Breast Reconstruction after Breast Cancer Breast Reconstruction following Mastectomy
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The female breast is the central symbol of femininity, sexuality, and motherhood. The loss of a breast – for example as a result of breast cancer – causes physical and emotional distress and greatly affects the self-confidence of those affected. After enduring a long battle with breast cancer, breast reconstruction is the heartfelt wish of many women.
Breast cancer now affects one in ten women. In many cases, breast-conserving therapy is possible. In principle, there are two different approaches to breast reconstruction following mastectomy – reconstruction with an implant or reconstruction using autologous tissue. In some cases, both techniques must be combined in order to achieve a beautiful and optimal surgical result.
Depending on the outcome of the reconstruction on the affected side, symmetry-correcting procedures may sometimes be necessary, such as a breast reduction, a breast lift, or a breast augmentation with implant. Following breast reconstruction, nipple reconstruction can be performed to make the result even more natural in appearance. The aim of breast reconstruction after cancer is to restore the self-esteem of those affected and to re-establish a full sense of femininity.
Dr. Karl Schuhmann is an expert in breast surgery and breast procedures. As a plastic surgeon, Dr. Schuhmann brings many years of professional and surgical experience to performing breast reconstruction in Düsseldorf and Bochum to the highest standard.
At a glance
- Duration of surgery: 2–4 hours
- Anaesthesia: General anaesthesia
- Hospital stay: 1–3 days
- Aftercare: 6 weeks of physical rest
- Costs: Covered by health insurance
Overview of breast reconstruction methods
Breast reconstruction with implant
Breast reconstruction with autologous tissue
Breast reconstruction with autologous fat
Breast reconstruction with Latissimus Dorsi flap
Breast reconstruction with TRAM flap
Breast reconstruction with DIEP flap
Breast reconstruction with SGAP flap / TMG flap
What can I achieve with breast reconstruction in Düsseldorf?
In a detailed personal consultation we discuss with the patient which breast reconstruction technique is the most appropriate and suitable for her. The right choice of breast reconstruction following mastectomy depends on many factors. A key role in the choice of technique is played by the condition of the tissue remaining in the breast after tumour removal or mastectomy.
The following factors have a particular influence on the choice of technique for breast reconstruction:
The amount and quality of the remaining skin and soft tissue of the breast
the size of the healthy breast on the opposite side
the patient's body shape and weight
the current stage of oncological treatment.
All breast reconstruction methods have their advantages and disadvantages, which must be explained and clarified in detail during the consultation. Complications are rare, but as with any surgical procedure they cannot be entirely excluded. After the consultation, you will know exactly what you can achieve with breast reconstruction using an implant, autologous tissue, or autologous fat and what to expect on the path to your desired breast surgery result.
What are the costs of breast reconstruction?
The costs of breast reconstruction are covered in full by both statutory and private health insurers. The price of breast reconstruction depends on which surgical technique is planned and how many operations are required to achieve a beautiful and satisfying result for the patient.
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Breast Reconstruction – Plastic Surgery Dr. Karl Schuhmann
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Breast Reconstruction with Implant or Autologous Tissue
What options are available for breast reconstruction after breast cancer and mastectomy?
Breast Reconstruction | Breast Reconstruction with Implant
Breast reconstruction with an implant is generally carried out in several stages. After complete removal of the breast, the breast envelope is absent and must first be reconstructed. Using a tissue expander placed beneath the remaining breast skin, the tissue is gradually stretched and shaped into a breast pocket. In the second stage, the expander is exchanged for a modern silicone breast implant. The size of the implant is determined, among other things, by the volume of the healthy breast on the opposite side and the patient's physique. The advantage of this breast surgery technique following mastectomy is the short operating time and straightforward execution without additional scarring.
Breast Reconstruction | Breast Reconstruction with Autologous Tissue
In breast reconstruction using autologous tissue, skin and fatty tissue – possibly together with muscle – are harvested from other areas of the body. Preferred donor sites are the back, abdomen, thigh, or buttocks. For the harvested tissue to survive, it must remain connected to its blood supply. There are two approaches to breast reconstruction here: "pedicled" and "free" tissue flaps, also referred to as "flaps" or "flap plasties". In pedicled flaps, the supplying blood vessels remain attached to the tissue and are transposed together with it.
In free flaps, by contrast, the vessels are first divided at the donor site and then reconnected microsurgically to the vessels of the breast or in the axilla. These approaches require multiple procedures and result in additional scarring at the donor sites. A high level of experience and strong microsurgical skills are essential. For this reason, breast reconstruction using autologous tissue is offered by only a very small number of plastic surgeons in Germany.
Breast Reconstruction with Latissimus Dorsi Flap
Breast reconstruction using a pedicled latissimus dorsi flap (back muscle). This technique is particularly suitable for women who are significantly overweight, in cases where other methods may not be an option.
In this standard breast reconstruction technique, the back muscle is transposed anteriorly into the breast region. During transposition, the muscle's blood supply is preserved, so microsurgical connection of the vessels to the chest wall is not required. With this method, however, the tissue flap alone is often insufficient to reconstruct a breast of adequate size. An implant frequently needs to be inserted in addition.
Breast Reconstruction with TRAM Flap
A prerequisite for the TRAM flap technique (Transverse Rectus Abdominis Myocutaneous flap) is the presence of sufficient tissue in the lower abdomen. For the reconstruction, a tissue block consisting of the rectus abdominis muscle, fatty tissue, and skin is harvested from the lower abdomen. This method can achieve very good cosmetic results. However, the tissue block with its supplying blood vessels must be completely detached and then reconnected to the blood vessels of the breast.
