Breast Reconstructive Surgery
In Finland, there are about 5000 new breast cancer cases yearly. Survival rate of breast cancer in Finland is one of the best in the world, the five-year survival rate is 92% and the ten-year survival rate reaches 86% (2017).
Among women’s oncological diseases, breast cancer is the most common disease affecting women worldwide. According to Globocan statistics (2018), number of new cases in 2018 (both sexes, all ages) was 2 088 849 (11,6% of all cancers).
This is why all efforts of global medical practice need to be focused on the development of it's diagnostics and new methods for improving the survival rates.
Traditional breast cancer treatment have caused women physical (f.ex. hand related problems, lymphostasis, body balance disturbance), social and psychological issues. They can be overcome with modern oncoplastic techniques in primary cancer surgery, and delayed breast reconstruction will maintain the women's quality of life.
Most of all reconstructive operations performed at Clinic Helena are carried out using the patient self-tissue transplantation method, which is rare for plastic surgery clinics in Finland.
Immediate breast reconstruction during mastectomy
The breast can be reconstructed already in the primary operation (after mastectomy) if the tumour is limited to the breast (not metastasised).
In these cases it is possible to spare the skin of the breast area and in most cases also the nipple.
The reconstruction can be performed with implants or own tissue transplants. The implant will be placed under the pectoral muscle. The muscle will not cover the lower, outer part of the breast, and that's why extra support (acellular matrix) is needed.
An immediate breast reconstruction is done for the breast cancer gene carriers prophylactically.
Own tissue reconstruction gives the best aesthetic results, because the transplant can be placed under the normal skin.
Delayed breast reconstructive surgery after mastectomy
A breast reconstruction surgery is performed in the period of 1-3 years after the mastectomy. The best possible outcome for the patient is to reconstruct a breast by using patient’s own tissue, as it delivers the most natural looking breast.
The reconstruction of a breast is planned already during mastectomy. In most cases an expander prothesis is placed below the mastectomy scar and pectoralis muscle so that the new, reconstructed breast will be covered by the patient's own skin. During the reconstruction surgery, the expander is then replaced with the own tissue flap or an implant.
Own tissue reconstruction methods will be performed as free or pedical flaps. Free flaps like muscle sparing (MS) - TRAM or DIEP, gracilis, lateral, thigh or buttock flaps are among the best options for the most natural looking breast. We use mostly MS-TRAM and DIEP flaps as they cause no asymmetry into the donor site. Doctor Puonti in Clinic Helena has developed a microneurovascular technique for ms-TRAM where the breast will become not only natural looking but also sensing.
The method chosen depends also on patient's body shape, general health and own wishes.
Free microneurovascular muscle sparing TRAM-method
Lower abdominal skin and fat tissue is transplanted as a free flap into the breast place. Blood vessels and nerves of the flap are connected into the vessels and nerves of the breast area (MS-TRAM).
In the figure the blood vessels are marked in red and blue and nerves in yellow. Nerve coaptation is covered with the NeuraGen-tube, which prevents the nerves from sprouting.
Donor site in the abdomen is then closed directly. The abdominal muscles remain almost intact. A patient of Doctor Puonti's has even delivered a baby after this procedure.
LD-flap is used for the reconstruction of small breasts of very slim patients lacking excess fat and skin on their abdomen. For this reason, the flap of skin, fatty tissue and necessary muscle piece for the formation of a new breast are transplanted from the back. It leaves a horisontal scar on the back which will usually remain invisible below the bra. If needed, LD-flap can be taken from both sides of the back for a bilateral breast reconstrution.
If needed, the size of the breast can be corrected by adding an implant underneath the LD-flap.
World-class breast reconstruction expertise
Since 2001 Doctor Helena Puonti has also been developing a unique microneurovascular technology which restores sensitivity as the reconstructed breast recovers. She has shown that it is possible to recover natural sensitivity in the breast skin when even just one nerve of skin-muscular tissue from the abdominal cavity anterior wall is sewed to the sensitive nerve fibre of the breast.
This innovative technology was published in her thesis in 2017. Many patients come to Clinic Helena for breast reconstructive surgery not only for breast shape, but also to recover breast sensitivity.