Breast Rehabilitation

Breast reconstruction after mastectomy is essential, in anticipation of permanent amputation and the psychological, social and appearance problems that this procedure creates. The patient can visit the plastic surgeon before the mastectomy and discuss with him the possibility of rehabilitation either immediately (at the same time as the mastectomy) or later (after 6 months).

About Breast Rehabilitation

Breast reconstruction after mastectomy is necessary considering the permanent amputation and the psychological, social and appearance problems that this operation creates. The patient can visit the plastic surgeon before the mastectomy and discuss with him the possibility of rehabilitation either immediately (at the same time as the mastectomy) or later (after 6 months) and the way this rehabilitation will be done.

There are many ways that are applied for breast reconstruction, the choice depends on the condition of the area (type of mastectomy, radiotherapy, etc.) patient’s desire and experience of the plastic surgeon. It is often underestimated and this is because we do not know that the skin is the largest organ of our body, constituting 16% of our weight, and is responsible for maintaining our homeostasis. The skin is a barrier to heat loss, water and electrolyte loss and is a major barrier to microbes.

Rehabilitation with skin expanders

This method exploits the ability of the skin to grow progressively like the skin of the abdomen during pregnancy. The skin expander is placed either directly at the same time as the mastectomy, or later without further incisions than the mastectomy incision, under the pectoralis major muscle. Through a small valve placed under the skin it is periodically stretched until it fills in after a few weeks or months. When the skin is sufficiently stretched the expander is removed in a second operation and the permanent insert is placed. Some dilators are designed to stay permanently. In a second phase the nipple – areola complex is created. Some patients do not need dilatation and the doctor can place the insert in the first operation.

There are many ways that are applied for breast reconstruction, the choice depends on the condition of the area (type of mastectomy, radiotherapy, etc.) patient’s desire and experience of the plastic surgeon. It is often underestimated and this is because we do not know that the skin is the largest organ of our body, constituting 16% of our weight, and is responsible for maintaining our homeostasis. The skin is a barrier to heat loss, water and electrolyte loss and is a major barrier to microbes.

Flat dorsal muscle reconstruction

When we also need skin for breast reconstruction we use the flat dorsal muscle from the back together with a skin island. The muscle together with a spindle-shaped skin island is transferred through a tunnel made under the skin of the armpit to the anterior chest wall and creates a sheath for the prosthesis or expander to be placed.

The disadvantage of this method is the creation of a new scar on the back, more scarring in the breast and discolouration in the breast area as the skin of the back is not the same colour as that of the anterior chest wall. In the back the wound is closed with a horizontal incision. This method is usually used when radiotherapy has been applied to the skin of the anterior chest wall.

Rectus abdominis muscle repair

In this method we do not use an insert. The method is ideal for patients who have some excess fat and skin on the lower abdominal wall. It makes it possible to restore even a bulky ptotic breast with a more natural shape than an inlay. The skin and fat of the abdomen are transferred through a tunnel created under the skin along with the rectus abdominis muscle and its vessels. A horizontal scar is left in the abdomen identical to the classic abdominoplasty incision.

The disadvantages of this method are the heaviness of the operation and the many days in the clinic as well as new scars on the abdomen and breast. The advantages are that the result is more natural especially if the breast to be reconstructed is massive. In the 2 methods described above, the muscle and tissue were transferred through a tunnel and without being detached from the donor area.

In another technique the tissue is surgically transferred and transplanted into the breast by reconnecting its vessels to the vessels of the chest wall using microsurgical techniques. Often after breast reconstruction an operation on the other breast is necessary (reduction, mastopexy, augmentation) in order to obtain a symmetrical breast.

Six months after breast reconstruction, a second operation is performed to create the nipple and areola. This is done under local anaesthesia and we usually take a skin graft from the femoral crease to create the areola and use a local flap to restore the nipple.