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Russia, Sochi, GAZPROM mountain resort

Breast reconstruction

(Mammary gland reconstruction, breast repair, post-mastectomy reconstruction)

The surgery is focused on the reconstruction of breast after partial or complete ablation for cancer treatment.

Anton Lesnyakov
Anton Lesnyakov,
A leading plastic surgeon specializing in breast reconstruction
Anesthesia Narcosis
Surgery duration from 1 hrs to 10 hrs
Residency from 3 to 7 days

The clinic you can trust

What is breast cancer?

Breast cancer is the most common type of cancer in women. Every year, up to 1.5 million new cases of breast cancer are detected globally.

For early detection of breast cancer, mammologists recommend annual check-ups. 1st or 2nd stage of cancer can be cured completely.

Breast cancer treatment

Surgery remains the primary method of breast cancer treatment. The extent of the surgical intervention depends on the stage of disease. There are two types of surgery for treating breast cancer

Mastectomy

Реконструкция молочных желез после мастэктомии в Сочи
Anatomy of the breast ©cancer.gov
  1. Subcutaneous mastectomy: removal of the breast with lymph nodes, while skin, nipple and areola stay intact.
  2. Skin-sparing mastectomy: removal of the breast with lymph nodes, nipple and areola, keeping the skin intact.
  3. Madden’s modified radical mastectomy: removal of the whole breast with lymph nodes, keeping intact the major and minor pectoral muscles.
  4. Conservative radical mastectomy: removal of the whole breast with the minor pectoral muscle and lymph nodes.
  5. Halsted’s mastectomy: removal of the whole breast with lymph nodes and with major and minor pectoral muscles.

Breast reconstruction after mastectomy

Breast reconstruction is the reconstruction of shape and size of the removed breast after mastectomy. The reconstruction is performed either at the same time as mastectomy or after the completion of combination treatment that includes surgery, chemotherapy and radiation therapy.

A plastic surgeon makes a decision regarding the extent and time of the surgery in consultation with the specialist in oncology and mammology.

The breast reconstruction method is chosen based on the extent of the breast cancer surgery and the condition of skin and subcutaneous tissue.

Expander/implant method of breast reconstruction after mastectomy

This method is used if the subcutaneous fat tissue layer is sufficiently thick and pectoral muscles are intact after mastectomy. This type of reconstruction is conducted in several phases

Реконструкция груди с помощью экспандера в Сочи
Technique of expander/implant breast reconstruction ©Lorna J. CookMichael Douek
  1. A plastic surgeon inserts an empty expander under the major pectoral muscle. The expander is a silicon balloon that has a shape of an ordinary implant.
  2. Through a special port, the surgeon gradually fills the expander with saline solution. The expander volume increases, stretching the skin and major pectoral muscles. The procedure is repeated several times and can be done under outpatient conditions. It does not require general anaesthesia or special preparation of the patients.
  3. After 3 to 6 months, when the skin and major pectoral muscle are stretched to the required volume, the plastic surgeon replaces the expander with an implant.

Breast reconstruction after mastectomy with patient’s own tissue flaps

Breast reconstruction with the patient’s own tissues uses flaps taken from other body parts, such as abdomen, back, thighs, or buttocks.

A flap can be transferred to the site of removed breast on a muscle pedicle. Another option is an adipodermal flap that is completely detached from its original site and grafted with microsurgery technique.

TDF: thoraco-dorsal flap

A thoraco-dorsal flap based on latissimus dorsi muscle.

Реконструкция груди с помощью пересадки лоскутов в Сочи
A thoraco-dorsal flap for breast reconstruction ©prestigeips.com

During the breast reconstruction surgery, a muscle flap (with or without skin), is taken from the patient’s back and transplanted to the breast.

This flap becomes a source for development of soft tissues that will be the basis for forming the breast.

Phases of breast reconstruction:

In this variant of breast reconstruction, an implant is often added for better aesthetic results.

After the surgery, a small scar remains on the back that can be easily masked under a bra strap.

