One of the most topical and discussed topics in plastic surgery is reconstructive surgery after removal of the mammary gland. Fortunately, thanks to modern and effective methods, breast cancer can be detected early enough and treated very successfully.
However, the quality of life of a woman who has undergone a mastectomy suffers greatly. To solve this problem, reconstructive mammoplasty using implants is performed. Andrey Zhigulin, an oncologist, surgeon, head of the Center for Modern Mammology at the Israeli Oncology Hospital LISOD, spoke about the features and key aspects of this operation especially for estet-portal.com.
How relevant is the issue of breast reconstruction after surgical treatment of breast cancer?
A.Zh.: This is a very topical issue, because among all cancers, women around the world are more likely to get breast cancer, and this is a serious social problem. Over the past 20-30 years, doctors have learned to detect early and treat this disease very well.
If breast cancer is diagnosed at an early stage – The 5-10-year survival of patients reaches 90-95%.
And these women need to live, and if they have their breasts removed or mutilated – what quality of life can we talk about? That is why the issue of breast reconstruction after surgical treatment of breast cancer is so relevant today.
What percentage of patients decide to have breast reconstruction after mastectomy?
A.Zh.:According to our clinic statistics, I perform more operations with one-stage reconstruction than just mastectomies. I have not yet seen such statistics anywhere in Ukraine, and even around the world it is very rare that the number of simultaneous reconstructions exceeds the number of mastectomies. But our policy is based on the fact that every woman has the right to beautiful breasts, and we try to do everything to maximize the aesthetic aspect of the treatment of patients with breast cancer.
When is breast reconstruction after a mastectomy not performed?
A.Zh.:There are medical contraindications for breast reconstruction, when we cannot offer the patient such an opportunity, because the disease is widespread or there are some serious comorbidities. But, fortunately, we have a minority of such situations. As a rule, women themselves can refuse the operation for two reasons: these are finances, since they are forced to pay for everything themselves, regardless of where they receive treatment, and also fear. You can still fight the latter by arguing your point of view, showing the results of examinations, demonstrating the results of operations and convincing the patient that reconstruction is the right thing to do. Well, financial problems, of course, are much more difficult to deal with.
Are there any differences in the choice of implants for reconstructive surgery and for augmentation mammoplasty?
A.Zh.:Yes, of course, there are differences. The fundamental difference is that when performing augmentation mammoplasty, the implant is placed between the tissues, that is, we do not destroy anything. In the vast majority of cases, these are healthy tissues that are minimally injured, and practically no harm is done to them.
When it comes to reconstruction – we destroy tissues, remove the mammary gland and remove most of the blood vessels that keep the skin alive.
The mastectomy implant is in much worse conditions.
If the patient still needs radiotherapy – tissues in the process of its implementation change radically, and this is a very serious problem, which leads to a significant increase in the percentage of complications associated directly with the operation. And here the choice of implant is much more difficult.
Peculiarities of choosing implants for breast reconstruction
The choice of implants for breast reconstruction depends on many factors, which Dr. Zhigulin spoke about.
Which implants are preferred for reconstructive mammoplasty?
A.Zh.: There are general principles for choosing implants for breast reconstruction. Most often, anatomical implants are used because they have a more natural shape, although this is not an axiom. Textured surface implants are now also favored, although recently we have more and more information that certain types of implants are statistically more associated with the development of large cell lymphoma. This issue is very actively discussed in professional circles of reconstructive surgeons, and requires some rethinking.
Patients often ask about what size implants they will receive. But we can't talk about it before the operation, as the implants are selected based on their geometric parameters and how the implant relates to the surrounding tissues, and this is always a rather difficult choice. There are temporary implants, that is, expanders, and permanent ones, and sometimes you need to make a choice in favor of a two-stage reconstruction. It is possible to use various synthetic or biological materials, such as meshes of different composition or a biological matrix. In general, this is a big and interesting topic.
Which company's implants do you personally prefer?
A.Zh.: I have been cooperating with Allergan company for a long time and very successfully, and I want to say that I am very pleased with both our cooperation and the products of this company. For breast reconstruction in our clinic, we successfully use different implants, which are produced by completely different companies. But personally I started with Allergan products and I don't want to stop using these implants.
See also: Round and anatomical breast implants: differences and features
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