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Reconstructive surgery is performed in the following special areas:
-
breast reconstruction after breast carcinoma and mastectomy
-
plastic surgery
for skin tumours
-
surgical treatment for burns
-
correction of
scars
-
hand surgery
-
microsurgery
-
surgical reconstruction after
trauma
The greater part of these operations are paid for and covered
by medical insurance because they are medically necessary procedures.
In the case of a breast reduction the goal is not only to reduce the size of the breasts but also to achieve a beautiful,
well-formed look to the shape of the breasts. As in a breast lifting, a minimal
scar technique (LINK Breast Lifting) such as the Lejour technique can be used.
Only in the case of very large and extremely saggy breasts is a reduction
performed using the inverted T- technique, which is then made necessary by the
larger amount of excess tissue.
The cost of this operation is seldom paid
by your health insurance because it is classified as a cosmetic operation.
However, when the size and weight of large breasts are the cause of physical
health problems or damage, then the operation is not a cosmetic procedure but a
functional medical necessity instead.
The advice of a surgeon with
training and experience in this field can help you determine your status and
inform you of the possibilities of a breast reduction including "before and
after" pictures of breast reductions that have been performed at our
practice.
Mastectomy
and oncologic surgery
Breast reconstruction surgery at our practice
is performed in close cooperation with the oncologic breast centre of Professor
Justus Apffelstaedt & associates (www.apffelstaedt.com). The latest
techniques of cancer screening, skin sparing mastectomy, and sentinel node
mapping are performed.
Immediate
or Delayed Reconstruction
Reconstruction of a breast that has been
removed due to cancer or other disease is one of the most rewarding surgical
procedures available today. New microsurgical techniques and implant devices have
made it possible to create a breast that comes close in form and appearance to
a normal breast. Reconstruction is possible immediately following breast
removal (mastectomy) and the patient can wake up after mastectomy surgery with
a breast mound already in place, having been spared the experience of seeing
herself with no breast at all. Reconstruction can also take place at a later or
delayed stage, after the mastectomy and adjuvant oncologic chemo- and radiotherapy
has been completed. Generally, whether immediate or delayed, breast
reconstruction surgery takes often place in stages, requiring a second stage
procedure a few months after the first surgery to accomplish the final result.
Most mastectomy patients are medicallyappropriate for a reconstructive procedure, many at the same time (immediate) that the breast is removed. Any woman who will lose her breast to cancer disease can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with
the different types of breast reconstuctive procedures.
In general, the usual problems of surgery, such
as bleeding, fluid collection, excessive scar formation, or difficulties with
anesthesia can occur, although relatively uncommon. Smokers should be advised
that nicotine can delay healing, resulting in more conspicuous scars andprolonged recovery. Occasionally, complications are severe enough to require a second operation.
If an implant is used, there is a remote
possibility that an infection will develop, usually within the first two weeks
following surgery. In these cases, the implant may need to be removed forseveral months until the infection is cleared. A new implant can be inserted at a later stage.
The most common problem, capsular contracture,
occurs if the scar or capsule around the implant begins to tighten and contract.
This squeezing of the soft implant can cause the breast to feel hard, the
breast can be tender and deformed. Capsular contracture can be treated byremoval of the scar tissue and replacement of the implant in a new pocket if possible.
Reconstruction has up to date no effect on the
recurrence of breast cancer, nor does it generally interfere with chemotherapyor radiation treatment, should cancer disease recur.
Planning reconstructive breast surgery
You can find out more about the possibilities
of breast reconstruction as soon as you are diagnosed with cancer. Ideally, the
breast surgeon and plastic surgeon should work closely together from this earlystage to develop a strategy that will help decide and put you in the best possible condition for reconstruction.
After a first evaluation and consultation, we
will explain which reconstructive options are available and most appropriate
for your age, health, anatomy, tissues, and goals. Be sure to discuss your personal
expectations with us. Post-mastectomy reconstruction can improve appearance and
renew self-confidence - but keep in mind that the desired result is improvement,
not perfection. In most cases, medical aids will cover a part or most of thecost of post-mastectomy reconstruction. Check with your medical health provider to make sure how much is covered.
