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Resuelve aquí todas tus dudas sobre el cáncer de mama y las opciones quirúrgicas de reconstrucción mamaria tras mastectomía, total o parcial, que existen: tipos de prótesis, técnicas, resultados... Conoce, además, testimonios de primera mano de pacientes que han sufrido un cáncer de mama. 

  • Can PIP breast prostheses be cancerous?
    According to a risk assessment commissioned by the Spanish Agency for Medicines and Health Products (AEMPS), there is no evidence of an association between PIP prostheses and the development of cancer or connective tissue diseases. Likewise, with the limited data available, it is verified that there is no evidence that women who wear these prostheses are exposed to a greater risk to their health than women who wear other breast implants. However, due to the limited existing clinical data, and the results of the physical, chemical and irritation tests carried out, the possibility of health effects cannot be excluded. Note from the Spanish Medicines Agency
  • What can be done to avoid breast cancer?
    In other types of cancer there is a clear triggering factor, such as smoking in squamous cell lung cancer. But breast cancer is not the result of a single preventable cause. Therefore, primary prevention is not possible. But it is possible to modify different circumstances that are related to a greater probability of developing breast cancer. The increase in breast cancer in developed countries has been related to the socio-professional changes of women, conditioning a delay in the age at which they have their first child. Having the first child before the age of 25 reduces the risk of developing breast cancer, as well as having several children and opting for prolonged breastfeeding. The use of hormone replacement therapy to relieve menopausal symptoms has been shown to increase the risk of breast cancer, especially if it continues for more than 5 years. A healthy diet, rich in vegetables and fruits and low in animal fats, seems to reduce the risk of breast cancer, in addition, obesity and moderate or high alcohol consumption are also risk factors. Recent studies find that doing aerobic physical exercise for half an hour three days a week is capable of reducing the risk of developing breast cancer by between 15 and 20%. Knowing all these risk factors can help women to modify behaviors and lifestyles that reduce breast cancer in our environment, but the most important thing is to reduce mortality from this disease and for this a diagnosis is essential early through participation in population prevention campaigns that have mammography as the main diagnostic test.
  • Is it safe to remove only part of the breast to treat breast cancer?
    Several decades ago it was thought that the only way to treat breast cancer was to completely amputate the breast. Subsequently, numerous controlled clinical studies on thousands of patients with small breast cancer, less than 3-4 cm, demonstrated that breast-conserving surgery achieved the same survival as mastectomy. In practice, mainly due to the diagnosis of the disease in early stages, the majority of women with breast cancer, about 70%, are treated without a mastectomy. Conservative treatment consists of removing the tumor with a margin of healthy breast tissue around it, followed by studying the possible spread to the lymph nodes, in most cases by means of sentinel lymph node biopsy, and later radiotherapy to reduce the risk of tumor grows back in that breast. The location, shape and size of the scars are especially related to where the tumor is located in the breast, but also to achieving a good cosmetic result. Conservative treatment is not considered indicated when there are more tumors in other areas of the breast (multicentric cancers), there are extensive microcalcifications that appear malignant on mammography, and when the tumor cannot be resected with sufficient margins. The size of the tumor is a relative contraindication because it depends firstly on the relationship with the size of the breast and secondly it is possible in many cases to reduce it by treatment with chemotherapy before surgery (neoadjuvant chemotherapy). The main risk of conservative treatment is regrowth of the tumor and currently this is approximately 1% per year, but studies have shown that it does not affect survival. When it occurs, it is usually treated by mastectomy.
  • What is sentinel node biopsy?
    Breast cancer tumor cells can escape into the nodes, most often in the armpit on that side. The probability of this occurring depends fundamentally on the size of the tumor, the larger the risk, the greater the risk. But because breast cancers are being diagnosed early, about 60% have no node involvement. Removing axillary nodes with metastatic breast cancer decreases the risk of recurrence in the axilla and better classifies the disease, but removing nodes if they are not affected has no benefit for the patient and does carry a significant risk of difficult complications treatment such as chronic arm swelling, called lymphedema, and chronic painful shoulder. To avoid unnecessary extirpation of lymph nodes in the armpit, the sentinel node technique has been developed. The lymphatic drainage of the breast is carried out in an orderly manner, first reaching a small number of nodes, often one, and from there to other nodes. The sentinel node technique identifies this first or first nodes by using a protein labeled with a radioactive isotope, by a dye, or a combination of both. Subsequently, it is removed and analyzed microscopically. If no tumor cells are found in the sentinel node, we know that it is very unlikely that there are any other nodes with tumor cells, so it is unnecessary to remove the nodes. If the sentinel node has metastasis, the rest of the axillary nodes are removed, which is called lymphadenectomy. The possibility of not removing the rest of the nodes even when the sentinel node is metastasized in some types is currently being studied.
  • How does autologous or patient-tissue breast reconstruction work?
    In these cases, breast reconstruction is performed by transferring skin, fat, and sometimes muscle from other parts of the body. Advantages of these techniques: they don't use extraneous material the appearance of the new breast is very similar in its shape, temperature and consistency to the original breast loss or gain of body weight will affect you less. Counterparts: • They are more complex interventions, with a longer operating room and recovery time • scars are caused on the back or abdomen.
