Breast reconstruction by prosthesis

Mastectomy is the removal of the mammary gland, a skin spindle and areola. Unfortunately, it is still necessary in some forms of breast cancer. A request for breast reconstruction is quite legitimate after mastectomy.
The purpose of surgery is to restore the volume and contours of the breast by placing an internal prosthesis under the pectoral muscle.
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 use of an external prosthesis may be considered satisfactory for some women. Reconstruction remains a personal choice.
If breast reconstruction by prosthesis is the easiest procedure to propose, there are other techniques that bring tissues from another part of your body (large dorsal, large right abdomen) which are more sophisticated techniques that have their own advantages and disadvantages.

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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 can be performed at the same time as the mastectomy, referred to as immediate reconstruction, or after the additional treatments that have been required, referred to as secondary reconstruction.
The mastectomy scar is reused as an approach in reconstruction; while it can sometimes be improved, it is impossible to remove it.
The intervention consists in putting in place, usually under the skin and pectoral muscle, an internal prosthesis. This internal prosthesis is, in the simplest cases, the permanent prosthesis. In some cases, it may be a temporary tissue expansion prosthesis designed to increase the quantity of covering tissues (skin, muscle) of the permanent prosthesis, which may give a more natural appearance to the reconstructed breast.
This expansion of the skin is best illustrated during pregnancy. As a result of the child's progressive growth, the abdominal skin stretches to allow excess to persist after delivery. By analogy, in the case of breast reconstruction a temporary prosthesis is gradually expanded to obtain an excess of skin that is used to cover the permanent prosthesis.
Tissue expansion has the disadvantage of requiring two surgical procedures.
At the same time as the implantation of the permanent prosthesis, it is possible to reshape the opposite breast if necessary.
The nipple-areolar plate (areola + nipple) will most often be reconstructed later when the breast volume 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.
As for the temporary expansion prosthesis, it will be filled with saline solution.
The procedure can take one to two hours. At the end of the procedure, a shaping bandage with elastic bands in the shape of a bra is made.

At the first bandage, the reconstructed breast will look a little frozen, and the skin covering it will be less sensitive. Pectoral muscle contractures are sometimes described by patients.
This aspect will gradually evolve. It is necessary to wait two to three months to be able to assess the result of the reconstruction and possible symmetrization.
After implantation of an expansion prosthesis:
The prosthesis is usually swollen once a week with saline solution.
In 4 to 12 weeks, a significant volume is reached until it exceeds the volume of the other breast.
At the end of the swelling, it is advisable to wait at least another 3 to 6 months to avoid a secondary retraction of the skin.
The second intervention therefore takes place between 4 and 6 months after the first. It allows the replacement of the temporary expansion prosthesis that gives a tight look to the breast by the permanent prosthesis that will give a more natural shape.

About Breast reconstruction by prosthesis

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, which can lead to a leakage of the contents with variable consequences:

• With a serum-filled prosthesis, in the event of rupture, there is a collapse of the breast, usually occurring in 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 the most commonly used cohesive gels today, 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 delayed in the form of breast deformation 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