Preoperative preparation
Your oncologist and plastic surgeon will give
specific instructions on how to prepare for surgery, including guidelines on
eating and drinking, smoking, and taking or avoiding certain vitamins and
medications. Breast reconstruction usually involves more than one
operation. The first stage, whether done at the same time as the mastectomy or
at a later stage, is performed in a private hospital. Depending on the extent
of follow up surgery required, the second stage procedure can be performed at a hospital or an outpatient facility.
The different
options for breast reconstruction:
Breast implant:
If there is a sufficient skin envelope after
mastectomy surgeon a breast implant can be placed. A breast implant is asilicone shell filled with either silicone gel or a salt-water solution known as saline. Different shapes and sizes are available.
Skin expansion:
More commonly skin expansion is combined with
subsequent insertion of an implant, due to a decreased skin envelope after
mastectomy. Following mastectomy, a balloon expander is inserted beneath your
skin and chest muscle. Through a tiny valve mechanism beneath the skin, a
salt-water solution will be periodically injected to gradually fill the
expander over several weeks or months. After the skin over the breast area has
stretched enough, the expander may be removed in a second operation and a more
permanent implant can be inserted. Some expanders are designed to be left in
place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.
Some patients do not require preliminary tissue expansion before receiving an implant. For some women, the surgeon will proceed with inserting an implant as the first step.
Flap reconstruction:
Skin flaps can be taken from other parts of thebody, such as the back, abdomen, or buttocks.
In the first type of flap surgery, the tissue
remains attached to its original site, retaining its blood supply. The flap,consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to be inserted into the chest.
In the second, more sophisticated flap
technique the tissue is surgically removed from the abdomen, thighs, or
buttocks and transplanted to the chest by reconnecting the blood vessels to newones in the chest region. This procedure requires the skills of a plasticsurgeon who is experienced in microvascular surgery.
This type of surgery is more complex than skin
expansion. Scars will be left at both the tissue donor site and at the reconstructed
breast, and recovery takes slightly longer than with an implant. On the other
hand, when the breast is reconstructed entirely with your own tissue, the
results are generally more natural and there are no concerns about the possiblecomplications associated with a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour.
In our practice we perform all types of flap or
implant reconstructions on a regular basis and we offer all different
reconstructive possibilities, depending on the specific indications and the
personal choice of each patient. The latest flap techniques, including muscle
sparing transvers abdominal musculocutaneous flaps (TRAM-flap),deep inferior
epigastric artery flaps (DIEP-flap), and inferior and superior gluteal arteryflaps (S-GAP and I-GAP flaps) are perfomed. You are invited to inform yourself about the different possibilities of breast reconstruction in a personal consultation and view "before and after" pictures of our patients.
Follow-up procedures:
Breast reconstruction involves a series of
procedures over time. The initial reconstructive operation is usually the most
complex. Follow-up surgery may be required to replace a tissue expander with animplant or to reconstruct the nipple and the areola. The normal breast can be enlarged, reduced, or lifted to match the reconstructed breast.
After the surgery:
You are likely to feel tired and sore for aweek or two after reconstruction. Most of the discomfort can be controlled bymedication which will be prescribed at discharge.
Depending on the extent of surgery, you'll
probably be discharged from the hospital in two to seven days. Most
reconstruction options require a surgical drain to remove excess fluids fromsurgical sites after the operation, but these are removed within the first week
or two after surgery.
Recovery period:
It may take up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. Ifimplants are used without flaps and reconstruction is done apart from themastectomy, your recovery time may be less.
Reconstruction cannot restore normal sensation
to your breast, but in time, some feeling may return. Most scars will fadesubstantially over time, though it may take as long as one to two years.
Follow your surgeon's advice on when to begin
stretching exercises and normal activities. As a general rule, you'll want torefrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction.
Your new look:
The reconstructed breast may feel firmer and
look rounder or flatter than your natural breast. It may not have the same
contour as the breast before mastectomy, nor will it exactly match the opposite
breast. But these differences will be apparent only to you. For most mastectomypatients, breast reconstruction dramatically improves the appearance and quality of life following surgery.
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