Breast reconstruction by large dorsal

Mastectomy is the removal of the mammary gland, a skin spindle and areola. Unfortunately, it is still necessary in some forms of breast cancer.
Large dorsal flap reconstruction uses skin from the back, the large dorsal muscle (thin and extended back muscle) and adjoining fat, and may require a prosthesis to recreate breast volume.
The purpose of the surgery is to restore the volume and contours of the breast by using a spindle of skin and muscle taken from the back area. An internal prosthesis must complete the reconstruction whenever the transferred volume is insufficient.
This technique is very useful in cases where the residual skin of the thorax is insufficient or weakened by radiation and cannot, on its own, protect an internal prosthesis.
It is only one of the steps of complete breast reconstruction, which also includes, according to the patient's wishes, reconstruction of the areola and nipple and possibly an intervention on the contralateral breast to improve symmetry.
The intervention is most often carried out at after the complementary treatments that have been necessary, in this case called secondary reconstruction.
The mastectomy scar is reused as an approach in reconstruction; while it can sometimes be improved, it is impossible to remove it.

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A regular preoperative check-up is carried out in accordance with the prescriptions.
The anaesthetist will be seen in consultation at the latest 48 hours before the operation.
In all cases, the practitioner will check the breast imaging (mammography, ultrasound) of the other breast if the last control examination is not recent enough.
No medication containing aspirin should be taken within 10 days of the procedure.
It is possible that the anaesthetist will prescribe anti-thrombosis stockings (prevention of phlebitis) that you will have to wear before the procedure until you leave the institution.
Type of anesthesia:
This is a classic general anaesthesia during which you will sleep completely.
Hospitalization conditions:
A hospitalization of several days is usually necessary. The discharge will be conditioned on the removal of any drainage.

The operation consists of placing a spindle of skin and large dorsal muscle taken from the back at the thoracic level.
The large dorsal muscle is a thin, extended muscle in the back region whose function is not essential for everyday life gestures. The skin spindle is kept alive through the muscle spindle to which it adheres and the whole thing is transferred forward to the thoracic region.
This flap is inserted under the skin of the lateral wall of the chest and inserted between the mastectomy scar and the submammary fold as an "insert".
The placement of an internal prosthesis under the skin and muscle spindle can be used to restore sufficient volume.
In the area where the skin has been collected, the residual scar will most often be horizontal and concealable by the bra strap.
Symmetrization of the other breast and reconstruction of the nipple-areolar plate (areola + nipple) are most often performed later when the volume of the reconstructed breast is stabilized.
THE PROSTHESES
There are several manufacturers and several types of breast implants.
All prostheses are made of a silicone elastomer shell that can be smooth or more or less rough (textured) to reduce the risk of shell formation.
This prosthesis can be filled with either saline solution or silicone gel, the consistency of which is closer to the mammary gland.
There are several forms of prostheses: round, more or less projected, or "anatomical", whose thickness is greater in the lower part, simulating the profile of a natural breast.
The procedure can take three to four hours. At the end of the procedure, a shaping bandage with elastic bands in the shape of a bra is made.

However, the final result is not immediately certain. The breast may appear a little too stiff with a feeling of tightness in the back.
The appearance of the reconstructed breast will gradually change. It takes two to three months for your surgeon to appreciate the result and in particular the symmetry.
It is only at this stage that a possible retouching is possible.
In some patients, the psychological integration of reconstruction can be difficult and a period of ambivalence of at least six months is often observed. The medical and family environment plays an important role in this period when the patient needs to be reassured.
The purpose of this surgery is to bring a clear improvement without however being able to claim to perfection. If your wishes are realistic, you should be very satisfied with the result.

About Breast reconstruction by large dorsal

Complications that may occur following breast reconstruction by prosthesis are:
Infection: which requires antibiotic treatment and sometimes reoperation, up to and including temporary removal of the implant.
Hematoma: which may require a surgical evacuation procedure.
Skin necrosis: whose risk is especially high after radiotherapy, can lead to exposure of the prosthesis and require its removal. Smoking also increases this risk.
The formation of a contractile shell: the formation of a capsule around the implant is constant. In some cases, this capsule contracts, causing a sensation of hardening, sometimes painful. This contraction can sometimes lead to a visible deformation of the breast, which "globulates" as it becomes firmer. This risk has been reduced in recent years, particularly through the use of new prostheses, but remains totally unpredictable for each patient. It is increased if radiotherapy is to be administered on the prosthesis itself.
Waves and folds: when the skin covering the prosthesis is thin, it can suggest the deformation of the envelope in the form of waves or folds.
Implant displacement: an implant displacement is always possible under the effect of muscle contractions. It is not recommended to practice excessive weight training of the pectoral muscles in the postoperative period. Surgical resumption may be necessary.
Traumatic rupture or disbondment by external manoeuvre: the risk is real during intense trauma or excessive compression during a mammographic examination. The replacement of the prosthesis is then necessary.
Wear and "aging" of the implant: it is essential to understand that no prosthesis can be considered as implanted for life. Indeed, a prosthesis ages gradually and its lifespan is necessarily limited.
Over time, the envelope wears progressively and can lead to a leakage of the contents with variable consequences:

• With a serum-filled prosthesis, in the event of rupture, breast subsidence usually occurs within a few hours or days, corresponding to a deflation of the prosthesis
• With a pre-filled silicone gel prosthesis, clinical diagnosis is less obvious. With high cohesiveness gels, nowadays the most commonly used, you are protected from a rapid diffusion of the silicone gel outside the prosthesis.
  Due to the very progressive nature of the migration of the gel outside the prosthesis, the clinical signs corresponding to wear and tear of a pre-filled silicone gel prosthesis are most often late in the form of a breast deformity or the appearance of a shell.
  The timing of the occurrence is unpredictable.
  Digitized mammography diagnoses such a rupture.
  The late appearance of clinical signs of wear and tear on a silicone gel-filled prosthesis reflects the need for regular clinical monitoring of the reconstructed breast by your surgeon.
  Whether the wear concerns a serum or gel-filled prosthesis in both cases, the prosthesis must be replaced.
  By choosing a qualified and competent surgeon trained in this type of procedure, you minimize these risks but do not eliminate them completely.
  MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
  Any additional questions? Ask your doctor about it: careteam@medicaim.com