It’s a pretty frequent condition, in most cases not requiring any surgical correction.
It can be congenital (for example Poland’s syndrome) or acquired (i.e after surgical mastectomy). Sometimes a secondary corrective procedure in the involved breast only is required. In other cases a bilateral correction is mandatory.
RECONSTRUCTION POST-ONCOLOGIC SURGERY
Many are the factors leading to the best choice of surgery (general conditions, age, skin elasticity, kind of operation,..) in the right patient.
The radicality in cancer removal is the first and most important step and in treating this kind of patients.
The secondary reconstruction can be performed in one step (at the same time of the operation) or in two steps (by the use of a transient tissue expanders before the final reconstruction)
IMMEDIATE RECONSTRUCTION AFTER QUADRANTECTOMY
It’s well known that any surgery after radiotherapy is always really troublesome and challenging.
An inferior quadrantectomy can be associated to a contemporary breast symmetry correction on the contralateral side to prevent a secondary and more difficult surgery.
IMMEDIATE RECONSTRUCTION AFTER MASTECTOMY
The so-called “skin-sparing” and “skin-reducing” technique permits a “one step” procedure by the implant of permanent prostheses immediately after tumor excision.
On the contrary, in most case a “two steps” procedure is more indicated. A skin expander is located under the pectoralis major muscle after breast removal. It’s progressively inflated with time to gain the required volume. Finally the expander is removed and subsituted by the permanent prosthestic implant.
SUBCUTANEOUS MASTECTOMY AND IMMEDIATE RECONSTRUCTION
The whole mammalian gland is excised with no skin involvement and the prosthesis is located immediately under the pectoralis major muscle. In many case a further surgical correction on the contralateral breast is required (reductive mastoplasty or mastopexy)
BREAST DELAYED RECONSTRUCTION
It’s delayed till the 4-6th month post-operatively when all wounds and scars are completely healed.
It can be performed in three ways:
1) use of flaps (autologous tissue coming from the patient);
2) skin expanders and breast implants;
3) use of flaps and implants;
– Thoraco-dorsal flap: indicated when an adeguate skin paddle is not viable to cover a prosthesis. The flap involves the muscular fascia and It’s transferred to cover at 90° the scar. This technique requires no skin expanders and allows a reconstruction in “one-step”.
– Latissimus dorsi flap: Iindicated when a muscle and skin reconstruction are needed at the same time. To enlarge the final volume a prosthesis is implanted at the same time
– Muscolo-cutaneous transverse rectus abdominalis flap (TRAM flap): this technique transfers a great volume of skin and fat tissue harvested from the region under the umbilicus.
CONTRALATERAL BREAST PROCEDURES
Due to the usual appearance of a new conic breast after the aforementioned reconstructions, it’s often required a further operation on the contralateral breast to improve the asymmetry by a corrective mastopexy or a reductive mastoplasty or a well-calibrated breast augmentation
NIPPLE AND AREOLA RECONSTRUCTION
After breast balancing and stabilization the nipple can be reconstructed in different ways: using the contralateral nipple as free composite graft or by the use of local flaps. The areola can be reconstructed by a skin graft from the contralateral side or by a FTSG from the thigh associated with dermopigmentation (tattoos).
The skin is the human organ mostly involved by cancer. In Switzerland only, more than 250 persons per year die because of a skin cancer
It’s the most frequent skin tumor in Central Europe. Its’ mainly due to U.V. rays exposure. It’s slow-growth tumor with a high-rate of success after radical excision. It doesn’t give metastasis but local recidives are possible.
Sun exposure is the main risk-factor. It’s a slow-growth tumor, appearing as small nodules. In cases of early diagnose and therapy a high rate of success can be found. In late-diagnose cases bone, muscle and cartilage involvement is frequent
It’s the main cause of deaths due to a skin cancer. It’s topical to reduce all risk factors (sun exposure, burns,..) and checking periodically all skin nevi (change of colour, margins,..) by the dermatologist. Epiluminescence microscopy (dermatoscopy) ed eventual biopsy are useful methods to differentiate a benign nevus from a melanoma.
HYPERTROPHIC SCARS AND KELOIDS
Many are the risk-factors leading to these conditions: individual reactions, race, surgeon/instruments used, medicines and home-remedies.
The scientific literature has identified three main active factors involving and improving the healing process: compression, hydration (to improve elasticity) and microclimate (for example Polyurethan)
The hypertrophic scar are only raised scars that do not grow beyond the boundaries of the original wound. A keloid scar is the result of the overgrowth of granulation tissue at the site of a healed skin injury. Keloids are sometimes painful, firm, rubbery lesions or shiny, fibrous nodules and can vary from pink to the colour of the patient’s flesh or red to dark brown in colour.
For hypertrophic and keloid scars the use of cortisone injections, lasertherapies associated to easy home-remedies are usually effective to improve the pathologic condition