Breast reconstruction with dorsalis major with or without prosthesis
The breast reconstruction is plastic surgery to reconstruct a breast that has been partially or totally destroyed, most often after breast cancer surgery. Breast reconstruction with a surgical flap uses your own tissue displaced from another part of your body (stomach or back) to reconstitute your breast: this is also known as autologous reconstruction.
This reconstruction may or may not be accompanied by breast implants.
What are the indications for breast reconstruction with dorsalis major in Paris?
There are two main causes of breast volume loss requiring dorsal flap reconstruction:
- accidental causes, such as major trauma or burns: this is the rarest situation.
- a voluntary cause where the tissue has been removed for therapeutic purposes, typically breast cancer surgery (mastectomy or mammectomy).
Lumbar spine reconstruction is based on the harvesting of skin and muscle from the side of the thorax and the back.
It creates an additional scar in this area.
Dr. Christelle Santini offers this technique of breast reconstruction using a dorsalis major flap when the quality of the skin of the thorax does not allow the placement of a prosthesis alone. However, the morphology of the thorax and the size and shape of the contralateral breast must be suitable. It is rare for the morphology of the thorax and contralateral breast to make it possible to dispense with a prosthesis and use the flap alone. In the majority of cases, breast volume is therefore reconstructed by combining a prosthesis with the dorsalis major flap.
In most cases, breast reconstruction using the lumbar spine will be partially reimbursed by the health insurance system, subject to approval by the consulting physician.
What recommendations should I follow before surgery?
One or more appointments with Dr. Santini are made beforehand, to accompany the patient through the surgical process.
Particular attention is paid to listening to their needs, so that this "renewal" surgery matches their expectations as closely as possible.
That's why you need to take very strict precautions to ensure optimal recovery. Smoking cessation is recommended one month before and one month after surgery. Smoking reduces tissue vascularity, which can delay healing. This is an important point to consider for tissues that are sometimes more fragile, having undergone initial surgery and sometimes adjuvant treatments such as radiation or chemotherapy.
No aspirin-containing medication should be taken for 10 days prior to surgery.
What is the procedure for breast reconstruction with dorsalis major?
This surgery is performed under general anesthesia, on an empty stomach, with a hospital stay of 1 to 2 days.
The latissimus dorsi is a thin, extensive muscle.
In a dorsalis major muscle flap reconstruction, Dr Christelle Santini removes almost all of the muscle and the amount of skin she needs to reshape the missing breast.
A paddle of thoracodorsal skin and dorsalis major muscle is harvested through a horizontal or oblique incision on the same side as the mastectomy. This flap is rotated from the lateral and dorsal area to the anterior thoracic area. This musculocutaneous flap remains connected to the axilla by the artery, nerve and vein of the axillary fossa, ensuring tissue vitality. The mastectomy scar is opened and the flap inserted. The donor area of the flap is then sutured.
When the volume of muscle transferred is insufficient and creates an asymmetry in relation to the volume of the contralateral breast, a breast prostheses to complete the reconstruction. Additional volume can also be added by breast lipostructure or lipofillingan autologous fat graft.
The surgical procedure is performed under general anesthesia and lasts from 3 to 5 hours. This breast reconstruction technique is less demanding and less time-consuming than reconstruction using a flap of the rectus abdominis muscle.
At the end of the operation, drains are inserted to aspirate postoperative serosities and reduce the risk of hematoma, along with a pressure dressing.
What is the post-operative course of breast reconstruction?
Pain varies in intensity. It is systematically managed by Dr. Santini in a preventive manner and adapted to your case. Flap vitality (color, warmth, capillary pulse) is monitored regularly.
The dressing is redone on the second post-operative day. Drains are removed between the second and tenth day. A support bra must be worn day and night for several weeks, on average between 6 and 8 weeks.
A recovery period of between 1 and 2 months will be observed.
Resumption of sporting activity is not recommended before 3 months post-op.
Any surgery may also present complications, which will be explained to you by Dr Christelle Santini during your pre-operative consultations.
Rigorous follow-up is organized with several check-ups, the first of which generally takes place between D7 and D10.
What is the outcome of breast reconstruction with or without breast implants?
The reconstructed breast is flexible, with varying degrees of volume. Over time, it will tend to follow the natural evolution of the contralateral breast.
A second or even third stage of surgery may be required a few months apart to symmetrize the contralateral breast and reconstruct the areola and nipple.
Unilateral harvesting of the latissimus dorsi muscle does not cause any significant functional impairment in daily life. Temporary limitation of shoulder mobility may require physical therapy. In all cases, physiotherapy sessions are systematically prescribed.
It is important to warn patients in advance of the creation of an additional scar at the harvesting site of the dorsalis major in the back. The scar is usually horizontal and partially or totally concealed by the bra. It can also be vertical, hidden under the arm, or oblique.
It's also important to note that the color and texture of the skin on the back may vary from that of the skin in the breast area, leading to slight differences in hue or appearance in the bust area once reconstruction is complete.
Highlights of breast reconstruction with dorsalis major
- Procedure covered by social security under certain conditions
- Custom surgery for a natural look
- High symbolic value for patients, with aesthetic and psychological improvements
Breast reconstruction with dorsalis major in brief...
What should I do before undergoing breast reconstruction?
- 1 to 2 plastic surgery consultations with a quote and medical photographs.
- Selection of suitable breast prostheses
- Consultation with anaesthetist, blood test, mammogram +/- breast ultrasound as appropriate
How is breast reconstruction performed?
- Breast reconstruction under general anaesthetic
- 3 to 5.5 hours of surgery for lumbar spine reconstruction
- Whether or not to fit dentures
- Return home the next day or two.
- Medical compression bra fitted after drain removal, to be worn for 2 months.
What is the post-operative course of breast reconstruction using the dorsalis major?
- The threads used are absorbable.
- Follow-up consultation with Dr Santini 7 to 10 days after breast reconstruction surgery.
- Final result after 12 months.
- Surgery may be required later on the areola.