Breast reconstruction

Breast reconstruction in Munich and Starnberg with PD Dr Max Geishauser

Breast Reconstruction – Breast Restoration

Are you looking for breast reconstruction in Munich or Starnberg? Then find out more from PD Dr. Max Geishauser.

Breast reconstruction for breast cancer

Restoring the shape and aesthetics of the breast after breast cancer has become a standard operation. There are various procedures available which are individually adapted to the patient.

Here we present the various options for reconstructing the female breast and try to give you an initial overview of the possibilities and our assessment.

In the case of breast cancer, but also in the case of other serious breast diseases, a complete or partial removal of the breast (mastectomy – amputation, there are also different operations for this) may become necessary.

Simultaneous reconstruction of the breast

In most cases, the breast can be reconstructed in the same operation. This is called immediate reconstruction or primary or simultaneous breast reconstruction: removal of the breast tissue and breast reconstruction in one operation.

This spares you the feeling of “waking up without a breast”. It has been proven that the removal of the breast and its reconstruction in one operation has no negative influence on the course of the cancer or further chemotherapy. If the breast is reconstructed with the patient’s own tissue, then radiation therapy can also be performed well. Foreign material such as silicone prostheses or expanders should rather not be irradiated because the tissue can change considerably. If radiation is necessary, the breast should be reconstructed with autologous tissue.

Secondary – later breast reconstruction

If the breast has already been removed or you cannot decide to have the primary reconstruction right away, the breast can be reconstructed later: Secondary or two-stage breast reconstruction. There are also a number of different procedures available for this.

What are the options?

Restoration with implant

Silicone implant (one-time – multiple-time)

Restoration with silicone implant plus mesh implants.

For example:

Silicone implant plus titanised polypropylene mesh (TCPM/TiLOOP®Bra

Silicone implant plus partially absorbable plastic mesh (SeraGyn®BR)

Silicone implant plus acellular porcine dermis StratticeTM

Silicone implant plus acellular human dermis (Epiflex®).

Reconstruction with autologous tissue:

Transplantation of fat tissue (micro fat transplantation).

Transplantation of (skin and) fat tissue with vascular (and nerve) connection.

For example:

Free microsurgical flap, e.g. DIEP flap or FCI flap.

Pedicled TRAM flap (only in exceptional cases, as the lifting defect is greater)

Combinations

Implant and soft tissue grafting as a flapplasty.

For example:

Implant and back muscle (latissimus dorsi – only in exceptional cases now).

Combinations with micro-fat transplantation

Reconstruction of the nipple and areola

Which procedure is best?

There is no general best procedure. Which option is most likely to be recommended for you must always be clarified and discussed individually after a detailed examination. The technical possibilities, but above all your personal wishes, play a decisive role here. We will be happy to advise you.

Breast reconstruction with implant

Are you thinking about breast reconstruction in Munich or Starnberg? Then please contact PD Dr. Max Geishauser for more information.

Breast reconstruction with implants is still a very common type of breast reconstruction. It is considered the simplest type of reconstruction, which is not always true. Whether it is easy and what the results will be depends on the shape of the breast, the size of the breast and other factors, for example, whether the breast needs to be radiated or has already been radiated.

What has to be taken into account during breast reconstruction?

The skin of the breast is preserved during the operation, and the volume is replaced by an implant made of silicone. However, in order to minimise the risk of recurrence of breast cancer, the breast cancer operation must be carried out very carefully and completely. Only with this procedure can the same safety be achieved as with a complete breast removal (ablation of the breast). Then, however, a large part of the nerves and vessels are removed and the blood supply to the breast skin is reduced. In this case, tissue with a good blood supply must be placed between the implant and the skin so that the implant can be held in place and the skin of the breast can be supplied with blood again.

How many operations are necessary for breast reconstruction after a mastectomy?

In (two-stage) breast reconstruction with an implant, an expander implant is often first placed under the large pectoral muscle and under part of the anterior sawtooth muscle. This is then stretched and after several weeks, in a second operation, this implant is exchanged for a silicone implant.

Large studies have shown that on average not two operations are needed until the breast is restored, but on average 2.6 operations. This means that one or more further operations are often necessary.

This also applies to the (one-stage) reconstruction of the breast with implant and mesh (ADM – acellular dermal matrix, plastic mesh or titanium mesh). Here, too, another operation is always necessary until a permanent result is achieved.

In the case of reconstruction with the patient’s own tissue, only 1.3 operations are required on average. However, the operation takes longer.

The downtime after the operation must also be taken into account

Breast surgery with simultaneous reconstruction

If simultaneous reconstruction of the breast with implants is to take place during breast removal, the desired breast shape and size must be discussed with you beforehand. Then the implant shape and size will be determined. It may be necessary to adjust each other’s breasts to achieve good symmetry.

How safe is the implant?

Modern silicone implants are very safe. It is important to pay attention to the best quality. The further development of implants has progressed so far that it is very rare for the silicone gel to leak out of the implant. Worldwide studies have shown that there is no connection between silicone implants and other diseases such as migraine or neurological disorders. The implants of the companies we use have been tested and approved in all of Europe as well as in the USA.

The insertion of an expander or an implant can also be useful as a temporary measure. In this case, the implant serves as a placeholder to bridge the time until further surgery.

Possible risks with silicone implants

The implant is a foreign body and is surrounded by the body through connective tissue. We call the resulting surrounding shell a capsule. In some cases – and much more frequently after radiation treatment of the breast – the shell can become so firm that it compresses the implant: hardening of the capsule – capsular fibrosis. This can lead to deformation and pain. Unfortunately, the risk of capsular fibrosis cannot be determined before the operation.