TRAM is a transversal musculocutaneous flap taken from the rectus abdominal muscle.

The most common method of breast reconstruction after ablation is the reconstruction with an adipodermal flap taken from the abdominal area.

Реконструкция груди с помощью пересадки лоскутов в Сочи
TRAM flap for breast reconstruction ©uihc.org

The TRAM flap is similar to the breast tissues and it takes on the new site.

The skin of lower parts of abdominal wall is an ideal match by color and texture for breast reconstruction.

This method enables to restore a sufficient volume of tissues and skin.

Phases of breast reconstruction:

DIEP is a flap taken from the abdominal wall, without muscles

The flap consists of skin, subcutaneous fat tissue and blood vessels.

There are no muscles in the flap. This is the basic difference between DIEP and TRAM techniques.

Реконструкция груди с помощью пересадки лоскутов в Сочи
DIEP flap for breast reconstruction ©uihc.org

This method of breast reconstruction tends to cause less complications in the area of the flap formation. Another important difference between DIEP and TRAM is in the way of supplying the flap with blood.

In breast reconstruction with DIEP method, the flap is called a free flap because it is completely separated from the tissues of its original site. To restore blood supply in the free flap, microsurgical technique is used to connect blood vessels. After transplantation of the flap, abdominal cosmetic surgery is performed to repair the donor area.

Buttock flap

The flap consists of skin, subcutaneous tissues and muscles.

Реконструкция груди с помощью пересадки лоскутов в Сочи
Buttock flap for breast reconstruction ©davidgreenspunmd.com

Phases of breast reconstruction:

For transplantation of the flap from a buttock area, all the vessels of the flap are cut and repaired afterwards with the use of microsurgery techniques.

Reconstruction of the nipple and areola

After the restoration of breast volume, the nipple and areola need to be reconstructed. There are two primary method methods in the nipple reconstruction:

First: Use of the patient’s own breast tissue for building a pillar that looks like a nipple.

Реконструкция соска и ареолы в Сочи
Nipple and areola reconstruction after breast reconstruction ©Dr. Daniel Calva

A few months after newly formed nipples are healed, the areola can be reconstructed.

This procedure involves tattooing, which is made with special ink.

The secondmethod involves the transplantation of donor’s tissue. In this case, the surgeon uses a part of the remaining nipple on the other side, or a part of the minor labia. The best aesthetic results are obtained with tissues taken from the nipple on the other breast.

The transplant is transferred to the prepared site in the area of the future nipple and is attached there.

Stitches are placed on the donor nipple,.

This type of surgery cannot be performed if the nipple is small.

Minor labia are rarely used as donor areas. This method can be helpful if both nipples have been removed, and the reconstruction with the use of local flaps failed.

Can breast reconstruction heighten the risk of cancer recurrence?

According to a set of researches, breast reconstruction doesn't increase risk of a cancer recurrence.

But for prevention all patients surely have to check breast regularly by means of mammography.

Breast reconstruction price list

Monolateral microsurgical breast reconstruction

Monolateral breast reconstruction with patient’s own tissues after mastectomy

535 000 rub
Monolateral microsurgical breast reconstruction

Monolateral breast reconstruction with patient’s own tissues after mastectomy. An implant is used to fill up the volume.

535 000 rub
Bilateral microsurgical breast reconstruction

Bilateral breast reconstruction with patient’s own tissues after mastectomy

967 000 rub
Bilateral microsurgical reconstruction of mammary glands

Bilateral breast reconstruction with patient’s own tissues after mastectomy. Implants are used to fill up the volume.

923 000 rub
Monolateral breast reconstruction with an expander

Phase 1: installing a tissue expander.

319 000 rub
Bilateral breast reconstruction with expanders

Phase 1: installing tissue expanders.

481 000 rub
Monolateral breast reconstruction with an expander

Phase 2 : exchanging the expander for a round implant.

157 000 rub
Bilateral breast reconstruction with expanders

Phase 2: exchanging the expanders for round implants.

319 000 rub
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