  • What is post-mastectomy breast reconstruction?
    Breast reconstruction is part of the comprehensive treatment of breast cancer and is performed when complete removal of the breast is essential for the surgical treatment of breast cancer. the breast (mastectomy). Breast reconstruction must always be performed following the principles of oncological surgery and with the most appropriate technique for each patient.Breast reconstruction does not interfere with complementary treatments that may be necessary, nor does it worsen the prognosis of the disease, nor does it make it difficult to diagnose the possible local recurrence of the cancer. In fact, not only does it not increase surgical complications if performed immediately, but it adds psychological benefits to patients. Characteristics of the new breast after breast reconstruction: Symmetry: Although breast reconstruction does not perfectly compensate for the loss of the breast, it can maintain symmetry with the contralateral breast in contour and volume. Sensitivity: Since the mastectomy removes the entire mammary gland and part of the skin that covers it, this new breast has a loss of skin sensation , totally or partially. Touch: When it is reconstructed with a prosthesis, part of the prosthesis or a fold in it can be felt, as well as a different consistency and temperature in relation to the other breast.
  • What types of mastectomies are there?
    Simple and radical mastectomy Drawing of post-mastectomy breast reconstructionIn these cases, the breast and a large amount of skin are removed. In radical mastectomy, the muscles below the breast (pectoral muscles) are also removed, but this type of mastectomy is performed very rarely and only when the muscles are affected by the tumor. To reconstruct this type of mastectomy it is necessary to dilate the existing skin or transfer tissue from another part of the body. Skin and nipple sparing mastectomy Currently, whenever possible, when a mastectomy is performed we try to preserve most of the skin that covers it, as well as the inframammary fold and the musculature located below the breast (ms. pectoralis). We will keep the areola and the nipple as long as the tumor is not close and that there is no tumor in the intraoperative nipple biopsy. Although this type of mastectomy greatly facilitates the reconstructive process and symmetry with the other breast, it is technically more complex than the standard mastectomy since it is necessary to maintain a good irrigation of the skin to avoid partial or complete loss of the thickness of the mastectomy. skin, which may compromise the final result and/or delay the start of adjuvant treatments. If the areola and the nipple are preserved, logically there are more possibilities of complications in the preserved skin.
  • When to perform a breast reconstruction?
    Immediate breast reconstruction It is the one that is performed at the same time as the mastectomy and has the advantage of preventing the patient from seeing herself without one or both breasts. Depending on the type of breast reconstruction performed, it can be the beginning or the end of the reconstructive process, waiting for the nipple-areola reconstruction and symmetrization of the contralateral breast if the patient wishes. Although the surgical time and outpatient postoperative control is longer, the complications are similar to those of a simple mastectomy. It should be kept in mind that the appearance of the breast will change after the intervention and that the final result will not have been achieved at that time. Delayed breast reconstruction It is the one that is performed months or years after the mastectomy. In this type of reconstruction, one or more surgical interventions are necessary since the skin must be dilated with "expanders" or supplied from other parts of the body by means of musculo-cutaneous grafts. The advantage is that the patient has more time to choose the technique and will concentrate more on the complementary treatments to the mastectomy. Something to keep in mind… Radiation therapy is the only complementary treatment for breast cancer that can condition the timing and type of reconstruction. Radiotherapy can affect the reconstructive process, since it can cause “fibrosis” of the residual skin, which causes: in delayed reconstruction, difficulty in dilating the skin and in immediate reconstruction, worse aesthetic results. However, immediate reconstruction does not reduce the efficacy of radiotherapy, nor does radiotherapy contraindicate the reconstructive process, but the patient must be aware of the difficulties it can cause.
  • Is the symmetrization of the breasts taken into account in a breast reconstruction process?
    In breast reconstruction, a balance and symmetry between the breasts is sought. However, it must be taken into account that a patient's natural breasts do not have total symmetry and that it will be difficult to achieve it after breast reconstruction. Even after corrective interventions, the differences between the breasts can grow or appear over time. Symmetrization of the contralateral breast can be performed during immediate reconstruction or at some time thereafter. Sometimes the contralateral breast needs to be increased, decreased, or raised using augmentation, reduction, or mastopexy techniques. The patient is the one who must make the decision to perform an intervention on the healthy breast. They must be done before starting the creation of the areola and nipple.
  • How is the nipple and areola reconstructed after a mastectomy?
    The nipple and areola can be reconstructed from the same tissue as the reconstructed breast, the contralateral nipple, or the skin of the inguinal area. There are many techniques, since it is difficult to maintain the projection of the nipple. An easier way is micropigmentation of the areola and nipple. It is performed on an outpatient basis or in a consultation.
  • What types of breast reconstruction are there?
