BREAST PROSTHESIS RECONSTRUCTION IN PARIS
Breast reconstruction by prosthesis after cancer consists of a breast augmentation in Paris.
Most breast implants are made of silicone.
- The breast prosthesis reconstruction restaure le sein après une mastectomie, sans recours à un lambeau.
- Elle est indiquée pour les patientes non irradiées, with a peau souple and a volume mammaire modéré.
- The procedure is performed under general anesthesia, en reconstruction immédiate ou différée, selon le traitement du cancer.
- Theimplant en silicone est souvent placé behind the muscle, parfois associé à une matrice dermique.
- L’hospitalisation dure quelques jours, le temps de retirer les drains.
- C’est une solution rapide et fiable, adaptée aux reconstructions bilatérales or prophylactiques (gènes BRCA).
POUR QUI EST RECOMMANDÉE LA RECONSTRUCTION PAR IMPLANT MAMMAIRE ?
There are two types of breast reconstruction. The flap reconstructionwith the patient's tissuesand reconstruction by prosthesis.
Implant reconstruction is the technique of choice:
- Après mastectomie (ablation totale du sein)
- pas de traitement par radiothérapie ;
- petit sein à reconstruire ;
- bonne qualité des tissus, élasticité de la peau.
- En reconstruction immédiate
- reconstruction bilatérale ;
- small breasts.
SURGICAL TECHNIQUE
The reconstruction mammaire par prothèse est pratiquée sous anesthésie générale.
A distinction must be made between reconstruction différée ou secondaire (à distance de la mastectomie) de la reconstruction immédiate (ablation et reconstruction dans le même temps). Dans les deux cas, l’objectif est d’augmenter le volume des seins pour redonner à ces derniers leur forme d’avant le cancer.
- Secondaire – plusieurs semaines après la fin du traitement du cancer :
- 1H30 de chirurgie à 2H30 pour les deux seins.
- L’implant est le plus souvent mis derrière le muscle.
- Immédiate :
- Combines mastectomy and reconstruction;
- Peut être réalisée par le plastic surgeon exclusivement. Un chirurgien gynécologue peut pratiquer la mastectomie ;
- Approximately 2 hours of surgery for a single breast and approximately 3 hours 30 minutes for both breasts;
- Une matrice dermique est le plus souvent mise en place (couverture supplémentaire de l’implant).
Whatever the type of surgery plastique reconstructrice et esthétique sélectionné, des drains (redons) sont mis en place pour éviter la formation d’un hématome.
La patiente est hospitalisée jusqu’à ablation des redons. Des soins quotidiens des cicatrices sont réalisés par une infirmière.
IN PRACTICE
La première consultation avec le chirurgien permet de faire le point avec la patiente sur son dossier médical et son cancer.
Plusieurs éléments sont déterminants pour choisir la breast reconstruction technique, notamment les traitements antérieurs comme la radiothérapie ou la chimiothérapie.
L’histoire chirurgicale récente est également importante : nombre de chirurgies mammaires, cicatrisation facile ou retard de cicatrisation…
Le chirurgien examine la patiente et expose les différentes possibilités de reconstruction, leurs avantages et inconvénients.
La patiente choisit avec le chirurgien sa solution de reconstruction.
Your Questions
Frequently Asked Questions in Consultation
WHAT IS A MASTECTOMY?
Mastectomy is a non-conservative breast surgery.
This surgical operation corresponds to the removal of the gland breastof the areola and nipple, associated with a variable amount of skin.
WHAT ARE THE CONTRAINDICATIONS TO IMPLANT RECONSTRUCTION?
Il n’existe pas de contre-indication « absolue ».
On the other hand, it is not advisable to undergo cosmetic reconstruction surgery with internal prosthesis if you have :
- A history of radiotherapy;
- Poor skin quality;
- Failed implant reconstruction.
In such cases, a autologous reconstruction using a DIEP flap, for example.
WHAT ARE THE EARLY COMPLICATIONS OF IMPLANTS?
Complications related to reconstruction can be :
- Mastectomy skin suffering;
- Suffering or even necrosis of the areola/nipple in the case of immediate breast reconstruction;
- The formation of a hematoma, which requires a second operation in the operating room;
- Healing problems in the first month after surgery. Nursing care may suffice, but if the prosthesis is discovered, implant removal should be discussed.
WHAT ARE THE LATE COMPLICATIONS OF IMPLANTS?
La complication à long terme la plus fréquente de la reconstruction par breast implant is the formation of a periprosthetic shell.
A membrane forms around the implant, which may harden. The aesthetic appearance of the breast changes. Sometimes the shell can cause pain.
En fonction du stade (degré) de cette coque, il faudra discuter le changement, ou l’ablation de l’implant.
WHAT PRECAUTIONS SHOULD BE TAKEN FOLLOWING BREAST RECONSTRUCTION?
Several precautions can be taken to ensure that aesthetic results and your health.
- When you leave the hospital and for the next 48 hours, get help;
- Wear a bra without hoops with staples attaching at the front. If you have undergone DIEP or free TRAM breast reconstruction, wear a girdle for the breast. abdominal wall. You must wear this underwear 24 hours a day for 3 weeks, then daytime only for the following 3 weeks;
- Do not take nicotine (cigarettes, electronic cigarettes, patches, gum) for 6 weeks;
- Do not drink coffee, tea, herbal tea, Coca-Cola, Pepsi, energy drinks or chocolate for 2 weeks after the operation.
IS FAT GRAFTING (LIPOFFILING) ENOUGH?
The lipofilling is a technique that involves liposuction (fat removal) and reinjection of this fat into the breast.
This technique can only be used to reconstruct small breasts.
In general, several sessions (>5) are needed to achieve sufficient volume. You also need good fat reserves to achieve this.
WHAT TYPE OF IMPLANT IS USED?
Silicone gel implants are the most widely used to reproduce the natural consistency of the breast.
Anatomical "macro-textured" implants have been withdrawn from the market since 2019. It was found that they were more often associated with anaplastic large-cell lymphoma. This means that this technique increases the cancer risk.
Since then, reconstruction using micro- or nano-textured round implants has been the best solution for implant-based reconstruction.
HOW WILL THE SCAR LOOK?
A distinction must also be made between secondary and immediate reconstruction.
In the case of secondary reconstruction, the surgeon tries to use the same scar as the one used to remove the breast.
In case of immediate reconstructionthere are several possible solutions:
- Submammary scar (in the submammary fold) ;
- External hemi-radial scar at areola level.
IS BREAST RECONSTRUCTION COVERED?
Yes,
After all, breast reconstruction after cancer is a very important cancer surgery. It is therefore 100 % reimbursed by the French health insurance system.
Dr. Jérémy Djian is a plastic surgeon based at 5 Square Thiers, near the Victor Hugo roundabout in Paris's 16th arrondissement.
He trained in Paris and remains affiliated with the hospital in the prestigious department headed by Prof. Laurent Lantieri.
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