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Breast Reconstruction

Breast reconstructive surgery is associated with the oncology diseases of lactiferous glands. Therefore, breast restoration is a highly demanded surgery in the West.

Recent oncology surveys have shown that 12% of women suffer from breast cancer, with the number of cases doubled in the last 10-15 years. The mammography and ultrasonic tests have made early diagnostics of the lactiferous gland cancer possible, which has led to the organ sparing and preservation surgery. 

The state of mind of a woman who has lost one or both breasts is truly horrible. Most of the women develop various psycho-neurological conditions caused by a malignant tumor and loss of a breast, an important part of womanhood. Women used to mask the defect by placing a special device in the bra. The outer fixation silicon prosthetic device used nowadays does not fully replace the breast.

The outer prosthetic device is hardly a good rehabilitation, especially for young women who find it awkward to reveal it. The reconstructive surgery aiming at provision of the prosthetic device closest to the female breast is the solution.

Breast reconstruction (restoration) can be achieved in three alternative ways:

  1. The lactiferous gland restoration by means of artificial materials (expander, implants);
  2. Breast restoration by the patient’s own tissues;
  3. The combination of the two implants plus the patient’s auto-transplanted tissues.       
 

Breast reconstruction surgery has been an important target in the field of surgery for a long time. For example, in 1897 Iginio Tansini used the thoracodorsal segment rotation method during the radical mastectomy to cover the existing defect.

Holmstriom was the first to conduct the transplantation of Vascularized TRAM-segments (segments from abdominal straight muscles) in  1979. These segements can be reversed to the leg muscle to recover , although the majority of  the specialists believe that this will disrupt the adequate blood supply of the segment, the result lacks the quality aestherically, and raises the risk of postoperative ventral hernia.

Koshima provided a DJEP segment from perforating blood vessels taken from the abdomen in 1989, which reduced the risk of hernia development and significantly reduces the post-traumatic effects of the operation.

Evolution of modern silicone implants that began in 1962, after Cronin and Gerow first used them for the breast augmentation, it became possible  to widely use silicone implants and expanders in advanced breast reconstructive surgery. 

Breast reconstructive operations in Georgia first started in our clinic in early 1990s. We use all three methods of breast reconstruction. The operation could be performed at one point during postmastectomy or can be deferred in several stages.

Single operations are carried out in our clinic together with leading oncologists and mammologists; Deferred breast reconstruction operations are coordinated and agreed with these specialists as well.

 

This method can be used in those cases where following the mastectomy there remains sufficient length of skin and subcutaneous tissue, and when a large breast muscles is maintained. In such cases the tissues can be increased by using expander dermotensia.

Expander is selected based on the healthy breast volume and size of ​​the base. The implantation is performed in the area of mastectomy, considering the middle lines and sub-mammary wrinkes.

The volume of the expander increases through periodic injection of the solution and the tissues are being stretched out. Expander implantation can be perfomed in one or two stages.

In the first case, the so-called expander – implant is used. Once it reaches the required volume, the expander fills the role of the implant. In case of a two-stage operation, after the expander increases in volume, it it removed and the endoprotetis is implanted. These operations are technically quite simple and provided good cosmetic results; it’s less traumatic and postoperative rehabilitation period is shorter.

This method has gained popularity in the recent 20 years, as the breast reconstruction using the auto-tissues is possible where expanders or implants cannot be implanted. Additionally, using this method provides better results aesthetically and ensures more acceptable shape of the breast and the results are permanent.

For the breast reconstruction surgery, different segments can be used for transplantation, though the most common ones are the skin segments from the thoracodorsal, skin and musle TRAM-segment and skin-facia DIEP- segment.

Breast reconstruction using the LD segment is indicated for patients with small and medium-sized breast. Spinal surgery is to recover from the side surface of the vascular thoracodorsal segment rotation into the chest. Taking the thoracodorsal muscle  does not have harmful effects on the donor area.

This method is indicated for patients with medium and large-sized breast. Cannes - the muscular abdominal TRAM- segments are taken from the front surface fo the abdomen; it is made ​​up of the skin - the fat layer of the abdominal muscles in the right part of it. Using the free vascularized TRAM- segments reduces the risk of ventral hernia, whereas such risk is much smaller compared to the rotation to the leg muscles.

The aesthetic result of this method is also much more acceptable.

This method is indicated for patients with medium and large-sized breast. DIEP- segments are taken from the front surface of the abdomen, unlike the TRAM- segments, its composition is of skin-facia, which means that it does not use the muscle and therefore prevents the risk of hernia development. The two breast reconstruction methods, using TRAM and DIEP-segments allows to achieve two goals of breast restoration and abdominal reduction.  . In July 2008, breast reconstruction using the DIEP-segments was first performed at our clinic in Georgia. 

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