Breast reconstruction is an array of plastic surgery procedures used to rebuild the breast lost to cancer surgery and trauma (burns) or build up a breast in congenital anomalies. The most appropriate reconstructive option considers a woman’s unique desires, lifestyle, her body shape and specific medical conditions.
Our goal in breast reconstruction is not to simply recreate the breast, but to optimize the appearance of both breast for the finest aesthetic result possible. The current techniques of reconstruction range from the use of a silicone implants to the most advanced microsurgical methods utilizing body’s own tissue. Regardless of the reconstructive method, we always aim to create natural and beautiful breasts.

Immediate reconstruction is performed during the same operation as the mastectomy (removal of the breast). Delayed reconstruction can be done at any later time when the patient has fully recovered from cancer treatment.

Whenever circumstances permit we encourage women to undergo immediate reconstruction since it has many benefits; better cosmetic result, shorter breast scars, only one operation and recovery, no period of time without a breast. Immediate reconstruction does not delay any additional cancer treatment needed.

However, some women are not candidates for immediate reconstruction and for some immediate reconstruction was not available at the time of cancer treatment. Delayed reconstruction can be performed at any time after mastectomy and similar results compared to immediate reconstruction can be obtained. There is no age limit for breast reconstruction, as long as the candidates are healthy, in good physical condition and without significant co-morbidities.

We preferentially use patient’s own tissue to reconstruct the breast. Even though it is a complex procedure requiring a work of two experienced microsurgeons, it gives the most natural and long-lasting result. The tissue is usually taken from the abdomen (DIEP and TRAM flaps) with the procedure similar to aesthetic abdominoplasty or tummy tuck. Sometimes tissue can be harvested from the back (latissimus dorsi), buttocks (s-GAP flap) or thighs (TUG flap). The greatest benefit of autologous breast reconstruction is that it is durable, and once a satisfactory result is achieved it tends to be static and permanent.

We usually recommend reconstruction with implants to patients who are not good candidates for autologous reconstruction. These are women who:

Are thin and do not have enough tissue at the donor areas;
Are medically unfit for a major operation;
Do not want any additional scars elsewhere on the body.
Implant based reconstruction is best suited for women with relatively small and perky breasts. Typically implant reconstruction involves two stages. In the first stage the shapeless skin remaining after a mastectomy is slowly expanded using a tissue expander placed beneath the chest wall muscles. The expander is replaced with a permanent implant after a couple of months in a second operation under general anesthetic. Sometimes it is possible to place the permanent implant at the time of mastectomy (single stage reconstruction).

The main drawback of implant-based breast reconstruction is that it is impossible to create a breast with a natural shape and feel. Implant-based reconstruction is associated with a higher rate of complications (infection, extrusion, capsular contracture) in patients who had radiotherapy. Most patients having an implant-based reconstruction will require modification of the opposite breast to improve the shape and size match.

Sometimes it is esthetically preferable to adjust the healthy breast to improve the symmetry with the reconstructed breast. Therefore we sometimes advice the patients to lift, enlarge or reduce the healthy breast for optimal aesthetic result.

Minor procedures for symmetrization, such as a small breast lift, liposuction to reduce the size of the flap, scar revisions, lipofilling or nipple reconstruction can be done under local anesthetic on an outpatient basis. More extensive procedures, such as breast reduction and enlargement will be done under general anesthesia – most often during the second stage of implant-based reconstruction.

There is an increasing demand for bilateral reconstruction as more and more women undergo prophylactic (preventive) removal of both breasts due to genetic predisposition for breast cancer.

In women with enough excess tissue we can use the abdominal wall to harvest two flaps for reconstruction of both breasts. If one breast has previously been reconstructed with the abdominal tissue we have to use other donor areas or silicone implants.

Women who are too thin, unfit for a longer operation or do not want additional scars, can have an implant based reconstruction. Bilateral implant reconstruction can give very satisfactory results as the symmetry is normally superior compared to unilateral implant reconstruction.

Breast reconstructive procedures involve not only the reconstruction of the breast mound, but recreation of the nipple and areola. We usually wait for a few months before reconstructing the nipple and areola to allow the breast to assume its final contour. The new nipple will not have the erotic sensation, but its creation completes the reconstruction and is always recommended. We perform the procedure on an outpatient basis, with local anesthetic. New nipple can be created from local tissues or with nipple sharing procedure, when a piece of nipple from the other side is transplanted to form new nipple on the reconstructed breast. Whatever method used the reconstructed nipple tends to contract and flatten with time.

For the areola, a medical tattoo is used to create an areola circle. Special pigments are chosen to match the variety of shades women have naturally. The tattoo may fade with time and a touch up may be required.

Breast reconstruction can be a complex procedure, often involving microsurgical techniques. It is therefore best carried out in specialist centers equipped with state-of-the-art facilities. Latest and most advanced forms of breast reconstruction, as well as all balancing procedures, including breast reduction, breast lift or breast augmentation, should be offered to individual well-informed patient, keeping in mind her wishes and needs. If immediate reconstruction is planned, a good cooperation with oncologic surgeon is extremely valuable.

We perform all types of breast reconstruction as well as other breast surgery procedures on a daily basis. We are part of a plastic surgery team of experienced micro surgeons in the University Clinical Centre in Ljubljana. We perform up to 3 microsurgical breast reconstructions per week. The broad range of surgical techniques routinely used allows us to choose an appropriate surgical strategy for each individual patient.

You can find detailed descriptions of the procedures, with risk and safety information as well as pre and post-operative instructions, on the official sites of the world leading organizations:

American Society of Plastic Surgeons:
http://www.plasticsurgery.org/...

British Association of Plastic Reconstructive and Aesthetic Surgeons
http://www.bapras.org.uk/guide...