Breast reconstruction

Breast reconstruction is surgery to rebuild breast tissue that has been partially or totally destroyed.
There are two main causes of breast volume loss:

• accidental loss, such as an accident, major trauma or burn; this is the rarest case.
• voluntary loss for therapeutic purposes, whether through radiotherapy or, more often, excision surgery (mastectomy or mammectomy for breast cancer).

The extent of surgery required will depend on the volume of tissue missing, but also on the state of the underlying tissues, which may be inflamed (recent surgery) or dead (radiotherapy).

This is also what determines the timing of breast reconstruction: in some cases, it can be carried out immediately after a mastectomy, in others after several years, sometimes requiring several operations over several months. This also explains the symbolic significance of breast reconstruction, as the patient experiences it as the end of a long struggle and a return to a "normal" life.

In most cases, breast reconstruction is partially reimbursed by the health insurance system, after approval by the medical officer.

The initial examination by Dr Christelle Santini is essential, so that she understands both your medical history and your hopes.

The clinical examination is based on an examination of the breasts and a review of the medical records, often including a discussion with the surgical oncologist or senologist.

This step is complemented by an artistic eye, to recreate a harmonious, shapely and symmetrical breast that meets the patient's expectations.

The reconstructed breast is never perfectly identical to the contralateral breast, for example in terms of consistency and mobility. But the aim is to achieve the most natural rendering possible by determining :

• the right time for reconstruction surgery
• the best surgical technique.

A visit even before excision surgery enables us to optimize surgical procedures, while taking a very positive medium-term view.

Dr Santini will also give you his main recommendations:

• Agreement of the social security medical officer if applicable.
• Smoking cessation one month before and one month after surgery to optimize healing of often fragile tissues.
• Discontinue certain medications with medical approval, such as the contraceptive pill (risk of embolism) or anticoagulants (risk of bleeding).
• You must fast on the day of surgery.

These procedures are carried out under general anaesthetic, and each technique is adapted for a tailor-made solution: all breast reconstruction operations are different from one another.

Dr Santini can combine different methods in a single procedure.

When this is not possible, several operations are required.

Breast reconstruction with breast prostheses

After the complete removal of a breast (mastectomy), the simplest solution for reconstruction may be the insertion of a breast implant.

If the thorax lacks skin, one solution is to fit a temporary prosthesis known as a breast expander. An internal valve allows it to be progressively inflated with physiological saline to help the skin expand. Once the desired volume has been reached, on average after 4 to 6 months, the definitive prosthesis is fitted.

This implant-based reconstruction technique restores the breast and the femininity of the bust, making it sublime.

Breast reconstruction using the flap technique

Surgical flap breast reconstruction uses the patient's own tissue from other parts of the body (autologous flap taken from the abdomen or back) to reconstruct a breast by relocating it.

1. The dorsalis major involves harvesting skin and muscle from one side of the thorax and from the back. This is necessary when the skin of the chest has been altered and does not allow a prosthesis to be placed on its own. In the majority of cases, displacement of the dorsalis major is combined with breast prosthesis placement and/or breast lipofilling.
2. Reconstruction using the rectus abdominis muscle flap takes longer. The DIEP (Deep Inferior Epigastric artery Perforator) flap can be used to add volume when the contralateral breast is large, provided the abdominal morphology allows. This type of breast reconstruction gives a natural result without breast prosthesis, with soft, sensual tissues.

Lipofilling breast reconstruction

Breast lipofilling or lipostructure is a technique whereby fat is removed from another part of the body and reinjected into the breast.

This is a breast reconstruction technique often used as a complement to another method, or to correct imperfections of a partial mastectomy (such as a hollowed out curve).

Nipple reconstruction

A final stage of surgery may be required to symmetrize the contralateral breast by reconstructing the areola and nipple.
Depending on the case, this procedure may be performed independently or as a continuation of other breast reconstruction operations, in a single operation.

This is often the last surgical procedure, which will enhance the new breasts with symmetrical, positioned nipples.

Pain varies in intensity, but Dr. Santini systematically manages it in a preventive and appropriate way, to ensure that the post-operative period is as comfortable as possible.

The dressing is redone the day after or two days after the operation, with the drains removed between the second and tenth day, depending on the volumes collected. A support bra must be worn at all times for at least 6 weeks.

Convalescence generally lasts 1 to 2 months, with resumption of sporting activity not recommended for 2 to 3 months.

Dr Christelle Santini provides regular follow-up and adapts her advice to your actual tissue recovery. Particular attention is paid to the healing process, on tissues that are sometimes initially weakened in their vitality.

It takes at least 6 months after the operation to appreciate the final result, with a supple, symmetrical reconstructed breast.
It is sometimes useful to supplement this with physiotherapy sessions, to restore good mobility to the shoulder and chest, particularly in the case of a lumbar spine graft.

Scars fade after 6 to 12 months, and are usually perfectly concealed by the bra. They try to match those of the initial mammectomy, so as not to add to them.