The path to dealing with breast cancer may also require the removal of part or all of the breast: A delicate step for a woman, both physically and psychologically. Thanks to the collaboration between plastic reconstructive surgery and cosmetic plastic surgery (in fact two sides of the same branch), it is possible to reconstruct the breast, respecting the physicality of the patient, his sensitivity and his needs.
In Humanitas, the reconstruction is part of the Breast Unit: the Senology Center, directed by Dr. Corrado Tinterri, dedicated to the diagnosis and treatment of breast cancer, which accompanies women in all phases of the disease, reconstruction included, and brings together different professionals, such as oncologists, breast specialists, plastic surgeons and psychologists.
But what does reconstruction mean and how is the intervention performed? We talk about this issue with Professor Marco Klinger, Head of Plastic Surgery at Humanitas, a specialist in reconstructive plastic surgery who, together with his team, is also working within the Breast Unit for the benefit of cancer patients.
What does it mean to rebuild a breast?
Oncological procedures are different, as are the characteristics of the patients and therefore each reconstruction is unique.
Rebuilding a breast means re-creating symmetry with the healthy breast in terms of volume, shape and position; the breast furrow, i.e. the fold at the bottom of the breast, must be at the same height in both breasts. It is also necessary for both breasts to react to movements as much as possible in the same way, for example when the arms are raised or widened, and for them to behave in a similar way in the ageing process and in the relative and physiological fall of the tissues.
There are many cases, ranging from quadrantectomy, which involves the removal of only one part of a breast, to bilateral mastectomy, which involves the removal of both breasts. Then there is what is known as nipple sparing, a technique that involves emptying the breast and preserving the upholstery tissues, i.e. the skin, areola and nipple. The prostheses are placed under the pectoral muscle in this empty “bag”.
When is the reconstruction work carried out?
In the case of nipple sparing, only one surgical operation (oncological and plastic) is performed, with considerable benefits for the patient, who is not subjected to a double operation. In other cases, a second operation is performed a few months after the oncological intervention.
So-called devices (such as prostheses or expanders) can be used to reconstruct, or the remaining gland can be remodeled by removing only one mammary quadrant, or healthy skin or musculoskeletal tissues taken from the abdomen or back can be used.
The decision on the type of intervention and the timing is made by the breast specialists and the plastic surgeons together, taking into account the clinical and physical characteristics of the patient.
The value of reconstruction
As Professor Klinger points out: “Having had a tumor means not only having had an illness, but also having suffered a trauma; a trauma that it is important not to amplify with that of mutilation. That is why we strongly support the need for reconstruction, in order to restore the patient’s initial condition. Rather than an aesthetic motivation, therefore, the reconstruction is supported by the evaluation of psychological aspects, so important as to influence the attitude towards the disease and, consequently, to contribute positively to healing.
The role of fat in breast reconstruction
With the lipofilling technique, the necessary amount of fat is sucked from the abdomen or hips of the patient by means of an aspirating cannula. The fat is then purified and transferred to the breast. Lipofilling allows you to recreate the volumes lost as a result of cancer surgery, helping to remodel the breast and improve the quality of tissues and scars.
Various scientific studies have shown that human fat is rich in adult stem cells, capable of deeply regenerating the tissues into which it is transferred. Fat has also proved invaluable in countering Post Mastectomy Pain Syndrome (PMPS): a disorder that affects about 40% of women operated mastectomy and manifests itself in excruciating pain between the scar left by the operation, the armpit and the arm; a pain resistant to pain relievers and anti-inflammatories. As a study published in the Plastic and Reconstructive Surgery Journal shows, after a fat transplant, pain in PMPS patients decreased by 3.23 on a 10:00 scale.