Expander and Implant Reconstruction

سال انتشار: 1393
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 335

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شناسه ملی سند علمی:

ICBCMED10_020

تاریخ نمایه سازی: 21 اردیبهشت 1397

چکیده مقاله:

Breast reconstruction is an extremely sophisticated subject and the reconstruction strategies differ a lot between so-called reference centres and between each specialist. It is often thought that the application of the autologous flaps is the wisest solution. In our centre we use them, nevertheless principally to the high-risk patients, undergoing radiotherapy. I such cases only the flap based operations are advisable; in our institution we prefer to perform the least invalidating DIEP flaps that allow muscle preservation, avoiding alterations of body biomechanics.If the radiation therapy hasn’t been neither performed, nor planned, it is possible to reconstruct a female breast with a use of an implant. A skinsparing mastectomy leaves the opportunity to a big variety of reconstructive strategies, including: reduction, augmentation, both often with a contralateral breast treatment. In those cases a careful planning, together with modern implants and new surgical techniques lead to the achievement of very high aesthetic results, comparable with a look of natural breasts or these after the aesthetic surgery.To perform a successful reconstruction, a first thing is to choose an adequate type of the incision during a skin sparing mastectomy: large and ptotic breast may request an inverted T incision, but if the ptose is more moderate a transverse access or even periareolar in case of smaller breasts should become enough. The second step consists in the proper planning of the reconstruction strategy. In reference to breast size and patient’s wish a breast may be augmented or reduced. Small breasts may permit a one-stage-reconstruction, but usually a previous expander insertion is needed. In breasts with a moderate grade of ptosis we use autoprostheses in addiction to the implant and in larger weperform the inferior pedicle breast reduction. Breast implants have been designed for the aesthetic purposes. Since the first application in 1962, byDow Corning, six following generation have been designed and released on the market, including the most recent one, released in 2004 by Inamed: the style 510 dual gel. Its posterior part is filled with the standard cohesive silicone gel like the one of the Style 410; the anterior part is filled with a special, high-cohesive gel. This feature provides more projection and support of the nipple-areola area. Even with use of those modern products the achievement of the projection in the reconstructed breast is not an easy task. In order to establish a fullness of the upper pole of the breast, we have started to inject an autologous fat. It has dramatically improved the surgery outcome. Our late experience consists of Two-hundred-thirty-four women with a mean age of 47 years (range 19-67 years) who underwent extra-projection based reconstructions. Two-hundred-thirty-eight were inserted (four bilateral procedures). The mean follow-up time was 18 months (range 12-45 months). A peculiarity of our study was that a total of 197 (84%) patients received contra-lateral procedures, including 82 augmentations, 55 mastopexies, and 60 breast reductions. In our experience we haven’t found any malignancies in the contra-lateral specimen. The rest of patients (10%) had no symmetrisation on the contra-lateral breast as a personal request. The highest rate of positive opinion is reported in patients who underwent augmentation (74%) and thehighest rate of bad opinion in those who received a mastopexy (10.4%). The final results should resemble those of a cosmetic surgery with implants; the highest satisfaction rates are reported for patients treated by contra-lateral augmentation while ptotic breast on the healthy side, when reshaped without prosthetic devices, tend to recur with the highest level of bad ratings. Therefore we may confirm that a breast-reconstructive surgery should no longer be a procedure leading to just compelling results. Due to our modern techniques, especially the fat injection to the upper pole, the result can be easily compared with the aesthetic surgery outcomes.

نویسندگان

Nava M. B

Milan, Italy