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Breast reconstruction after cancer

Breast reconstruction allows the reconstruction of the breast after cancer.

This medical information sheet was written in July 2020 by Dr. PESSIS who practices breast reconstruction surgery very regularly.

Dr. Rachel PESSIS is a plastic surgeon in Paris, specializing in breast reconstruction. She was Chief of Clinic at the Paris Hospitals in the department of Plastic and Reconstructive Surgery specializing in breast surgery. She will be able to take care of you for breast reconstruction after cancer or for all cases of breast malformation (asymmetry, tuberous breasts, plastic surgery of the breast). Dr. Pessis is a practitioner of the Hospitals of Paris and exercises in parallel to her surgical activity an activity of medicolegal expertise.

As an insurance consultant, she is involved in both medical liability and specialized advice on personal injury. All our cases are discussed in multidisciplinary consultation meetings with medical specialists in order to guarantee the best medical and surgical care.

Before and after breast reconstruction photos in Paris

What is breast reconstruction ?

Breast reconstruction allows the reconstruction of the breast after breast cancer by :

  • immediate reconstruction (at the same time as the cancer treatment)
  • Delayed reconstruction (after the end of medical treatment)

Breast cancer affects a woman in one of her most intimate organs. The treatment of a breast cancer is heavy and most often involves :

  • lumpectomy (removal of the tumor)
  • a complete removal (mastectomy).

Breast reconstruction after cancer allows :

  • Reconstruction of breast volume.
  • areola and nipple reconstruction.
    symmetrize the other breast.
  • to provide physical comfort. It relieves back or neck pain and muscle contractures. Particularly when the other breast is large and asymmetrical.
  • to “turn the page” and move on, and to put the period of active treatment of the disease behind you.

Breast reconstruction is intended for patients who have suffered from breast cancer and who wish to reconstruct the volume, shape and shape of their breasts.

The breast reconstruction operation

Before the operation, you must have medical consultations with your plastic surgeon. You must also schedule an anesthesia consultation and a preoperative check-up and mammogram. It is imperative to stop smoking.

Breast reconstruction is then performed in the operating room. Most often it is done in several stages, depending on the result you want to obtain and the time you want to spend on it. Some patients do not need all the steps. Others do not want to perform all the steps, preferring a shorter protocol. You will need to discuss all of this with Dr. Rachel Pessis.

  • The first step is the reconstruction of the breast volume on the operated breast. The reconstruction of the breast volume can be done either with a prosthesis or without a prosthesis.
  • The second step is the symmetrization of the other breast, often accompanied by touch-ups on the reconstructed breast.
  • The third step is the reconstruction of the areola and the nipple.

Breast reconstruction by breast prosthesis

The breast prosthesis can be placed immediately under the pectoralis major muscle (general anesthesia) in certain favorable cases:

  • no radiotherapy
  • very good skin quality
  • sufficient fat thickness under the skin
  • non-smoking patient

The operation requires an overnight stay in the hospital. Post-operative convalescence lasts about fifteen days. In most cases, however, preparatory steps must be taken to allow your skin to better accept the prosthesis:

  • Pre-implant lipofilling which consists of “lining” the thoracic area around the implant with fat. This is to increase the future thickness of the skin tissue above the implant.
  • Placement of a temporary saline expansion prosthesis which consists of placing a temporary inflatable prosthesis before the definitive silicone implant.

Breast reconstruction using a large dorsal bone

In some cases, it is not possible to place the prosthesis alone, even with the preparatory steps of lipofilling and skin expansion. In this case, a prosthesis associated with a dorsalis major flap can be proposed. This solution has the advantage of being able to be performed in a single step, and to allow the implantation of large-volume prostheses. Contrary to popular belief, it has no impact on the mobility of the arms or the back and after quality rehabilitation there are no functional sequelae. The scar on the lumbar spine is horizontal and hidden in the bra. The operation requires one to two nights of hospitalization and a three-week convalescence.

Breast reconstruction without prosthesis (flaps)

Breast reconstruction using an autologous dorsalis major flap = dorsalis major flap with fat. Here the breast is reconstructed using tissue from the back.  When possible, this is an excellent technique, extremely reliable, with almost no risk of failure, and a remarkably natural result. It has no impact on the mobility of the arms or the back and after quality rehabilitation there are no functional sequelae. The scar on the lumbar spine is horizontal and hidden in the bra. The procedure requires one to two nights of hospitalization and a three week convalescence. It can also be used secondarily in a case where another technique would have failed.

Breast reconstruction by fat injection

For breast reconstruction after lumpectomy (partial removal), we can often propose breast reconstruction by breast lipofilling or fat injection

  • Breast lipofilling allows the reconstruction of the breast in a very natural way without additional scarring by reinjecting one’s own fat. The fat needed for the procedure can be removed by liposuction from any area of excess fat. Lipofilling can be performed on an outpatient basis (no overnight stay at the clinic). Convalescence lasts about two weeks and work can be resumed very quickly.

Nipple and areola reconstruction

We use a special technique that does not involve skin grafting or removal of the contralateral nipple. In fact, the skin graft is usually harvested right next to the labia majora, but we prefer to propose techniques that do not involve touching the other breast or any other female organ. We propose a technique of reconstruction of the nipple by folding a small flap of skin over itself, and reconstruction of the areola by lifting the local skin. This procedure can be performed under local anesthesia and does not require hospitalization.

What are the consequences after the operation?

Depending on your case, the postoperative and convalescence period lasts between 7 and 15 days. Postoperative pain is moderate. The bruising and swelling last about 15 days.

 

How much does breast reconstruction cost?

Breast reconstruction is covered by social security.

Interventions
Price
Breast reconstruction by prosthesisFrom 1 500 €
Lipofilling in breast reconstructionFrom 1 800 €
Placement of an expansion prosthesisFrom 1 500 €
Breast reconstruction with a long dorsal flapFrom 4 000 €

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