    The choice of the type of breast reconstruction, whether immediate or delayed, is based on several factors such as the body configuration and health of the patient the size and skin of the breast location and type of cancer However, the final decision will depend on the expectations, preferences and lifestyle of the well-informed patient, since all possibilities must be previously discussed with the surgeon. In summary, breast reconstruction can be performed using the following techniques: Breast prosthesis or implants (heterologous) The patient's own tissue (autologous) In a mixed way using both procedures
  • What is breast reconstruction with prosthesis or heterologous?
    Breast reconstruction with prosthesis or heterologous is one of the most widely used and simplest reconstruction techniques. Your advantages: it does not leave more scars than that of the mastectomy since it is not necessary to obtain tissue from another part of the patient herself it is suitable for women of all ages.
  • What is the reconstruction like if a skin-sparing mastectomy has been performed?
    Skin-sparing mastectomy makes it possible to perform immediate reconstruction and to be able to give the breast volume in one stage, since most of the skin has been preserved and the prosthesis it will fill the mammary hollow and give it the lost volume. Currently we use definitive anatomical prostheses (the most frequent) or expander prostheses (mixed silicone and saline) and they are usually placed below the pectoralis major muscle to achieve better reconstructive results. To give the prosthesis greater stability and protect the skin, a biological mesh or absorbable tissue can be attached to the pectoral muscle. The prostheses or implants can be filled with silicone or saline and have different sizes, shapes and textures that adapt to the characteristics of each patient. Expander prostheses, although they have a similar shape to prostheses, are mixed, that is, they have a fixed silicone part and a refillable-expandable part of physiological saline through valves that are placed at a distance from the prosthesis. In immediate reconstruction, it has the advantage that the volume of the prosthesis can be adjusted to the situation in which the preserved skin is found, injecting more or less serum. It is a longer intervention than other types of mastectomy, in which there are usually no major complications. Within the reconstructive possibilities, it is the simplest technique, but it is not without difficulties.
  • What is the procedure like if you have had a simple or radical mastectomy?
    Due to the greater removal of skin, in order to place a prosthesis that replaces the breast volume, the skin must be stretched to create the necessary space. This "expansion" of the skin can be done in one or two stages. In two stages: it means that, in the first operation, a breast tissue expander is placed, which is filled in over the following weeks or months, dilating the skin to accommodate the final prosthesis or permanent in a second stage or operation. In one stage: A mixed expander prosthesis (discussed in the previous section) is placed, which serves as a tissue expander and as a long-term breast prosthesis. With this procedure, the patient only needs to undergo this reconstruction operation, as long as adequate skin dilation and volume are achieved. Breast reconstruction with prostheses as the years go by entails the progressive loss of the initial symmetry. In other words, over time it is normal to have to reintervene if you want to maintain symmetry.
  • How is the breast reconstruction with latissimus dorsi muscle graft (FAMC)?
    If you've had a skin-sparing mastectomy: With this type of mastectomy, the breast can be reconstructed exclusively with tissue obtained from the back. During this procedure, an island of skin and muscle from the back (m. latissimus dorsi) is removed and brought to the breast area where it is used to reconstruct it. To achieve a sufficient breast volume, the fat that exists around the muscle is collected. Logically, this type of autologous reconstruction is indicated in patients with breasts that are not too large and with a certain thickness of the fat pad on the back. Since the skin has been preserved, virtually the entire volume of tissue is used to fill the breast gap. In thin patients with medium-large breasts, this procedure could be performed using a complementary prosthesis (mixed technique). If you have had a simple or radical mastectomy: In these cases, the skin of the back is used to replace the skin removed during the mastectomy and the rest of the volume will be obtained with a breast prosthesis that will be covered with the dorsal muscle obtained in order to give your new breast a fuller appearance. It is a mixed technique with prosthesis and own tissue. Reconstruction with the latissimus dorsi myocutaneous graft is a more complex intervention and lasts longer, but except for the usual complications of surgery, it does not leave functional alterations in the arm or shoulder, but leaves a scar on the back that can be hidden by matching the bra line.
  • What is breast reconstruction with rectus abdominis myocutaneous graft (TRAM) like?
    It is based on the transfer of abdominal skin and fat, which is generally obtained below the navel, together with the rectus abdominis muscle and raised towards the area of the removed breast, providing a large amount of of tissue (muscle, skin and fat) for reconstruction. It is indicated in the reconstruction of a medium or large size breast and not having undergone certain surgical interventions in that area. It is a complex intervention that lasts longer, with the usual complications of surgery, and can leave abdominal sequelae such as hernias or weakness of the abdominal wall, sometimes requiring surgical intervention to correct them. The possibility of a subsequent pregnancy must be considered.
  • How is breast reconstruction with free TRAM graft or DIEP graft?
    They are variants of the last technique and are called free TRAM and DIEP. They consist of transferring the same skin and abdominal fat but with the advantage of not removing the abdominal muscle, joining the small arteries and veins of these tissues to those existing in the residual mammary bed using microsurgical techniques. In this way, the same advantages are obtained in terms of skin and fat volume and it does not have the disadvantages of weakening the abdominal wall. Surgeons with experience in vascular microsurgery are required and the duration of the intervention is approximately seven hours.

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