Breast Reconstruction after Breast Cancer

Breast cancer is the most common cancer in women. Every year 6000 women in Switzerland are diagnosed with breast cancer. Patients are cared for by an interdisciplinary team of specialists within a breast cancer centre. Here, gynaecologists, oncologists, radiologists, radiotherapists and plastic surgeons look after the patients and make joint decisions on therapy. 70% of patients suffering from breast cancer can be treated in a way that preserves their breasts. Of the 30% who have to have their breasts removed, more than one third of the patients decide to have their breasts reconstructed. This very decisive part of the therapy is performed by us as plastic and reconstructive surgeons.

Dr. Winterholer spent several years in the management team of Reconstructive Breast Surgery at the Kantonsspital Luzern and brings many years of experience and sound knowledge to the table. Dr. Winterholer and Dr. Allemann belong to the team of the Breast Cancer Centre of the Andreas Clinic in Cham – a clinic of the Hirslanden Group – and are responsible for the reconstructive plastic breastsurgery. There, they also regularly take part in the official tumour boards.

As plastic reconstructive surgeons, we play a central role in the reconstruction of the female breast after breast cancer removal. The maximum variant involves the complete reconstruction of the breast after mastectomy.

Breast reconstruction can, but does not have to be performed. However, many women decide to have their breast reconstructed. This can be done immediately after removal of the breast carcinoma, or later. Both have advantages and disadvantages and have to be discussed in detail and decided individually depending on the situation and the recommendations of the board.

A special type of reconstruction is rebuiding the breasts after prophylactic mastectomy. The prophylactic removal of the mammary glands has been increasingly discussed in the media in recent years. This is a preventive removal of both mammary glands to reduce the risk of breast cancer development by up to 90%, if there is a known genetic mutation. This genetic risk has been detectable for BRCA 1, BRCA 2, BRCA 3 and others such as ATM, p53 and CHEK2.

The reconstruction of the breast can be achieved according to the complexity of the operation and the pre-existing skin and tissue quality conditions of the breast with the following procedures:

• Breast reconstruction through the body’s own tissue:

With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area.

• • Breast reconstruction with tissue from the back (latissimus dorsi muscle)

With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels I the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.

• • Breast reconstruction with tissue from the abdomen (DIEP flap surgery, formerly TRAM flap surgery, and SIEA flap surgery)
  • Breast reconstruction with tissue from the thigh and gluteal fold (TMG flap surgery)
  • Breast reconstruction through tissue from the buttocks (S-GAP)

 

• Building up through exogenous tissue:
  • Breast reconstruction with implant by previous skin stretching with expander.
  • Reconstruction of the breast by placing the implant during the same surgery as mastectomy (skin sparing mastectomy.

Additional interventions are

• nipple reconstruction
• Corrective interventions with autologous fat by lipofilling
• Symmetry adjustment of the counter chest

Breast reconstruction is planned in accordance with oncological therapy. We are in constant contact with the extended team such as oncologists and gynaecologists and discuss decisive steps together on so-called tumour boards. After recording your detailed medical history, we will thoroughly examine your breasts, measure them and document them using digital photographs.

In a detailed consultation we will ask for your wishes and expectations and discuss the various options for breast reconstruction. Together we will decide whether breast reconstruction is suitable for you, whether primary or secondary reconstruction is possible and which surgical procedure is best for you.

By asking specific questions, we will get a thorough picture of your medical history in order to identify possible contraindications for an operation at an early stage.

It is our deep concern to support you in all questions, concerns and wishes. We take our time for this, but we also give it to you. Experience has shown that it makes sense to let our conversation and our recommendations go through your head and to see us a second time in the consultation before we fix a final surgery date.

Depending on the procedure, the procedure takes 2-6 hours and always takes place under general anesthesia. We operate at the Andreas Clinic in Cham, a clinic of the Hirslanden Group. This is an inpatient procedure lasting several days. In case of reconstruction with implants/expanders patients stay overnight for 2-3 days. In the case of a reconstruction with the patient’s own tissue, a close intensive care supervision is followed immediately after the operation and the patient should stay in bed for 1-2 days. The patient can be discharged after 5-7 days. In order to drain off wound water and blood, in certain cases drainage tubes are inserted, which can be removed after a few days. A compression bra will be fitted in the clinic and taken home with you.

As with any surgical procedure, you will feel pain in the first few days. You will receive painkillers from us and we will also be there for you in case of any queries.

Close meshed outpatient breast checks are carried out. The removal of the sutures usually takes place after 14 days. We will be happy to see you again after 1, 3, 6 and 12 months for a follow-up check.

The final result can be expected after about 3-6 months after the swelling has subsided.

After the operation, a tumor follow-up can be carried out without any problems using sonography or magnetic resonance imaging.

Every operation involves surgical and anesthesia-related risks. There is an increased risk of surgical complications, especially for patients who smoke or suffer from obesity or diabetes.

Risks associated with any surgical procedure

• secondary bleeding
• infection
• Unpleasant or excessive scarring
• wound healing disorders
• thrombosis

Special risks of breast reconstruction with implants

• wave formation (rippling)
• Slippage or rotation of implants
• Noticeable implant margins
• asymmetry
• implant rupture
• (Temporary) sensory disturbance of the nipple(s) (rare)
• Limited ability to breastfeed (rare)
• Contraindications for irradiation, multi-stage and follow-up procedures due to prosthesis changes
• capsular fibrosis
• Special risks of breast reconstruction with autologous tissue
• Imperfect aesthetic breast shape
• Lack of blood circulation with tissue death, or necrosis, which may develop in the skin and fat with loss of parts or the entire new breast.