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Breast cancer: nipples can be preserved or rebuilt after surgery

Breast cancer: nipples can be preserved or rebuilt after surgery

Oncological mammoplasty or oncoplastic mammoplasty consists of the association of breast cancer surgery techniques with plastic surgery techniques in the same procedure, in order to provide an adequate treatment of breast cancer and also enable breast remodeling. There may also be a reduction of the other breast, in order to make both aesthetically pleasing and more balanced.

These techniques allow large oncological resections with the maintenance of an esthetic result, becoming one of the major surgical advances in the treatment of cancer Surgery is primarily indicated in medium and large volume breasts that would benefit from breast reduction - in which the surgeon takes advantage of breast tissue that would normally be removed in conventional breast reduction surgeries to fill defects resulting from resections oncological, that is, the breast donates tissue from a healthy region to a diseased region that will be removed. In summary, oncological mammoplasty techniques are indicated in the case of patients with breast cancer and medium and large volume breast .

In cases where the surgeon needed to remove the areola and nipple due to oncological made immediate reconstruction of this region

In most cases of breast cancer it is possible to preserve the areola and nipple. It is only necessary to remove the areola and nipple when this region of the breast is affected by cancer, or when the tumor is so close to the areola and nipple, although it is not contaminated in the anatomopathological report, but the proximity is so great that it would be necessary to remove these structures as safety margin. This definition depends primarily on the evaluation of the oncologist, based on the imaging examinations and the patient's medical examination, in which he will associate a number of factors to indicate the best treatment in this case.

In cases where the surgeon needed to remove the areola and nipple due to cancer, the immediate reconstruction of this important region in the aesthetics and self-esteem of women can be made. We perform advanced techniques of oncoplastic mammary to, with the skin of the breast, simulate an areolar and a nipple. It is worth mentioning that this reconstruction aims to minimize the aesthetic discomfort of the absence of the areola and the nipple. From a functional point of view, it is about breast skin and will not have the same sensitivity that the areola and natural nipple would have. It is an alternative to minimize the problem, but it brings great satisfaction to the patients, reducing the sensation of mutilation.

How the surgery is performed

Here we will have 2 situations:

When the whole breast is removed including the breast nipple)

When the breast is partially removed (what we call conservative breast surgery - but it is necessary to remove the breast nipple for oncological reasons).

  • In the mastectomy scenario, when removes the areola, nipple and breast contents preserving almost all skin (what we call mastectomy with preservation of the skin), an immediate reconstruction with silicone prosthesis is done. In general, the scar is in the central region of the breast (areola) and it will often be preferable to wait for the complete scarring of this region, as well as wait for the prosthesis to become fully natural. In these circumstances, it will be easier to find the ideal site for the areola.
  • After this accommodation has taken place, which takes around three to six months, the areola and nipple can be reconstructed with skin of the breast itself, inguinal or mucous membrane of the genital region, depending on the evaluation of the surgeon and the patient's desire or not to have tissue removed from other regions of the body and scars in these regions as well.In the scenario of conservative surgery, the ideal breast to make a new areola and nipple in the same cancer removal surgery would be that of medium and large volume, in which there is enough skin and breast tissue to be mobilized from other regions of the non-affected breast for cancer in the central region that was removed.

In this case, cancer surgery is performed to remove the tumor with the necessary safety margins, associated with reduction and complete remodeling of the breast, in which the result of the scars at the end corresponds to an "inverted T". This breast is used in this same surgery to form a new areola and a new nipple. The other breast will also be reduced in order to have similarly sized breasts with better body and breast balance. The association of all these techniques and procedures demands great expertise of the surgeon, being a rather laborious and prolonged surgery. But all this effort is worthwhile, since it makes it possible to reconstruct the areola and nipple that are so important for the woman's self-esteem, giving identity to the breast.

After the complete cicatrization of the areola can be made a pigmentation in the region, in order of leaving the tonality of this more similar to that of the contralateral areola


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