People who are diagnosed with breast cancer experience a completely new situation in life. This news changes your life dramatically and you have to make important decisions in a very short time.

Many discussions are concerning treatments which have to take place immediately for a possible healthy recovery.
After having come to terms with the illness the well-being of the patient depends on the physical reconstruction which is a very important psychological aspect for many women.

Breast reconstruction surgery after cancer (as well as a breast augmentation) is a voluntary operation, a decision you have thought about carefully. That is why it is useful and helpful for you to get thoroughly informed and to talk to people you trust during your decision-making process. The decision in favour or against the surgery though, is your personal decision which should be made solely by you !

You should not hesitate to ask about our experience in your initial discussion. You will get a complete consultation including clinical pictures of former patients. We recommend you write down all your open questions before your initial discussion with us.

A thorough pre-operative evaluation includes information about any allergies or chronic diseases, if anticoagulant medication is taken or if there is an increased tendency to form scars.

For cancer patients there is a wide selection of operating possibilities for the breast reconstruction. For you as a patient, it is important initially to decide carefully whether you wish a breast reconstruction and if yes, which method you would prefer. The priority of most women is consequently to put their whole energy into fighting the cancer and only consider a reconstruction when their mind is at rest.
In any case there is an adequate possibility to reconstruct your breast.

Breast-Conservation technique is the most frequently used method preferred by up to 70 to 80 % of patients. In this case the tumour is removed together with a sufficient radius of healthy tissue. By pushing the remaining tissue a new form can be achieved and the second breast reduced to fit. Radiation treatment is the usual procedure after removing the cancer.

Reconstruction with implants

Implant-based reconstruction is carried out following the complete removal of your breast and the tumour. This is often done in one operation, the tissue removed is straight away replaced by the implant. This technique is therefore called one-stage immediate breast implant reconstruction (IR).
An expander may be necessary before inserting the final implant. The expander is slowly filled with a saline solution to stretch the skin in order to make room for the implant. This occurs especially when a lot of time has passed between tumour removal e. g. after an Ablatio mammae and reconstruction and if not enough skin is present. In this case two operations are necessary. This method is called two-stage delayed breast implant (DR) reconstruction.

Reconstruction with your own tissue

In the case of Flap Reconstruction, body tissue from other parts of your body is shifted to the area around the breast. The most common methods are the TRAM Flap (Transversular rectus abdominus muscle Flap) and the Latissimus dorsi muscle Flap.

By the TRAM Flap method the new breast is formed from parts of the straight stomach muscles plus the skin and fat tissue of the lower tummy area.

In the case of the Latissimus dorsi muscle Flap the donor tissue is available on the back (Latissimus dorsi muscle). Unfortunately this method does not always provide enough volume and is therefore consequently used for small breasts or the Latissimus flap is rather used over an underlying implant to recruit the missing volume.

There are pedicled and free flap reconstructions.
In pedicled flaps, the fat and skin is moved from one place to another on the body by tunnelling it under the skin so that the blood to the tissues from the muscle does not need to be cut.
In free flap reconstruction, areas of fat, muscle and skin from one part of the body are moved to another. The blood supply is cut and then a new blood supply for the flap is created at the area of the breast.

Another technique which has been used more often lately is the DIEP-Flap (Deep-Inferior-Epigastric-Perforator-Flap). By this method skin and fat is taken from the lower abdomen. The blood supply is cut and then a new blood supply for the flap is created at the area of the breast. No abdomen muscle is taken.
The advantage of this technique for the patient is a breast reconstruction and a tummy tuck at the same time. After the surgery the lower abdomen area has to be compressed for about four to six weeks. A very good and lasting result is achieved by this method.

3. Types of implants

		Silicone - a natural decision Silicone implants of the new generation are determined to be absolutely safe and offer the most natural looking breasts. In our clinic we use only high quality gel-filled implants manufactured by leading producers according to EC standard.
round-shaped silicone implant	drop-shaped silicone implant

Previously applied hydro-gel implants are not used any more because there is no sufficient long-term data available to fully assess safety and a possible interaction between implant and filling. Soja bean filling in breast implants proved not to be stable and deteriorated after some time thus being suspected to cause cancer.

