- Reconstructive or reconstructive surgery
Reconstructive surgery is a fundamental branch of plastic surgery, it is intended to reconstruct what nature, disease or trauma has destroyed or distorted.
The natural, a component of beauty, an act that should improve the appearance, without being visible.
Reconstruction is a very large and exciting field of surgery, which can affect all areas of the human body.
Our preferences for reconstructive or reconstructive surgery
At the technical level, breast reconstructive surgery is an ambitious goal, since this surgery aims to restore shape, volume, symmetry, harmony, to an amputated anatomy where the contralateral reference is visible to all.
This intervention requires a sense of aesthetics so that the reconstructed breast meets the patient's expectations.
These acts are paid for by social organizations, sometimes automatically, sometimes subject to a request for prior agreement.
Breast reconstructive surgery has 3 objectives:
- Reconstruct the volume and shape of the breast,
- Symmetrize the contralateral breast,
- Reconstruct the areola and the nipple
Today, plastic surgery is able to achieve these goals with very good results that bring satisfaction to patients and surgeons.
In all cases, the reconstruction requires two or three operative stages separated by several months apart.
Breast reconstruction can be immediate or secondary, it is a personal choice, it allows the woman to regain her bodily integrity, but it is by no means mandatory.
You have to know how to respect the patient's wishes, whatever her age.
Thanks to the wide range of techniques, breast reconstruction is possible.
Le choix dépend de différents paramètres, la qualité et la souplesse de la peau autour de la cicatrice, la forme et le volume du sein restant et l’état des tissus utilisables.
1-Immediate reconstruction
It takes place during the same procedure as a mastectomy, and is usually only offered when there is no radiotherapy planned after the operation.
Most immediate reconstructions are done with prostheses.
2-Deferred reconstructions
It is still possible to reconstruct a breast, even years after removal.
In the absence of radiotherapy, reconstruction can take place 6 months after the mastectomy (after good tissue healing).
In case of radiation therapy, it is best to wait a year. In the meantime, it is recommended to massage the chest area of the breast to soften the tissues.
- Breast reconstruction by prosthesis consists of introducing a prosthesis through an incision at the level of the mastectomy scar.
This procedure does not require an additional scar, no flap is necessary.
This method is quick and the immediate consequences are usually simple, the hospital stay is short.
- Reconstruction by lipofilling is very useful for improving the shape of the breast and filling the hollows.
- Reconstruction by rags
- Breast reconstruction by rectus abdominis flap (TRAM) by transferring the skin and excess fat from the belly, it is possible to reconstruct a breast using the skin paddle usually excised during abdominal plasties.
The intervention of the rectus femoris flap eliminates the need for a breast prosthesis since the volume is reconstructed by fat which gives the reconstructed breast flexibility and mobility similar to the contralateral breast and to improve the silhouette of the belly.
This technique (Transverse Rectus Abdominis Myocutaneous flap) makes it possible to reconstruct a breast with a very favorable aesthetic result. - Breast reconstruction (musculocutaneous flap of the latissimus dorsi muscle) The latissimus dorsi muscle has a constant pedicle, making it possible to reliably produce a musculo-cutaneous flap (supply of skin and muscle containing the arteries), with or without prosthesis, at the cost of a dorsal scar at the level of the passage of the support. throat. This technique causes little functional sequelae.
3- Harmonization of the breasts
Reconstruction of breast volume can be followed by a second procedure that aims to harmonize the shape of both breasts, and a third that aims to reconstruct a colored areola and a nipple.
These two operations are sometimes carried out at the same time. Neither is systematic. This is a personal choice.
This intervention is shorter and less restrictive than the first which consists in recreating the breast volume. While it is difficult to obtain two absolutely identical breasts, satisfactory symmetry is most often possible.
