breast removal, and a decision is made with the patient.

Since the restoration of the breast appears to be of secondary importance in the acute / shock situation of receiving the breast cancer diagnosis, it is often not given the necessary importance at first. However, since the prognosis after breast cancer has improved so much nowadays and enables long survival up to a normal life span and the breast is an important organ for the femininity of women, it is very important to us not to lose sight of the importance of recovery in the shock situation to let. Accordingly, detailed information and clarification is necessary, divided into several sessions.

• When will the recovery take place? Immediately, ie at the time of tumor removal, or in two stages, ie later.
• Can you do something in the meantime in order to keep your options open and decide later? Intermediate solution with expander (stretching of the breast skin).
• What options are there for building up? Structure with own tissue or silicone - if own tissue, which method is there? Own tissue of the back, abdomen, thighs or buttocks.
• What methods are there to rebuild the areola and nipple? Own tissue (or epithesis that means something comparable

• Is an adjustment of the opposite side necessary? A tightening or reduction of the opposite side or an
enlargement is possible, this depends entirely on the wishes of the patient. For a nice end result, an alignment of the opposite side is often recommended, but not absolutely necessary if not desired.

Almost every patient has the option of rebuilding the diseased breast immediately or later. Both options have their own advantages and disadvantages. With immediate breast reconstruction, the tumor is removed and the breast is restored in the same surgery. The big advantage is that the patient does not have to go through a transition period without a breast and the associated problems and restrictions (stigmatization, prosthetic bra, etc.).

Interim solution
If the breast is completely removed or if further therapy is unclear, an expander can be placed under the existing breast muscle and you can wait. After the wounds have healed (approx. 2-3 weeks), the inflatable silicone cushion can be filled with a saline solution every week during the consultation. These pillows serve as temporary placeholders and are easily tolerated.

Own tissue or silicone prosthesis?
Both methods have their advantages and disadvantages. The greatest disadvantage of breast silicone implants is the rare complication of capsule fibrosis, which can lead to subsequent interventions. Self tissue is certainly the best method. It mostly looks better and more natural. The own tissue also feels more similar to the earlier breast, although today's silicone implants are also of very high quality.

Restoration of the areola
To complete the breast restoration, the areola (areola) and the nipple (nipple) are created. Here, too, different approaches are possible, the nipple can be built up using its own tissue and / or a kind of "tattooed".

Matching the opposite side
If the opposite side is an asymmetrically large or sagging breast, it will be aligned with the restored breast. This means that you reduce it or just tighten it.
When restoring the breast with a silicone prosthesis, we often use a silicone prosthesis on the opposite side in order to achieve the most perfect aesthetic result possible.