Techniques to surgical breast reconstruction

Introduction

There are two main reconstructive techniques: breast implants (which are foreign material) or reconstruction with autologous tissue (your own tissue). The choice of technique is up to the individual patient, following consultation with their plastic surgeon.

A breast treated by breast conserving surgery is normally reconstructed with smaller volumes of autologous tissue.

In the video below you will find a short overview of modern techniques used today (source: understand.com):

Further below is a list of factors that help decide which technique may be suitable for you. The ultimate goal of breast reconstruction is symmetry between both breasts and these factors help to achieve this.

Factors influencing the choice of reconstruction

The condition of the chest wall after removing part or the entire breast

The following anatomical structures will have an important role to play when considering a reconstruction:

  • The presence of the anterior axillary fold.
  • The presence of the pectoralis major muscle.
  • The quality of the remaining breast skin.
  • The position and quality of scars.
  • The presence and / or condition of the nipple areolar complex.
  • The weight of the patient.

Generally, patients in whom the anterior axillary fold has been damaged, the pectoralis major muscle removed, with poor skin quality, bad scars, an absent nipple areolar complex and who are not very thin, are better candidates for autologous reconstruction. Otherwise, implant based breast reconstruction may be considered.
A small non-sagging breast can be reasonably well reconstructed with an implant. However, patients who will undergo, or who have undergone radiation therapy, are poor candidates for this form of reconstruction. Autologous tissue will achieve superior aesthetic results for larger volume breasts with moderate to severe sagging.

 

The contralateral breast

What ultimately happens to the contralateral breast (other unaffected breast) is determined by the patient. If she is satisfied with the shape and volume of her contralateral breast, no further intervention is required. However a breast augmentation, breast reduction or breast lift can be performed to improve symmetry.

 

Additional important factors

The choice of reconstructive technique is also influenced by the oncological requirements of surgery. Wide and extensive resections require reconstruction with microsurgical tissue transfer (free flaps). Post-operative radiotherapy is a contraindication to the use of implants. The logistics and technical capabilities of the plastic surgery team within the multidisciplinary framework are also an important factor determining the selection of reconstructive technique. Finally, patient expectations influence the final decision. Patients with high aesthetic expectations, requesting a stable long-term result will clearly benefit from an autologous reconstruction.