The symmetrization of the opposite breastaims to harmonize the volume of the two breasts either
- by breast reduction surgery either
- by a prosthesis augmentation
- by mammopexy
After reconstructing the volume and shape of the breast, it is advisable to offer reconstruction of the areola-nipple plate, areola + nipple, in order to completely restore this symbol of femininity that is the breast. The purpose of the surgery is to dermopigmentation of the areola as well as a nipple graft.
It is not systematic. Some women deem sufficient reconstruction of the breast size alone. Others, on the contrary, feel that this last step is important in order to regain their full physical integrity.
4-Reconstruction of the areola and nipple
Reconstruction of the Areolo-Nipple Plaque (MAP) is the last step in breast reconstruction.
Reconstruction of the areola
There are two techniques for reconstructing an areola.
The tattoo
It is often best to have a two-sided tattoo so that it is the same color on both sides. Touch-ups are sometimes necessary to obtain a better result or to maintain the result over time. The anesthesia is local
Skin grafting
Reconstruction of the nipple.
It is usually reconstructed at the same time as the areola. Three techniques are possible.
- Transplanting part of the nipple from the other (contralateral) breast, provided it is not too small. The sample does not cause any visible scar or change in sensitivity.
- The transplant of part of the gynecological labia minora.
- A small local flap: a skin graft is then performed to reconstruct the areola.
It is still possible to reconstruct a breast, even years after removal.
In the absence of radiotherapy, reconstruction can take place 6 months after the mastectomy (after good tissue healing).
- Breast asymmetry and breast hypotrophy
Breast asymmetry is represented by a different morphology of the 2 breasts, more or less important, between the shape, the volume and / or the position of two breasts.
This asymmetry is said to be "pathological" when it is obvious and causes significant aesthetic, functional (clothing) and psychological discomfort.
It can be of congenital origin, develop gradually during pre-puberty or, more rarely, appear after pregnancy and breastfeeding or because of changes in weight.
Some asymmetries are the consequence of malformations with united or bilateral hypotrophy: for example, the malformation of the tuberous breasts and Poland's syndrome.
Breast asymmetry with breast hypotrophy is corrected by breast augmentation with placement of unilateral or bilateral breast prostheses.
A skin plasty is sometimes associated to obtain a harmonious curve.
Breast asymmetry with breast enlargement is corrected by breast reduction techniques in order to balance curves and volumes.
This surgery can be covered by the Primary Health Insurance Fund under certain conditions.
Poland Syndrome
is a congenital malformation which associates thoracic anomalies, anomalies of the ipsilateral upper limb and an insufficiency or even an absence of breast development. The treatment, which is based on surgery, gives very good results, consists in first correcting the malformation of the thorax by deformities of the ribs, then in reconstructing the insufficiently developed breast. Breast volume reconstruction is done using a breast implant.
Tuberous breasts
are fairly rare breast malformations, corresponding to a defect in the development of the breast base. A breast lift with prosthesis is often necessary combining the installation of breast prostheses to fill the deficiency of the breast and the mammary plasty to repair the glandular and skin parts. The scar is sometimes only periareolar or in the lower part of the breast, by vertical scar, so as to correct excess skin. The tuberous breast surgery is usually performed under general anesthesia. Hospitalization for 1 to 3 days may therefore be necessary.
- Nipple and areola surgery
Imperfections of oversized, asymmetrical, protruding or inverted (inverted) nipples occur in women as well as in men. Many people who are embarrassed opt for nipple surgery.
Sometimes “tucked in”, it is an inverted nipple, also called invaginated nipple, which can be exteriorized from a small scar located at its base.
Sometimes too big, too long or too pronounced, they are the consequence of breastfeeding or of a genetic predisposition. The use of nipple reduction surgery is possible.
Sometimes “tucked in”, it is an inverted nipple, also called invaginated nipple, which can be exteriorized from a small scar located at its base.
Sometimes too big, too long or too pronounced, they are the consequence of breastfeeding or of a genetic predisposition. The use of nipple reduction surgery is possible.
