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Breast reconstruction can ease the effects of breast cancer
October is the month in which the prevention and fight against breast cancer is celebrated all over the world. It has a special symbology. It is icon of femininity, sensuality and maternity. On the other hand, the treatment of breast cancer often requires partial and even radical removal of the breast. The result is sequelae that associated with debilitating treatments such as chemotherapy and radiotherapy, cause profound sadness and melancholia in women.
Breast cancer affects 8% to 12% of the female population up to 80 years of age. Of the multifactorial cause, it presents heredity as one of the most important factors.
Post-operative period requires special attention
When dealing with the disease, its perspectives and treatment stigmas - when faced with a lack of breast or the deformity resulting from the surgery - the postoperative period becomes very complicated for the patient.
It is preponderant to understand breast reconstruction as an effective part of the treatment of breast cancer, since the procedure has the power to improve the perspectives of the postoperative period, to positively change the mood, in addition to changing the focus of the disease and, thus, helping the patient to overcome a very critical moment.
Many times, with the treatment of breast cancer, the losses reveal are greater than the loss of the organ itself. The consequences go beyond the physical and psychological aspects, and can be associated with affective, social and even professional losses.
Types of procedure - quadrantectomy
Breast reconstruction can be performed in conservative surgeries (quadrantectomies), when a part of the breast is preserved and remnant of the remaining tissue is made, in parallel, the symmetrization of the opposite breast being performed. This results in an aesthetic aspect similar to that of a mammoplasty.
When faced with very beautiful breasts - sometimes even prettier than in the preoperative period, as there is the possibility of correcting the fall, hypertrophy or even the lack of glandular tissue - the patient may be extremely happy. In cases of quadrantectomies, we should always think about the effects of radiation therapy, which considerably increases the incidence of capsular contracture. Thus, we must use silicone prostheses accurately. Of course, the oncological aspect should prevail, but the resulting aesthetic effect is of fundamental importance in raising self-esteem, which contributes greatly to the treatment as a whole.
The association between oncological and plastic surgeons is extremely beneficial for the patient, because it allows the mastologist to have a concern only with the oncological part, leaving the repair to the plastic surgeon. With this, the treatment becomes more precise and complete.
Types of procedure - mastectomy
"Breast reconstruction is a key aspect in the treatment of breast cancer"
In cases of mastectomy, where withdrawal of the breast is total (including areola and nipple), reconstruction can be performed immediately, at the time of withdrawal, or late. The indication of immediate or late reconstruction is based on the evaluation of the patient's clinical criteria, such as: age, absence of preexisting diseases and staging of the disease (assessment of its extent and impairment).
In cases where reconstruction is not indicated After the mastectomy is completed, the procedure can usually be done after completing the adjuvant treatments, such as chemotherapy and radiotherapy, waiting six to eight months after the mastectomy. breast, it is possible to use tissues of the body itself, performing what we call "flaps": tissue transfer for the construction of a new breast, which may have as a donor area, for example, the abdomen, back, and gluteus. When we choose to use the abdomen for this purpose, we should think about the secondary aesthetic gain. That is, we will perform an associated abdominal plastic, modeling and improving the region.
We must understand that when we can offer women an aesthetic gain associated with breast reconstruction, this gain has an effect on self-esteem at a time when they are usually very fragile. Some studies have shown that the reconstructions that have a donor area of the abdomen have a greater aesthetic satisfaction when compared to the use of prosthesis.
Types of procedure - prosthesis
Another option is to use the implants, or rather the silicone prostheses , whether or not associated with skin expanders, also silicone. Currently, we can also use the expansor prostheses, which allow the reconstruction of the breasts in a single surgical time, performing the skin expansion while using a definitive prosthesis. This is what we call reconstruction in a single stage, and it is not necessary to remove this prosthesis for the use of another silicone gel.
In addition to the reconstruction of the breast volume, we should also be concerned with the reconstruction of the areola and nipple . It fits here an analogy between the breast and a mountain with snow at the apex. In this image, what attracts the most attention is the snow. In the breast, what is most striking is the areola and nipple. Thus, it is an essential part of the surgery to make a new areola and a new nipple.
We can now program the exact color of these areas, with the contralateral areola as well as the size and projection of the nipple as the parameter with the opposite breast nipple. In cases of bilateral removal of the breasts, reconstruction will also occur bilaterally.
Types of procedure - prophylactic adenomastectomy
Another relevant situation today is the cases of prophylactic adenomastectomy. We know that heredity is a very important factor in breast cancer. In cases in which the family history is recurrent, we must make a genetic study. If positive, there is a factor that predisposes to breast cancer. We can then remove only the glandular contents, preserving the skin and the areolas.
In these cases, the reconstruction must be done immediately, and usually by the preservation of the skin and the areolas. We used silicone prostheses for this purpose and, in some cases, we can use the expansion prosthesis, which favors volume adjustments in the postoperative period, with a higher degree of breast symmetry.
Types of procedure - prophylactic adenomastectomy
Another technique used in breast reconstruction using prostheses or expanders is the use of fat grafts. Normally, when performing a mastectomy, the thickness of the skin resulting from surgery is thin, and the use of fat cells helps to make the thickness of the skin thicker. Thus, the consistency of the reconstructed breasts becomes more pleasant and natural to the touch.
In general, this technique is not used in the immediate reconstruction. We must wait for the healing period and, after three to six months, we can use the fat grafts. These are obtained through liposuction, where three to four graft sessions are required for the result to be satisfactory.
In all its possibilities, breast reconstruction is a key aspect in the treatment of breast cancer, as it allows that the patient guarantees their quality of life, and can generate relevant improvement, both in self-esteem and in the psychological setting, in the delicate postoperative period.
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