Breast Reconstruction

Along with breast augmentation surgery, reconstructive mammoplasty is one of the most popular plastic surgery services. But at the same time, reconstructive plastic surgery is the most complex. After all, this type of intervention is most often required by patients after sectoral and radical mastectomy, which have become part of the treatment of breast cancer. These operations are also indicated in the presence of congenital or acquired breast injuries and deformities.

Unfortunately, breast cancer remains the most common cancer. In order to prevent recurrence, depending on the location and size of the tumour, the oncologist decides on a sectoral organ-preserving surgery (removal of the area with the tumour) or radical mastectomy (complete removal of the breast). Along with physical discomfort and fear, patients experience psychological stress from changing their bodies and losing their identity. And the task of a plastic surgeon is to help a woman feel beautiful, happy, and attractive again. The Yurchenko Team regularly performs reconstructive breast surgery.

Types of reconstructive mammoplasty

A plastic surgeon at the Yurchenko Team practices two types of the procedure:

• Delayed. Reconstruction of the mammary gland is performed after the patient’s recovery and recuperation in 6-12 months;
• one-stage. Restoration of shape and volume is performed in parallel with tumour removal.

The plastic surgeon emphasises to patients that it is not always possible to perform a one-stage reconstruction for medical reasons. The task of oncologists is to save lives. Therefore, sometimes it is more expedient to direct all the body’s strength to recovery, and think about restoring aesthetics later.

In addition, several surgeries may be required to restore a beautiful breast shape within 1-2 years. It all depends on the patient’s breast condition and the capabilities of her own tissues.

Preparation

• Consultation. During the consultation, the doctor discusses with the patient all the important aspects of the operation: the specifics of the surgical procedure and the rehabilitation period, as well as other key points.
• Examination. The plastic surgeon takes detailed measurements, assesses the condition of the tissues and skin elasticity. At this stage, the optimal type of implant is determined, taking into account the patient’s wishes and physical characteristics.
• Comprehensive Medical Evaluation. Before the operation, all patients undergo an ultrasound examination of the mammary glands, an electrocardiogram, and a number of tests, including a complete blood count and urine test, a biochemical blood test, blood sugar, a coagulogram, testing for AIDS, HIV, hepatitis B and C, Wasserman’s reaction, blood type and Rh factor. In addition, patients are examined by a gynaecologist, general practitioner, an anaesthetist.

Stages of the operation

The reconstruction can be performed using implants, tissue expanders, local tissue, or a combination of these methods.

Restoration of breast aesthetics after sectoral surgery is most often performed using lipofilling. To eliminate asymmetry, correct the shape and volume, the patient’s own adipose tissue is often used (lipofilling), as well as redistribution and modelling of the existing breast tissue (various reduction and lift techniques). Implants can also be used.

One of the following techniques can be used to restore the appearance of the breast after a radical mastectomy

• endoprosthetics: one-stage (using implants) and two-stage (using tissue expanders and implants):
• the patient’s own tissues (various techniques using flaps – LD, LICAP, TEG; own adipose tissue);
• combination of methods

Implant reconstruction: breast reconstruction with implants is considered the least traumatic surgery with a minimal rehabilitation period. It is used when there is a deficiency in breast volume and shape, but there is enough skin and subcutaneous fat. We often perform an additional stage (breast lipofilling) to improve the aesthetics of the breast and to provide a more reliable cover for the implant in the case of a deficiency of covering tissues.

Two-stage endoprosthetics: A technique using tissue expanders. The surgeon places a tissue expander (special bag, expander) under the skin or under the pectoralis major muscle on the side of the mastectomy. Gradually, over a period of time, its volume is increased by injecting saline through a special valve. When the tissues are stretched to the desired degree, the expander is removed, and a permanent implant is placed in the formed pocket. The implant pocket takes 3-6 months to form.

The technique using flaps (TRAM flap) is an aerobatic technique of reconstructive surgery. The patient’s own tissues are used to form new breasts. They retain sensitivity and are soft to the touch. The surgeon moves skin-fat, muscle, or skin-muscle flaps on the vessels to the areas with tissue deficiency. This technique requires high skill from the surgeon, and the operation itself takes longer. There is a disadvantage: recovery is sometimes more difficult.

