Post-cancer breast reconstruction in Paris

Women's surgery at Henri Mondor Hospital

Post-cancer breast reconstruction in Paris

Plastic, Reconstructive & Aesthetic Surgery in Paris Est Créteil

The Henri Mondor Breast Centre offers an oncogenetic consultation service:

You can reach this consultation on 01 49 81 28 61

This consultation is intended for :

  • Patients with genetic cancer
  • Families of patients with cancer of genetic origin
  • Patients at high risk of developing breast cancer because of the large number of affected women in their family
  • Patients who wish to learn more about genetic cancers
  • Patients requiring screening or confirmation of mutations in the BRCA1, BRCA2 and P53 genes, etc.

 

IMPORTANT: screening for genetic predisposition to breast or ovarian cancer is never compulsory. It is suggested when the risk is deemed significant by the doctors at the Centre Sein.

Reconstruction using fat or lipofilling

Post-cancer breast reconstruction in Paris

This technique is very popular with patients who do not want foreign bodies. Fat not only improves the volume but also the quality of the skin, which may have been altered by radiotherapy.

In addition, it can be used to treat any localised fat deposits at the same time: hips, abdomen, saddlebags, knees.

The technique requires sufficient donor sites. Patients who are too thin cannot therefore benefit from this technique. The fat is removed in a non-traumatic way through small incisions hidden in folds.

Micro-cannulas are used to graft micro-particles of fat along a number of independent paths through the recipient tissue, ensuring a homogenous result.

As this is a graft of living cells, the tissue changes as the patient’s weight fluctuates. The result can be assessed 3 to 6 months after the operation.

Post-cancer breast reconstruction in Paris

Pr Hersant Plastic, Aesthetic & Reconstructive Surgery

The specific complications of this operation are cytosteatonecrosis: these are firmer areas that correspond to oily cysts. These areas eventually soften over time. If this is not the case, further investigations are necessary.

On average, 30% of the fat disappears, but the rest is permanently biointegrated. Note that if you gain weight, your breasts will enlarge, but if you lose weight, they will shrink.

This technique provides a natural, moderate increase in size (one cup maximum).

A support bra must be worn for 1 to 2 months.

A week’s convalescence is often necessary.

Reconstruction by exclusive lipofilling requires between 3 and 6 surgical procedures. This surgery is performed on an outpatient basis.

Lipofilling can also be combined with a small prosthesis or an autologous flap.

Lipofilling is also the technique of choice for patients with post-tumour sequelae.

This technique, known as the ‘free DIEP flap’, appeared around twenty years ago in English-speaking countries. It makes it possible to reconstruct a homogeneous, natural breast that evolves with the patient’s weight and age, without any foreign material (silicone prosthesis). This is a reference procedure, which is difficult to perform, requiring vascular microsurgery, but is routinely carried out in our clinic.

DIEP Flap = Deep Inferior Epigastric Perforator Flap = abdominal cutaneous fat flap based on the deep inferior epigastric vessels.

The main part of the technique consists of removing the abdominal cutaneous fat flap and ‘grafting’ it onto the breast reconstruction area. In some cases, this technique makes it possible to reconstruct both breasts (double-DIEP) for patients requiring removal of both mammary glands (BRCA 1 and BRCA2 positive genetic test).

This technique can also be performed at the same time as the removal of the breast (immediate breast reconstruction).

Smoking is strictly prohibited during this procedure.

A one-week stay in hospital is required, and convalescence of 3 weeks to a month may be necessary.

For more information on this technique, visit the DIEP website: http://www.diep-asso.fr

This technique, which is widely used, involves using the skin and a muscle from the back to reconstruct breast volume. The latissimus dorsi muscle on the side of the breast to be reconstructed is used.

Despite the removal of this muscle, it is usually necessary to use a breast prosthesis to obtain a satisfactory breast volume and shape. The muscle removed no longer performs its usual function, but does not prevent normal life or leisure sports activities.

Latissimus dorsi :

Muscle responsible for the stability of the back. It keeps the spine straight when we are standing or sitting. It plays a role in various arm and shoulder movements in addition to other muscles.

This long, wide muscle can be removed using a skin paddle to reconstruct the breast. Despite its size, it cannot be used to reconstruct the entire breast. It is necessary to add fat (autologous reconstruction with lipofilling) or a breast implant to complete its volume and have a reconstruction of the breast equivalent in size to the contralateral side.

In modern techniques for reconstruction of the breast using the dorsalis major muscle, not all of the muscle is removed, but only the most lateral part, to avoid the risk of unbalancing the back (muscle sparing technique). The advantage is that the harvesting scars are smaller, there is less post-operative pain and less risk of back deformity.

On the other hand, it is necessary to remove more fat by liposuction to ‘complete’ the volume thus saved.

Smoking should be avoided for this procedure.

You should expect to be in hospital for 3 to 5 days, and may need to convalesce for 3 weeks to a month.

The breast implants currently in use consist of a shell and a filler. The shell is always made of a silicone elastomer.

The filler contained within the shell may be silicone gel or physiological serum. The implant is said to be pre-filled when the filler has been incorporated at the factory. The surgeon orders the volume appropriate to the case.

The vast majority of implants fitted worldwide are pre-filled with silicone gel. Significant technical progress has been made. Silicone gel has become very cohesive to limit perspiration through the envelope, a source of shells. The strength of the envelopes has increased, reducing the risk of rupture.

The wall can be smooth or more or less textured, i.e. rough. Macro-textured prostheses are now banned. They are associated with a rare cancer affecting lymph nodes and organs: anaplastic large-cell lymphoma. The prosthesis can be round or more or less contoured for a more natural look.

With a view to surgery:

Smoking is always inadvisable, but even more so when it comes to placing prosthetic material. Depending on the case, the prosthesis may be placed just behind the gland or under the muscle. Depending on the case, a drain may be placed to evacuate the blood accumulated around the prosthesis. Finally, a modelling dressing is applied.

It is generally accepted that breast implants have an average lifespan of 10 years. Replacement should be discussed at this point. In all cases, an annual clinical check-up is recommended. The risks are the same as those mentioned above for the cure of isolated ptosis, with the addition of specific risks associated with the prosthesis.

Infection of the prosthesis cannot be treated with antibiotics. It leads to the removal of the prosthesis. A new prosthesis can only be placed after a few months. Ruptures of the prosthesis envelope naturally require replacement.

Secondary malpositioning or displacement will lead to an indication for surgical correction. The rotation of the prosthesis may affect the aesthetic result in the case of a contoured implant. Late periprosthetic effusion will require investigations to rule out the possibility of cancer.