Too few women know that breast reconstruction can be done at the same time as the removal of cancerous tumors. This is called an "immediate reconstruction". Especially possible when the skin of the breast can be preserved, this procedure greatly contributes to overcoming the trauma of the fight against cancer by eliminating the visible signs faster. In addition, it is fully covered by the Quebec Health Insurance Plan. If you were not able to benefit from an immediate reconstruction, Dr Bou-Merhi can see you and perform late breast reconstruction in Montreal. These reconstructive surgeries take place at the CHUM.
Placement of the Temporary Implant
Going through the mastectomy scar, the operation puts in place a temporary prosthesis called an "expander". This is an inflatable implant that aims to gradually stretch the skin of the breast in preparation for the installation of a permanent prosthesis. The "expander" is placed behind the pectoralis major muscle and is filled with salt water by an integrated valve. One or two suction drains are placed in the site to remove excess fluid from the operated area. These are usually removed one week after the procedure. At the end of the procedure, once the sutures of the muscle and the skin have been completed, a dressing is applied, which must be kept in place for 5 to 7 days. Performed under general anesthesia, immediate breast reconstruction only takes one to two hours, and does not cause additional scarring.
Filling the Expander
The expansion prosthesis will be filled with salt water with a fine needle two to three weeks after the first operation, and then weekly until the desired volume is reached. This painless expansion treatment lasts an average of 2 to 3 months.
Permanent Implant Placement
About 3 to 4 months after the first operation, the expansion prosthesis is replaced by a permanent implant, put in place under general anesthesia. This procedure lasts approximately 1 hour. Depending on your treatment plan, the time between the first and second interventions can be considerably longer. Treatments such as chemotherapy or radiotherapy often accompany mastectomy and may have an influence on skin healing. This is why it is necessary to wait 6 weeks after the end of the chemotherapy and a minimum of 6 months after the end of the radiotherapy before considering the second intervention for the replacement of the "expander" by the permanent implant.
Hospitalization lasts 24 hours. After the operation, the first night is relatively painful, but the prescribed analgesic medications are usually effective. The pain persists for 3 to 4 days, then gradually decreases over time, which varies from one patient to another. Drains, used to remove blood and serosities, are removed as soon as they only drain very little fluid, usually a week after the operation. The convalescence and work stoppage after implant expansion is usually about 8 weeks, but may be prolonged if additional chemotherapy or radiotherapy treatments are planned. Avoid significant physical activity for 6 weeks.
This technique may have some disadvantages, including regular weekly visits to inflate the expansion implant and a second operation to replace it. In addition, it will be difficult to get perfect symmetry of both breasts. The rate of complications with implant reconstruction is higher if the skin of the breast has been or will be irradiated.
This operation involves risks and complications. Apart from infection and bleeding, the main early complication of immediate reconstruction after total mastectomy is cutaneous pain due to poor vascularization of skin flaps of the mastectomy. This cutaneous pain can result in necrosis of the skin and exposure of the expander, resulting in a failure of the operation leading to surgical removal of the implant. Smokers have a higher risk of cutaneous necrosis and delayed healing, particularly if they have had prior chest wall radiotherapy. Stopping smoking preoperatively is therefore essential.
Risk of infection exists, as for any operation, and is prevented by the prescription of an antibiotic treatment. Other complications include poor scarring, hematoma, which may require surgical removal, and the risk of fibrous capsule formation around the implant. This risk increases when radiotherapy is administered on the breast reconstructed by expander/implant. There is also a risk of rupture or deflation of the implant (under 1% per year). In this case, the implant needs to be changed.
A conventional mastectomy without skin preservation will be performed in cases of late breast reconstruction. The expansion prosthesis will be introduced near the old mastectomy scar to increase the skin surface on the chest wall to more easily implant the definitive breast implant. The reconstruction is performed in two stages under general anesthesia during a one-day operation.
Immediate or late breast reconstruction surgery is a delicate procedure. Have yours done by a trusted doctor by consulting Dr Bou-Merhi, a renowned plastic surgeon involved in the fight against breast cancer, at the CHUM University Hospital.