Oncoplastic Surgery - Reconstructive breast surgery

chirurgia-reconstructiva-a-sanului

Nowadays there is a significant rise in breast cancer incidence, not only in Romania but all over the world.

In Romania, breast cancer is the main cause of death by means of malignancy among women.

The surgical treatment remains the elected treatment and, as part of it, a new surgical branch had developed in the world: Oncoplastic Surgery, which combines Oncologic Surgery, which ensures the surgical cure of the disease, and Plastic Surgery, which re-establishes the anatomical integrity of the area and allows a faster socio-professional and psychological reintegration of the patient with breast cancer.

View Oncologic Diagram

In our clinic, this specialty has developed through the collaboration between Dr. Gabriel Gogescu – surgical oncologist and Dr. Radu Ionescu – plastic surgeon.

One must understand the fact that, because of the complexity of this disease, patients must follow some important steps in the correct and early assessment of this disease:
The first recommended step is the periodic examination performed by the gynaecologist and by the patient at home, in order to establish the appearance of a nodular formation at the level of the breast, the periodic echography, mammography or NMR screening, which has to be made annually, will receive a BIRADS score.
-Score 1- Negative-Clinically normal
-Score 2-Benign- One or several benign findings
-Score 3-Probably benign finding- A finding is present and is most likely to be benign, over 98%
-Score 4-Suspicious malignancy- Does not clearly meet the malignancy characteristics, probability of malignancy 3%-94%
-Score 5- Possibly malign-High probability of malignancy, over 95%
-Score 6-Malign- Biopsy detected malignancy, certain diagnostics.

In case the BIRAD score is a risk, you must address to our oncology service to establish the course of treatment, after that you meet the plastic surgeon who will also offer you the immediate or remote reconstruction solutions, depending on the seriousness of your disease.

Mastectomy

Regardless of the scientific progress registered in the past years, the radical surgical treatment is sometimes the optimal solution to get a safe result from an oncologic point of view. This means a surgery by means of which the mammary gland will be totally removed, the adjacent skin and sometimes even the pectoralis muscle. This surgery is mutilating and leaves a horizontal or oblique scar on the thorax. In case you do not need post-operative radiotherapy (radiotherapy destroys the immediate post-operative reconstruction in proportion of more than 50%), one option could be the immediate reconstruction with breast implant – Allergan 510 style dual gel – or with the help of an expander (dual chamber implant which is filled with physiological serum) and over time, secondary, its replacement with a breast implant for contralateral symmetrisation.
In case you need radiotherapy, you will have these sessions and one year after surgery the reconstruction procedures are started, which consist in three successive grease injections with preceeding vascular tissue stem cells which have as purpose the regeneration of the cicatricial area damaged by the radiation treatment. In stage two the patient is inserted an expander which is filled over time with physiological serum, producing enough space to introduce a cohesive gel breast implant and the areola and the nipple are reconstructed. These reconstructive techniques are laborious and need multiple surgical interventions but on a world-wide level it has been noticed that after these interventions the patients’ life quality has changed radically from a psychological point of view which leads to a longer life expectancy.

Sparing Mastectomy- Subcutaneous Mastectomy

This technique is indicated in the case of the patients with small or medium breasts affected by neoplasia in initial stages (under 2 cm) which is located at least 2 cm further from the areola and the nipple and do not cause their retraction. In this case, a minimum incision is made on the inferior margin of the areola (the periareolar incision of the augmentative mammary surgery) where the mammary gland is completely extracted and the pectoralis muscle and the skin are preserved. An anatomic cohesive gel implant is introduced submuscularly in the remained space.

The result is spectacular immediately after surgery because it happens many times that the result is more beautiful from an aesthetic point of view than the pre-operative status.

Partial Mastectomy - Quadrantectomy

It is the minimum resection of the mammary gland within oncological boundaries with the extraction of the tumoral formation. In this case the reconstruction is operative at the same time and a scar is practised similar to the reductive mammary scar or to the mastopexy (breast lift) anchor scar.

The results are extremely satisfying because the breast is repositioned correctly on the thorax and the cure for the mammary ptosis (saggy breast) is made at the same time. This surgery addresses to the patients who discover the formation in the initial stages of the disease.

Reconstruction with Latissimus Dorsi

In case the oncologist has to extirpate the pectoralis muscle too or breast reconstruction with the help of a muscle is needed after long radiotherapy treatments: Latissimus Dorsi is found on the dorso-lateral wall of the thorax, from where it is harvested with a “land” of skin and is rotated on the level of the dorsal thorax on the defective area. Over time, secondary, a cohesive gel breast implant may be introduced to re-establish contralateral symmetry.

We believe that it is extremely important that the discovery of this disease is early in order to have stability results and oncological safety over time and to increase the life expectancy of the patients affected by this disease; this is why we have developed within the Queen Mary Clinic a breast screening program which allows us to have reduced incidence of breast cancer in advanced stages among the subscribing patients.