DÉFINITION
La mastectomie correspond à l’ablation de la glande mammaire, d’un fuseau de peau et de l’aréole. Elle reste malheureusement nécessaire dans certaines formes de cancer du sein. Une demande de reconstruction mammaire est tout à fait légitime après mastectomie.
Dans les cas où la qualité de la peau et du muscle pectoral sous-jacent le permet, le mode de reconstruction le plus simple reste la reconstruction mammaire par prothèse.
OBJECTIFS
L’intervention chirurgicale a pour but de reconstituer le volume et les contours du sein par la mise en place d’une prothèse interne au dessous du muscle pectoral. Elle ne constitue que l’un des temps de la reconstruction mammaire complète qui comporte en outre selon les désirs de la patiente, une reconstruction de l’aréole et du mamelon et éventuellement une intervention sur le sein controlatéral pour améliorer la symétrie.
PRINCIPES
L’opération peut être réalisée en même temps que la mastectomie, on parle alors de reconstruction immédiate, ou à distance des traitements complémentaires qui ont été nécessaires, on parle alors de reconstruction secondaire. L’intervention consiste à mettre en place, le plus souvent sous la peau et le muscle pectoral, une prothèse permanente.
Dans certains cas une prothèse temporaire d’expansion tissulaire destinée à accroître la quantité des tissus de couverture (peau, muscle) de la prothèse permanente ce qui peut donner un aspect plus naturel au sein reconstruit.
DEFINITION
Mastectomy or mammectomy (the terms are synonymous) corresponds to the removal of the mammary gland, a zone of skin and areola.
It is unfortunately necessary in some forms of breast cancer.
A demand for breast reconstruction after mastectomy is legitimate.
In the cases where the quality of the skin and underlying pectoral muscle allows it, the easiest mode of breast reconstruction is the breast reconstruction by prosthesis.
AIMS :
The surgery aims to restore the volume and contour of the breast by the placement of an internal prosthesis below the pectoral muscle.
It is just a time of the complete breast reconstruction, which according to the wishes of the patient also comprises a reconstruction of the nipple and areola and possibly an intervention on the opposite breast to improve symmetry.
PRINCIPLES :
The operation can be realized at the same time as the mastectomy, it is called immediate reconstruction, or remotely after complementary treatments that have been necessary have been done, then is called secondary or delayed reconstruction. The intervention consists of the placement, usually under the skin and pectoral muscle, of a permanent prosthesis
This can be in some cases a temporary prosthesis for tissue expansion to increase the amount of covering tissue (skin, muscle) of the permanent prosthesis, which may give a more natural appearance to the reconstructed breast.
Tissue expansion has the disadvantage of requiring two surgical times..
The nipple-areola complex (areola + nipple) will be rebuilt more often in a second time, when the volume of the breast is stabilized.
Breast reconstruction does not affect the oncologic surveillance.
BEFORE THE OPERATION
A pre-operative assessment is performed in accordance with the usual requirements.
The anaesthetist will be seen for consultation before surgery.
In all cases, the surgeon should check the breast imaging (mammography, ultrasound) of the other breast.
No medication containing aspirin should be taken within 10 days preceding the intervention.
Stop smoking is essential.
TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia
This is a classic general anaesthesia during which you sleep completely.
Hospital stay
Hospitalization for several days is usually required.
THE PROCEDURE
The intervention may take one to two hours. A modelling bandage with elastic bands shaped like a bra is made up in at the end of surgery.
AFTER THE OPERATION : FOLLOW UP
The immediate postoperative period is generally quite painful for a few days, may require strong painkillers.
Swelling (edema), ecchymosis (bruising) of the reconstructed breast is possible in the postoperative period.
Wearing a bra (night and day) is necessary for several weeks.
Consideration should be given to a recovery time of two to three weeks. It is advisable to wait one to two months to resume sporting activity.
THE RESULT :
AFTER IMPLANTATION OF A PERMANENT PROSTHESIS :
The reconstruction by prosthesis immediately restores volume and shape permitting the patient to dress normally with a low cut.
Patients will wait for two to three months to appreciate the result of the reconstruction and the eventual symmetrisation.
AFTER IMPLANTATION OF A EXPANSION PROSTHESIS :
The inflation of the prosthesis is made usually once a week with saline (salt water).
In 4 to 8 weeks, a large volume is achieved, up to exceed the volume of the other breast.
At the end of inflation, it will be necessary to wait at least another three months to avoid a secondary retraction of the skin.
The second operation occurs between 4 and 6 months after the first. It allows the replacement of the temporary expander prosthesis that gives a tense look for the permanent prosthesis.