The frequency of capsular fibrosis has decreased with modern implants, but the risk always exists. The percentages vary greatly: while a risk of 1.5% was reported in large implant studies, the rate of capsular fibrosis continues to rise annually up to about 10%. However, depending on the measurement method, capsular fibrosis rates of up to 40% have been reported. Even higher rates have been reported after breast irradiation, which is why breast reconstruction with autologous tissue is generally more appropriate in this case.

About 80% of all capsular fibrosis occurs in the first and second year after implant insertion. Further risks are the slipping of the implant (dislocation), palpability of the implant, accumulation of secretions, occasional and frequent feeling of pressure and rarely also foreign body sensation. As there are no blood vessels in the implant, the breast can be cooler in winter and remain cool for longer after cooling down.

Before the operation, the usual preliminary examinations and an anaesthetic consultation take place. In the case of a two-stage reconstruction of the breast with a change to expanders, there are usually two to four months between the operations, but a longer period is possible at the patient’s request.

After the operation, the breast is protected with a transparent foil dressing so that you can shower immediately. In the first few days after the operation, the wound secretion is drained to the outside via drainage tubes.

If an expander is used to stretch the muscle and skin, saline solution is usually injected once a week until the desired size and shape is achieved. This is usually not painful but there will be a feeling of tightness which will subside after a few days as the tissue stretches.

Breast reconstruction with autologous tissue

The use of the body’s own tissue for breast reconstruction leads to the most beautiful and natural results in the medium and long term. This is due to the principle of replacing like with like – fatty tissue with fatty tissue – skin with skin. This is the best way to restore the tissue characteristics. This means that the breast moves naturally, is warm because it is supplied with blood, and soft. And remains soft in the long run. In addition, it is often possible to connect nerves, so that the feeling is also often better.

The disadvantage is that tissue has to be taken from a second place on the body – abdomen – buttocks – thighs – flank – which leads to scars there. This is sometimes an option if, for example, you have already thought about a tummy tuck, but occasionally, such as on the top of the buttocks or thighs, the scars and the lack of volume can be disturbing. Here, an individual examination and consultation can provide clarity.

Other advantages of breast reconstruction with the patient’s own tissue are that on average only 1.3 operations are required to achieve the final result compared to 2.6 operations for reconstruction with breast implants. In most cases, the time to achieve the result is also shorter.

The complication rate is relatively low and there are few late complications, no capsular fibrosis as with silicone implants. Autologous tissue can almost always be used. The main risk is that the tissue is not supplied with blood and dies partially or completely. Then, however, other reconstruction methods are usually available.

In secondary reconstructions, when the breast has already been removed and reconstruction is done later, it is usually also necessary to insert skin from the area where the breast was removed. This has a different colour and texture than normal breast skin, and the reconstruction is then more easily visible.

Breast reconstruction using microfat grafting

One would wish to be able to suction out fat from areas where one has too much fat and use it for breast reconstruction.

The transplantation of the body’s own fatty tissue has been carried out for a long time, with widely varying results depending on the type of application and field of application. Since this is a suitable procedure, the principle was taken up again 30 years ago and refined further and further. For example, fatty tissue is suctioned from the abdomen, the fat cells are filtered out and then transplanted to the desired location using special instruments.

Unfortunately, only a relatively small number of fat cells can be transplanted in this way, as they have to be introduced into an area with a good blood supply so that they can grow. Realistically, one can assume a healing rate of 20-70% of the transplanted fat. One can thus expect an increase in the existing volume of a region of 20-50% per operation. Since almost the entire volume of the breast must be removed during a breast removal to reduce the risk of recurrence (recurrence risk), usually only a thin layer remains under the skin.

Therefore, several operations are necessary until a good volume is achieved. A complete breast reconstruction often requires 8-16 operations, often in a complex procedure (microfat grafting plus BRAVA expander). The time required for complete breast reconstruction is then several years.

This is why these procedures are rarely used.

Volume deficits, for example in the upper breast sections, or contour irregularities can be compensated well in this way. However, the procedure can also serve well in combination with breast reconstruction with implants or for shaping the breast reconstructed with the patient’s own tissue.

As the fat cells grow, new blood vessels are formed. Blood circulation improves. And there is good evidence that irradiated skin can also be significantly improved.

Complications can include cysts and calcifications. In general, repeated operations are usually necessary.

Reconstruction of the nipple and areola

Reconstruction of the nipple and areola

In one-stage breast reconstruction, the nipple with areola can usually be preserved. However, the nipple can often be replaced in the first operation if the nipple had to be removed for oncological reasons.

When the breast is reconstructed after ablatio mammae – complete removal of the breast including the nipple – the nipple has to be restored later.

This is often the icing on the cake of breast reconstruction.

Nipple reconstruction – own technique

We have developed our own scar-saving technique for the reconstruction of the nipple, which we will be happy to explain to you. The operation can be carried out under local anaesthetic – or as part of a corrective or approximating operation.

Alternatives

There are a number of alternative methods of nipple reconstruction with which we have experience and which we can offer you:

Reconstruction of the nipple from part of each other’s nipple (nipple sharing).

This is an option if the other nipple is very large. Here the lower half can be removed to form the new nipple.

Various local skinplastics (star-flap, skate-flap, etc.), this often results in scars around the nipple.

Reconstruction of the areola – the areola

Here our preferred technique is medical micropigmentation. We have special pigmentation equipment and pigments for this.

The pigmentation is done with a colour match to the opposite side and usually with 5-10 different colours to get a realistic and beautiful result.

The cost of this – as well as breast reconstruction after breast cancer or loss of the breast – is almost always covered by health insurance.

Alternative methods:

Skin graft from the groin

Skin graft from the labium

Skin graft from the upper eyelid

Etc…

These methods lead to additional scars and often to swollen looking areolas