Breast reconstruction is essential for a woman’s quality of life!
Traditional breast cancer treatment has 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, which 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.
Particularly we offer the unique “Sensing breast” method with free abdominal flap from patient’s own skin and fat tissue below umbilicus. By connecting also nerves from the flap to thoracic wall in breast area the sensation can return to the new breast skin.
Immediate breast reconstruction during mastectomy
The breast can be reconstructed already in the primary operation (during mastectomy,) if the cancer is limited to the breast (not metastasised). An immediate breast reconstruction with mastectomy is done for the breast cancer gene carriers prophylactically.
In many cases it is possible to spare the skin of the breast area and then 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.
The own tissue tranplants can be taken below umbilicus (free abdominal flap) or from back (LD-flap), from femur area or with a perforant flap with skin and fat around the breast. The transplant is placed under the normal breast skin, and it gives the best aesthetic result.
Immediate breast reconstruction with free abdominal flap from below umbilicus (left breast), also a nipple has been removed and reconstructed later with local flap and tattooing the areola.
Delayed breast reconstructive surgery after mastectomy
A final 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.
The figure of the technique for Sensing Breast. NervesTh XI and XII has been connected to Th IV and intercostobrachial (ICN) nerve. Epigastrica inferior blood vessels are connected to intra mammaric vessels.
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.
Blood flows into this so-called LD-flap through the axillary blood vessels. The entire flap is detached so that only the blood vessels and the nerve stay connected with the armpit; then the flap is turned over onto the chest and given the shape of the patient’s own breast. It is also possible to suture extra nerves with the flap, and try to gain better sensation for this new breast.
If needed, LD-flap can be taken from both sides of the back for a bilateral breast reconstruction.
LD-reconstruction result, a nipple will be reconstructed later.
If the patient wants bigger breasts, 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.