Sheets & information
Areola reduction
A medium areola has a diameter of about 4.5 cm. An excessively large areola can easily be corrected under local anesthesia. The surgeon removes the pigmented skin around the nipple or areola using a small incision around the outside of the nipple or areola. This procedure leaves a small scar around the areola.
An areola reduction preserves the milk ducts. Breastfeeding is therefore no problem.
It is a relatively simple procedure, performed under local anesthesia, in day hospitalization and lasting 30 minutes. The threads are absorbable, the scar invisible and the final result.
This intervention does not necessarily have to involve a work stoppage, even in the event of coverage by the Caisse d'Assurance Maladie.
- Restorative surgery of the limbs (Skin grafts - flaps)
Pressure ulcers are often deep sores that form in the support areas of bedridden or immobilized people. It is a frequent complication in people with disabilities. The place of surgery is mainly discussed in the paraplegic; it makes it possible to reduce the duration of healing.
The most frequent locations are the heels (poorly vascularized areas) and the sacral region. Are also often affected the ischia (support zone in a sitting position), the trochanters, the rachis, the occiput (back bump of the head) ...
The most appropriate surgical technique is certainly that of the musculo-cutaneous flap which makes it possible to obtain a good quality recovery of the pressure ulcer.
For the treatment of extensive loss of skin substances, the principle of reconstructive surgery is based on the cutaneous vascularization.
The most appropriate surgical technique is certainly that of the musculo-cutaneous flap which makes it possible to obtain a good quality recovery of the pressure ulcer.
For the treatment of extensive loss of skin substances, the principle of reconstructive surgery is based on the cutaneous vascularization.
Within the techniques used in plastic surgery, a distinction is made between grafts which provide a fine covering is a fragment of tissue completely separated from its donor site to be attached to a recipient site intended to spontaneously revascularize it.
Flaps are tissue structures that are immediately alive. They preserve their vascularization by a support which is kept permanently or temporarily in continuity with the donor area.
- Facial reconstructive surgery
Skin surgery or dermo surgery is used for the removal of all malignant, doubtful or benign lesions, post-traumatic lesions, burns.
Removal of skin lesions
Purely benign lesions such as certain "moles", cysts or lipomas, located on the surface or below the skin, can be removed because they are annoying, either for friction and irritation or for aesthetic reasons.
Surgery is often the only treatment for malignant lesions that results in complete recovery. The goal is therefore to remove the lesion by passing as far as possible, thus taking a safety margin. An anatomopathological analysis at the end of the operation which alone will be able to confirm the diagnosis and the total excision. When all the cells that normally multiply have been destroyed or only a small number remain, the destroyed skin must be replaced over a more or less large area.
Sheets & information
Surgery is often the only treatment for malignant lesions that results in complete recovery. The goal is therefore to remove the lesion by passing as far as possible, thus taking a safety margin. An anatomopathological analysis at the end of the operation which alone will be able to confirm the diagnosis and the total excision. When all the cells that normally multiply have been destroyed or only a small number remain, the destroyed skin must be replaced over a more or less large area.
The loss of skin substance is covered either by a graft (fragment of tissue which is completely separated from its donor site to be fixed on a recipient site intended to spontaneously revascularize it) or by a flap which retains its own vascularization by displacing a skin healthy neighbor.
Correction of scars
The treatment of scars is different depending on their depth, their anatomical location and their surface: for superficial acne scars, treatment by peeling or dermabrasion under local anesthesia with sedation will be used.
In the simplest cases, scar recovery usually results in improvement, but patient-specific factors may interfere with the final result. Often it is necessary to use another method of incision.
Deep scars after an accident, burns or repeated complicated surgery: the treatment calls for various cosmetic surgery techniques: local plasty, flap, injection of centrifuged fat (lipostructure®), sometimes skin grafting.
The scars can become "hypertrophic" inflammatory, painful, red, enlarged and especially swollen "in relief", they improve with time, the "keloid" scars remain stable.