The ‘thoracodorsal flap’ method is used for one-stage breast reconstruction. The doctor immediately places the implant in place of the removed breast, covering it with skin. In cases of skin deficiency, a donor flap is taken from the patient’s back.

IMPORTANT: the method of performing reconstructive breast surgery is chosen only by a plastic surgeon. Only a specialist can assess the scope of work, the condition of the skin and subcutaneous tissue after mastectomy or trauma, based on the patient’s anatomy and age.

Contraindications

There are no specific contraindications for breast reconstruction. They are determined on an individual basis and, as a rule, coincide with general surgical contraindications for the operation:

• severe somatic and mental pathology;
• acute diseases and chronic diseases at the stage of decompensation;
• blood coagulation disorders,
• severe anaemia,
• oncological diseases (in case of special treatment – chemotherapy, targeted therapy, radiotherapy);
• smoking.

Rehabilitation

After surgery, the most crucial period begins – rehabilitation. First, avoid sudden movements for a month, do not raise your arms above your head. In order not to injure the operated breast, you will have to give up driving and air travel for two weeks.

For the first two weeks, you will have to give up showering. After that, water procedures are allowed, but with the obligatory treatment of the sutures with chlorhexidine solution. The patient also takes antibiotics for the first 14 days. This is to prevent the inflammatory process.

During rehabilitation, you should retrain yourself to sleep. The first week in a semi-sitting position. You should not sleep on your stomach for up to 6 months, on your side for up to 3 months.

Another important point: for the first month, the patient wears corrective underwear around the clock. This is insurance against complications. After a month, the patient wears corrective underwear for another 60 nights.

Complications after reconstructive mammoplasty

Reconstructive mammoplasty is a sophisticated surgical procedure that can improve the quality of life of patients after mastectomy or other medical conditions. However, like any surgery, it carries certain risks and possible complications. Here are some of them:

1. Infections. One of the main risks after surgery is infections that can occur at the surgical site. This can be manifested by redness, swelling, pain, and fever. Treatment includes the prescription of antibiotics, and in some cases, a second operation may be required to clean the wound.
2. Bleeding and haematoma.  After surgery, bleeding may occur, leading to the formation of haematomas (accumulation of blood under the skin). This complication may require additional surgery to remove blood clots and stop the bleeding.
3. Scars. Surgery always leaves scars. Although they usually become less noticeable over time, some patients may develop large or hypertrophic scars that require additional treatment or correction.
4. Asymmetry.After surgery, breast asymmetry is possible, where one breast may be larger or have a different shape than the other. This complication may require additional surgery to achieve symmetry.
5. Tissue necrosis. In rare cases, tissue necrosis (tissue death) may occur in the nipple area or other parts of the breast. This is a serious complication that requires immediate medical attention and may require surgical correction.
6. Seroma is an accumulation of fluid under the skin in the area of surgery. This complication may require drainage or aspiration of the fluid.

Why you should choose Yurchenko Team

In our Yurchenko Team, each doctor has his or her own area of expertise. With more than 70 types of plastic surgery, each has many details. Thanks to the division of duties, our doctors can deepen their expertise in a narrow area, which allows us to provide high quality services. This is the basis of our philosophy.

Denys Yurchenko performs breast reconstruction surgeries. He is the inspiration behind the Yurchenko Team and the author of the unique 70/30 anchor lift method. Additionally, we involve the expertise of Dmytro Mikulich, a mammologist, oncologist and reconstructive surgeon. He has unique knowledge in breast reconstruction after cancer and complex reconstruction cases.

Therefore, if you need a beautiful bust, you should definitely visit the doctors of the Yurchenko Team.

Patients receive not only medical care, but also psychological support at all stages of treatment – from the first consultation to the completion of rehabilitation. This is evidenced by the well-thought-out locations in Kyiv, Bukovel and Limassol, which combine modernity, professionalism and comfortable conditions for recovery.