The TRAM flap also offers, among the breast reconstruction options, the possibility of reconstructing large, full breasts with a natural breast shape.
Breast Reconstruction with DIEP Flap
The DIEP flap (Deep Inferior Epigastric Perforator flap) currently represents the gold standard among breast reconstruction techniques. It is a further development of the TRAM flap. Unlike the TRAM flap, the abdominal muscle is not included, thereby avoiding weakening of the abdominal wall. In this technique, a new breast is shaped from the skin and fatty tissue of the lower abdomen. As this is a free flap, the vessels must be connected microsurgically to the chest wall vessels. In summary, the DIEP flap offers the above-mentioned advantages of the TRAM flap without its disadvantages.
Breast Reconstruction with SGAP Flap / TMG Flap
When abdominal tissue is insufficient for breast reconstruction after cancer, alternatives such as the free SGAP flap (superior gluteal artery perforator flap) may be considered. In this approach to breast reconstruction following mastectomy, a tissue block from the gluteal region is used for breast reconstruction.
A further option for breast reconstruction after breast cancer is the free TMG flap (transverse myocutaneous gracilis flap). In this breast surgery technique, a tissue block is harvested from the thigh to carry out the breast reconstruction.
Nipple Reconstruction
Following breast reconstruction, nipple reconstruction is often the final step in completing the overall result. For many women, this last step after breast cancer is very important in order to feel like themselves again. Various techniques are available, such as local skin rearrangement to form a nipple or skin grafting to reconstruct the areola.
Which type of nipple reconstruction is right for you should be discussed and clarified with Dr. Schuhmann during the course of your breast surgery treatment.
Facts about breast reconstruction after breast cancer
Duration of surgery: approx. 2–4 hours
Anaesthesia: General anaesthesia
Hospital stay: 1–3 days
Aftercare:
physical exertion (sport, physically demanding activities at home and at work) must be avoided entirely for 6 weeks
No sun exposure to the scars for 6 months
Regular follow-up appointments after 4 weeks
after 6 months
one year after surgery
thereafter at annual intervals
Breast Reconstruction in Düsseldorf – How to find us
Private Practice for Plastic / Aesthetic Surgery & Hand Surgery
Dr. med. Karl Schuhmann
Haroldstr. 34
40213 Düsseldorf
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Would you like to find out more about the options for breast reconstruction after mastectomy?
Breast reconstruction is a very sensitive and personal matter. I would therefore very much like to provide you with comprehensive, fully individualised advice on which type of breast reconstruction is personally the best option for you. Book a personal consultation with me. I would be delighted to welcome you to my private practice in Düsseldorf or my clinic in Hattingen and to support you as you recover.
Your expert in breast reconstruction –
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Dr. Schuhmann's BEAUTY FAQs on YouTube – Breast Reconstruction: https://youtu.be/HsZgBq2a0qQ
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Contact Düsseldorf
Private Practice for Plastic / Aesthetic Surgery & Hand Surgery – Cosmetic Surgery
Dr. med. Karl Schuhmann
Grabenstr. 17
40213 Düsseldorf
T +49 (0) 211 875 98 360
F +49 (0) 211 875 98 361
E kontakt@dr-schuhmann.de
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Düsseldorf
Frequently asked questions
When can breast reconstruction be carried out?
Breast reconstruction can be performed either immediately following mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). The optimal timing depends on various factors, including the oncological treatment plan, any necessary radiotherapy, and the patient's personal wishes.
What breast reconstruction methods are available?
There are two main methods: reconstruction with implants (silicone) and reconstruction using the patient's own tissue (autologous tissue reconstruction). Autologous reconstruction most commonly uses the DIEP flap (tissue from the lower abdomen). In some cases, both methods are combined to achieve the best possible result.
What is the DIEP flap?
The DIEP flap (Deep Inferior Epigastric Perforator) is currently the gold standard for autologous tissue breast reconstruction. Skin and fatty tissue are harvested from the lower abdomen and used microsurgically to shape a new breast. The key advantage is that the abdominal wall musculature is preserved, and the result looks and feels very natural.
Are the costs of breast reconstruction covered by health insurance?
Yes, the costs of breast reconstruction following breast cancer or mastectomy are generally covered in full by both statutory and private health insurers. This also applies to any subsequent procedures required to achieve symmetry with the healthy breast.
How long is the recovery period after breast reconstruction?
Recovery time varies depending on the technique. Following implant reconstruction, the recovery period is approximately 2–4 weeks. After autologous tissue reconstruction (e.g. DIEP flap), you should expect a longer recovery of 4–6 weeks. Physical exertion should be avoided for 6 weeks.
Can the nipple also be reconstructed?
Yes, nipple reconstruction is often the final step in completing breast reconstruction. Various techniques are available, such as local skin rearrangement to form a nipple or skin grafting to reconstruct the areola. Alternatively, tattooing can be used to achieve a natural-looking result.
Dr. Schuhmann's BEAUTY FAQs – Breast Reconstruction
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"It is a personal priority for me to enhance your natural beauty with autologous fat breast surgery. Aesthetic results and your complete satisfaction are close to my heart. With over 25 years of experience in aesthetic plastic surgery and as a former chief surgeon, I understand the concerns and worries of my patients. For this reason, I take ample time during a consultation to discuss your goals and simulate the results. This gives you a deep insight into my work and precision – for your perfect outcome.