Preferably, whenever a total mastectomy is performed, immediate breast reconstruction should be attempted, in the same surgery, by oncoplastic surgery techniques. When this is not possible, reconstruction may be delayed some months later. The esthetic results are quite satisfactory, and women who undergo reconstruction feel much better than those who do not, with obvious advantages in preserving their self-esteem and self-image.
There are several techniques for the reconstruction and the choice for one of them is individualized for each case, taking into account the size of the breasts, amount of skin removed, amount of abdominal fat tissue, presence of previous scars and patient preference. Basically, flaps with muscle and skin from another region, such as the abdomen (rectus abdominis muscle) or dorsum (large dorsal muscle), and expansive prosthesis implants, silicone implants, or silicone expansive prostheses may be used.
Oncologic prognosis is not interfered with by reconstruction and chemotherapy or radiotherapy is required when necessary. It is known, however, that reconstructed breast radiotherapy with silicone, slightly increases the frequency of complications such as hardening (capsule contractures), retractions and asymmetries. In some cases breast reconstruction seems to improve evolution, probably because of the better anti-cancer immunity favored by emotional balance.
The areola and papilla are not redone in the same breast reconstruction surgery, because in this eventuality many dehiscences occur. They are reconstructed later, through tattoos, skin grafts of the thigh root, tissue of the vulva lip or transfer of part of the nipple on the other side.
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