RECONSTRUCTION TREATMENT
Breast surgery primarily concerns the treatment of cancers,, but also non-cancerous breast abnormalities that sometimes need to be removed. Reconstruction surgery is an integral part of the treatment.
Breast cancer surgery can be envisaged according to the situation by:
– “Conservative” surgery, which removes only the tumor.
– More “radical” surgery called mastectomy which consists of removing the entire mammary gland.
– It is very often necessary to remove some lymph nodes under the armpit during breast removal (sentinel lymph nodes) or all the ganglia (axillary dissection).
In the case of conservative surgery, care will be taken, as far as possible to ensure that the breast maintains a satisfactory shape, using, if necessary, “oncoplasty” (aesthetic surgery techniques adapted to breast cancer).
Where a mastectomy is planned, which is the case in about 30% of cases, there is always room for breast reconstruction.
When chemotherapy and / or radiation therapy are necessary in addition to the mastectomy, reconstruction will be done a few months after the end of treatment.
If the situation allows, (depending on the histological characteristics of the tumor determined after biopsy and imaging assessment) it is sometimes possible to perform breast reconstruction at the same time as the mastectomy. immediate reconstruction
“Prophylactic” (preventive) breast surgery may be carried out when a woman has a significant risk of developing breast cancer, often related to a genetic risk.
Breast reconstruction at Lacassagne is practiced by surgeons trained in reconstructive surgery or by plastic surgeons.
CURRENT TECHNIQUES FOR PROPOSED RECONSTRUCTION
- Reconstruction by breast prostheses
- Large dorsal flap reconstruction allows for either autologous reconstruction (with its own tissue) or in combination with prosthesis. In the case of immediate reconstruction, the collection of the dorsal can be performed endoscopically, which considerably reduces the size of the dorsal scar.
- DIEP abdominal flap reconstruction also allows strictly autologous reconstruction.
- Reconstruction by lipomodelage: reconstruction of the volume of the breast using the woman’s own fat where present by liposuction (belly, thighs, loins …) and reinjected into the breast.
The choice of the reconstruction technique is determined with the surgeon according to various criteria (such as, for example, the morphology of the woman, the volume of the breasts, the quality of the skin, the risk factors for poor healing such as radiotherapy, smoking …) and of course the wish of the patient to the extent possible.
Reconstructive surgery most often involves performing surgery to symmetrize the other breast to achieve the best possible harmony between the two breasts. This may involve reducing or increasing (by inserting a small prosthesis) the other breast.
Lipomodelling is also often used to improve the esthetic result of the reconstructed breast.
To complete the reconstruction, enlargement of the nipple is always proposed (a small intervention performed under local anesthesia) and the areola by tattooing (dermopigmentation).
AMBULATORY CARE
Our Breast Surgery Department prefers where possible to carry out interventions in outpatient care, which enables the patient to arrive in the morning and to leave a few hours later, while ensuring their security. The main objective of outpatient hospitalization is to reduce the risk of nosocomial infections.
This mode of hospitalization involves rigorous organization, starting with programming the intervention and ending with a telephone call the next day from a nurse to ensure that the return home and the night following the operation went well.
In 2015, 48% of breast conservative surgery at Lacassagne was carried out on an outpatient basis.
Breast surgery commonly performed as an outpatient are lumpectomies, zonectomies, alone or associated with ganglionic surgery (sentinel lymph node or axillary dissection), as well as certain reconstructive surgical procedures (symmetrization, lipomodelage, nipple reconstruction).
