Dr. D. NARDELLA
Plastic and cosmetic surgery
                       

Breast reconstruction using abdominal flap:

The flap is a segment of skin associated with its fat. It is taken from the belly in the part below the navel and leaves a scar at the bikini line.

This technique is ideal in the case of additional treatment (radiotherapy) following breast removal (mastectomy) because the part to be reconstructed is entirely made up of tissues belonging to the patient. This technique is more difficult for the patient but certainly more "aesthetic".

The reconstructed breast will therefore be more natural and of a similar density to that of the non-operated breast.

This flap is taken with or without a part of the rectus abdominis muscle. It depends on the technique. Sometimes a technique combining microsurgery avoids taking the muscle. This technique is known as the DIEP flap or Deep Inferior Epigastric Perforetor. It is an innovative technique but has the disadvantage of a long duration and a difficult post-operative period due to complications from microsurgery. Certainly this technique makes the breast supple and natural. It is considered one of the best breast reconstruction techniques when possible (excess belly and slight abdominal apron) with an aesthetic result comparable to an unoperated breast.

Breast reconstruction using a latissimus dorsi flap:

The latissimus dorsi flap is made up of back skin, fat and latissimus dorsi muscle located on the same side as the breast removal. This assembly is transferred to the area to be reconstructed. It can be alone, associated with fat ( lipostructure ) or with an implant. Depending on the desired volume, one technique will be used rather than another.

When the flap is not associated with an implant, it is considered autologous reconstruction. The breast is very natural and resembles in consistency the unoperated breast.

This technique is used when the breast is of moderate volume and the abdominal muscle is unusable.

Breast reconstruction by fat injection:

Lipostructure can be used in addition to other reconstruction techniques or used in isolation. In the context of a mastectomy with good preservation of the skin and subcutaneous tissue (fat under the skin), lipostructure in several surgical sessions can reconstruct a breast of moderate volume.

Intervention at the level of the non-operated breast (symmetry):

The contralateral breast often needs to be lifted ( breast lift ) or reduced ( breast reduction ). This procedure allows you to regain a natural and uniform curve at the neckline.

Complication of autologous reconstruction:

These are the same complications that occur in implant reconstruction except the shell around the implant.

In addition, there may be complications related to microsurgery such as thrombosis of the vessels (interruption of blood flow in the flap), which requires a return to the operating room.