Breast Reconstruction: Expert insights

Breast reconstruction after a mastectomy is a critical component of the journey for many breast cancer patients. We have gathered insights from leading surgeons to provide a comprehensive overview of the various aspects of breast reconstruction, including the transition from tissue expanders to final implants, surgical options, and the benefits of advanced implant technologies. 

These experts offer valuable information on the different procedures and considerations involved in breast reconstruction.

What are the differences between immediate and delayed reconstruction methods?

Prof. Dr. med. Matthias Reichenberger head of the Department of Plastic Surgery at ETHIANUM clinic in Heidelberg, Germany, explains the timing of reconstruction:

“There is immediate reconstruction, where the breast is reconstructed at the same time as the mastectomy, and there is delayed reconstruction, where the breast is first removed and then treated with medication or radiotherapy, followed by breast reconstruction. Which of these methods is right for each woman depends not only on the patient's wishes and expectations, but also on many other factors, such as the type of tumor, the patient's physical condition and any previous surgery.”

What main surgical options are available for breast reconstruction?

Prof. Dr. med. Reichenberger explains: "There are two types of breast reconstruction: using the body's own material and using foreign material. Foreign material means silicone implants that can be placed in front of or behind the muscle as part of the reconstruction. The procedure is generally much quicker, but unfortunately the results are not permanent, as there are always risks associated with implants. Augmentation with your own tissue is a permanent solution. Tissue is taken from the abdomen, thigh or buttocks and then placed under a microscope in so-called recipient vessels in the breast. This means that we use the body's own tissue, consisting of skin and fat, to create a breast that is permanent, as mentioned above. The procedure is a little more complex and should only be performed in trained centers. However, when professionally operated, it is a very safe procedure."

The journey from breast expander to a final POLYTECH implant

Breast expanders are temporary devices used in breast reconstruction to stretch the skin and muscle to make room for a future permanent implant. They are particularly useful when the mastectomy requires the removal of a significant amount of breast tissue, and the remaining skin needs to be gradually expanded to accommodate an implant. This two-stage reconstruction process involves initially placing a tissue expander and later replacing it with a permanent implant once the desired breast size is achieved.

Dr. Francesca de Lorenzi, Director of the Innovation, Development, and Organization Unit, Department of Plastic and Reconstructive Surgery at the European Institute of Oncology in Milan, explains:

"Thanks to screening programs, the improvement of radiological examinations and patient awareness, the diagnosis of early-staged breast cancers and even non-palpable tumors is currently possible in the vast majority of cases. This allows conservative mastectomies and the immediate use of definitive implants. However, tissue expanders are still necessary in case of mastectomies requiring the removal of the breast skin or in case of poor quality of the mastectomy flaps. In this cohort of patients, tissue expanders allow immediate reconstruction. They are filled with saline solution as an out-patient treatment till the final desired volume of the breast to be reconstructed is achieved. In a further surgery, they are changed with the definitive implant and surgery on the contralateral healthy breast is performed, if needed, to improve symmetry.”

What is a nipple-sparing mastectomy and how does it differ from other procedures?

Dr. med. Mehrnoosh Akhavanpoor, Head of the department of Plastic surgery Agaplesion Diakonie Kliniken Kassel in Germany explains this procedure:

"It's important to know in advance whether the diagnosis allows us to preserve the nipple and areola. If so, a procedure called a nipple-sparing mastectomy may be successful. In this procedure, the tissue under the skin is carefully removed while preserving the areola and nipple. If, unfortunately, the diagnosis doesn't allow for this, then the areola and nipple must be removed."

