A Soft Breast Using Your Own Fat

Plastic surgeon M. Huikeshoven of the Kennemer Gasthuis answers the question of what the possibilities are for breast reconstruction after breast cancer in this edition of the medical column: "Fortunately, there are nowadays various possibilities for the restoration of the affected breast, whereby the plastic surgeon has a broad arsenal of reconstructive techniques to offer. In addition to the specific medical situation, the preferences of the woman also play an important role. Is there a preference for immediate mastectomy (primary)? Or would she prefer to have the reconstruction done later (secondary)? Would the woman prefer a prosthesis or material from her own body, such as abdominal fat?

In an immediate reconstruction, the plastic surgeon begins the reconstruction during the same operation, immediately after the surgeon has performed the mastectomy. A so-called 'skin-sparing' mastectomy is performed, in which the surgeon removes the entire mammary gland, usually including the nipple and areola, but leaves the skin in place. A prosthesis is then placed under the pectoralis major muscle. This can be a definitive silicone prosthesis straight away. When there is insufficient skin, however, a 'tissue expander' is first inserted. The tissue expander is a small balloon that is repeatedly punctured through the skin and inflated with water so that it gradually increases in size. This stretches the skin and chest muscle so that the balloon can later be replaced with a definitive silicone prosthesis once there is sufficient space.

After some time, a small nipple is created from a piece of breast skin, and finally an areola is tattooed around it. An immediate breast reconstruction has many advantages. The result is often better than when done at a later stage. Women wake from the anaesthesia with a 'filling', meaning they have never been 'flat'. The drawback is that it can only be done at one moment, namely simultaneously with the mastectomy. With a secondary breast reconstruction, the reconstruction only takes place at a later stage. An expander will almost always first need to be placed to stretch the skin and chest muscle sufficiently to accommodate a prosthesis.

A breast reconstruction is also possible using only the woman's own tissue, usually abdominal fat and skin. (This is called a DIEP flap: Deep Inferior Epigastric Perforator). To create a breast from abdominal fat, the blood vessels supplying the fat are located and freed. They are then dissected through the rectus abdominis muscle down to the groin, where they are divided. Meanwhile, a piece of rib cartilage is removed behind the pectoralis major muscle to expose blood vessels there. Under a microscope, the blood vessels of the abdominal fat are connected to those behind the pectoralis major muscle, restoring blood flow. A new breast is then shaped from the transplanted fat and skin. The nipple and areola are created as described earlier. The abdominal wound is finally closed and sutured, leaving a scar comparable to a tummy tuck. Not only for mastectomy but also for breast-conserving surgery can the plastic surgeon be of value. In a breast-conserving operation, tissue is always removed, which can cause deformity. The plastic surgeon can relocate tissue to restore the breast shape. Radiation therapy will follow after breast-conserving operations and often causes further deformity. If well-vascularised tissue is moved to the area during the first operation, this can reduce deformity and restore shape. Preventing deformities is very important because operating on an irradiated breast carries a high risk of complications. For the same reason, it is advisable to ask women with a large cup size whether they were already considering a breast reduction before their cancer diagnosis. Such a breast reduction is best performed simultaneously with the breast-conserving operation, as it is practically no longer feasible after radiation therapy.

After reconstruction of the affected breast, the healthy breast can also be adjusted to match if desired. This usually involves a breast reduction or breast lift to achieve two symmetrical breasts. At the end of the entire treatment trajectory, we hope that the reconstruction helps restore self-confidence and the sense of femininity, and contributes to an improved quality of life for the many women affected by breast cancer." View here the full article by dr. Menno Huikeshoven on 'breast reconstruction using your own fat'. Source: Anneke Wijsman, IJmuider Courant