Breast reconstruction - postoperative recovery

Breast reconstruction is the restoration of the appearance and shape of the breast. Such surgeries are performed mainly in patients after breast oncology, when part or all of the breast has been removed. Renewal can be performed at the same time as the oncology surgery, thus avoiding the stage during which a woman has to live with the absence of a breast. It is possible to perform reconstruction later, when the oncological therapy has already been completed.

It must be taken into account that each case is individual, and the specialists of our center will apply the best method to the capabilities and wishes of each patient.

Reconstructive surgeries at the Latvian Microsurgery center are performed using the patient’s own tissues, implants or breast expanders, as well as various combinations of these methods. Each of the methods has its advantages and disadvantages, and the physician will evaluate the most suitable one during the visit.

Soft tissue flaps are used to restore the breast with the patient’s tissue. They are divided into microvascular flaps and rotated flaps. Microvascular flaps make it possible to transplant tissues from more distant parts of the body, where the loss of tissue will not only not cause a defect, but will even improve its shape and appearance. In addition, compared to an implant or expander, the texture of the breast is significantly more similar to the natural one. However, it should be taken into account that these types of surgeries are longer and more risky, so the patient’s suitability for them should be carefully assessed. The most popular microvascular flaps are DIEP and TUG, but in some cases others are used.

DIEP flap is made of excess skin and subcutaneous tissue of the anterior abdominal wall, protecting the muscles and their fascia. This virtually eliminates the risk of abdominal hernia. The result is also a slim abdomen, just like performing abdominal aesthetic surgeries. Long-term results show that patients have less pain and earlier activation after these operations compared to a TRAM (abdominal muscle) flap, which includes the skin and subcutaneous tissue in the same region, but also includes anterior abdominal muscle to allow the flap to rotate.

The TUG flap includes the skin and subcutaneous tissue of the inner thigh, as well as one of the muscles. The skin and subcutaneous area corresponds to that which is removed by cosmetic surgery of the thigh. Inclusion of additional muscle does not cause a functional deficit, as it is one of the weakest, the loss of which is fully compensated by other muscles. This flap may be more appropriate in patients who have too little skin on the front of the abdomen and subcutaneous tissue, or who have scarring on the skin.

Illustration 2: TUG flap and its scar localization

Rotated flaps do not require microsurgical suturing compared to microvascular flaps because the original blood circulation is maintained. This makes these surgeries simpler and shorter, making breast reconstruction more accessible to patients whose condition is unsuitable for microsurgery. The most commonly used rotated flaps are latissimus dorsi flaps and abdominal muscle flaps (TRAM).

Latissimus dorsi flap is formed from the skin, subcutaneous tissue and part of the flat muscle covering the width of the middle and lower back. This is one of the oldest methods of breast reconstruction. With this flap, it is not always enough to completely restore the breast, so it can be combined with implant placement. The scar is projected in the area of the back strap of the bra to make it less noticeable. The main disadvantage of this method is the moderate attenuation of individual arm or shoulder movements.

The same tissue as the DIEP flap is used in the rectus abdominis muscle flap, but the muscle is also included to maintain blood circulation. Aesthetic results are equivalent, but muscle inclusion can increase the risk of hernia and reduce the ability to stand up straight from a supine position.

The final stage of reconstruction is the restoration of the nipple, which is performed 6-12 months after the initial operation. At this stage, surgical techniques can be combined with tattooing to achieve the best results.

In addition to all of these methods, it is sometimes necessary to correct a healthy breast to make both breasts as similar as possible. Possible correction methods are augmentation, reduction or lifting (mastopexy). Reconstructed breasts can also be corrected over time, as it is not always possible to predict changes in the healing process. In this case, scar correction or fat injections (lipofilling) may be performed.

The inpatient treatment phase lasts from a few days to a week, but with some exceptions. The surgery itself can take several hours, and recovery takes an average of 6 weeks. In the postoperative period, patients should wear a restraining bra and abdominal belt for better tissue healing.