The advantages of Microthane^® for breast reconstruction

One of POLYTECH’s favourite implants for breast reconstruction is Microthane®, our micro-polyurethane covered breast implant. We asked Dr. Alessandro Quattrini Li, Medical Director at Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, the advantages of Microthane^® implants:

Dr. Alessandro Li explained: “Microthane^® micropolyurethane-foam coated surface implants offer several benefits beyond reducing capsular contracture in breast reconstruction. From my experience, here are some key points:

1. Reduced Capsular Contracture Rates

Capsular contracture is one of the most common complications following breast implant surgery. It occurs when the scar tissue around the implant, the so called capsule, tightens and compresses the implant, potentially causing pain and altering the appearance of the breast. Studies have shown that Microthane-coated implants have significantly lower rates of capsular contracture compared to smooth and textured surface implants. The micropolyurethane-foam coating seems to affect the formation and organization of fibrous capsule tissue, thereby reducing the incidence and severity of capsular contracture.

2. Improved Implant Stability 

The micropolyurethane-foam coating on Microthane^® implants provides a scaffold surface that promotes better tissue integration. This enhanced integration helps anchor the implant in place, reducing the risk of displacement or rotation. The improved stability is particularly beneficial in reconstructive surgery, where maintaining the correct position of the implant is crucial for achieving the desired aesthetic result.

3. Better Aesthetic Outcomes 

Thanks to the wide range of available implants shapes and sizes, I can choose the best implant for every single patient. Even in challenging cases, such as elderly patients with wide, low-volume breasts, I have access to implants that allow me to achieve optimal breast reconstruction. Thanks to the versatility of POLYTECH polyurethane implants and my “SIMPLE” surgical technique, I am able to reconstruct the breast to closely match the contralateral one, thereby reducing the need for a symmetrization procedure.

4. Lower Incidence of Double Capsule Formation 

Double capsule formation is a rare but possible complication where two layers of fibrous tissue form around the implant. The micropolyurethane-foam coating has been shown to reduce the risk of this complication, likely due to its ability to promote more uniform tissue integration.

It’s important to emphasize that tailoring the procedure to the individual needs of each patient is crucial to achieving optimal outcomes in breast reconstruction."

Advantages of lightweight implants in breast reconstruction

B-Lite^® lightweight implants are a significant advancement in the field of breast reconstruction, offering several benefits over traditional implants. We asked two experts on the advantages of using lightweight implants in breast reconstruction and how they enhance patient outcomes.

Dr. med. Mehrnoosh Akhavanpoor from Germany highlights the benefits of lightweight implants:

“For breast reconstruction, it's fantastic that we now have a variety of implants available. What I mean is that when someone decides to replace their breast tissue with implants, they have specific size requirements. Some patients have large breasts and therefore need larger volumes. This means a lot of weight, pressure, and tension, especially on the tissue. That's why I'm very pleased that we have this option. We've had significantly lighter implants available for years now, allowing us to choose lighter implants, especially for breast reconstruction.”

Dr. Martin Colombo from Argentina adds:

"Polytech offers implants with the unique composite B-Lite^® gel, made by the combination of the latest generation of cohesive silicone gel bonded with lightweight microspheres designed for the space industry, which makes the implants up to 30% lighter. First used in 2013, this implant constitutes the latest breakthrough in the breast implant industry. The fact of being lighter is a great advantage in breast reconstruction where, on average, larger, therefore heavier implants are often used. Being lighter, they generate less stress on the tissues, with reduced breast sagging in the long term and a more comfortable for daily life, especially when doing sports activities. Due to its characteristics, the gel of B-Lite^® implants allows the image of the tissues in radiological studies of the breast to be clearer, giving more diagnostic security."

Conclusion

Breast reconstruction can be a vital part of the journey for many breast cancer patients, offering both physical and emotional restoration. Expert insights emphasize the importance of tailored treatment plans that consider individual patient needs, the latest advancements in implant technology, and the benefits of both immediate and delayed reconstruction methods. By staying informed about these options and advancements, patients can make empowered decisions about their breast reconstruction journey, leading to improved aesthetic results and overall well-being.

To continue learning and supporting breast cancer awareness, make sure to read our other blog posts and follow our social media efforts throughout October.