Silicone-filled implant is the most frequently used type of implant in breast enlargement as well as breast reconstruction surgery in Europe and in the USA. The cross-linked silicone implant keeps its anatomical shape because of the cross link inside the silicone gel and in case of deformation regains its initial shape due to a so-called “memory-function”.

Such implants do not leak, even if the outer shell is injured they remain firm. Implants are available with a smooth, textured or polyurethane-coated surface. A human organism is able to react to any foreign body by modifying the surface. The body's natural healing process creates a capsule around the breast implant, just as it would around any other foreign object. This might lead to a capsular contraction (capsular fibrosis) resulting in pain, hardening of the breast and deformation of the implant.

Contraction of connective tissue capsules is mainly influenced by the arrangement of its fibres. The more regularly they are arranged the greater the risk of a capsular fibrosis. To avoid formation of a capsule with regular woven fibres around the implant, the surface of the outer shell is modified thus disturbing the arrangement of the fibres so that they cannot be woven linearly around the implant. The result is minor or no contraction of the fibres.
Thus capsular fibrosis rates of 50% have been reduced to less than 3 %.

To avoid blood-clotting or serum fluid it is very important to add compression to the operated part. In implant-based reconstruction this is achieved through special compression bras. The pressure they provide prohibits the built-up of lymph and blood between implant and tissue. Otherwise this could lead to scarring, capsular fibrosis and bad healing.

In autologous tissue-based reconstruction compression achieves direct contact with the tissue thus accelerating the healing process. With this technique, too, the development of a haematoma or seroma may cause scarring. For this reason the drainage is left for some time after the operation in order to allow superfluous serum and blood to drain.
Patients with autologous tissue-based reconstruction are likely to suffer from restriction of movement for some time, their tissue may be taut and their skin on the donor flap site needs some time to stretch again. Recovery takes longer if autologous tissue has been used than if an implant has been used.

After the operation an appointment will be made to discuss all relevant themes, where you can ask any questions which have arisen.

What is silicone?
Silicone is used in various products in medicine like tubes, catheters, coatings of cannulation needles and pace makers, gloves and wound plasters. In surgery implants are used for body contouring.
Silicone Polymere was first developed and patented in1958.
The chemical terminology for silicone is polydimethylsiloxane. It is used in the production of silicone gel, silicone elastomer or silicone oil. In silicone compounds the bond between oxygen and silicon is the same as it is in stones and glass. Moreover methyl groups are attached to the silicon atoms. Except for pyrogenic silicic acid (amorpheous silica) which is a highly stabilising filling material there are no more additional components especially no softening agents. That means silicone is a stable, chemically exactly defined implant material.

How long does an implant last?
For a single implant we cannot answer this question because of the various reactions of an individual organism to a foreign object. We can only use the statistics of medical studies on this theme. This reliable data is derived from studies of implants which had to be extracted due to various reasons. It showed that the average expiry date was more than 10 years. The continuous improvement of modern implants enabled this durability to be extended. Especially young women should, however, be aware of the fact that a replacement of the implant may be necessary disregarding implant type or make. We recommend a medical check-up every six months to one year.

Implant pass and documentary
After the operation you get an implant pass which you should carry at all times, so that type and size of your implant are readily accessible. For your own safety please inform your GP about your implant.

Are safety tests presently being conducted?
Yes. For many years reliability and health risks of implants have been constantly checked. The safety profile is based on experience of over 35 years. All over Europe there are certain specifications concerning norm and standard of medical products which also apply to these implants. Strict rules concerning material, product development, production sterilisation and packing have been laid down as well.

Is there a higher risk of breast cancer due to breast implants?
It was proved in a wide study that women with implants were not more susceptible to breast cancer than women without an implant.
Neither in animals nor in people were cancer-cells observed due to smooth, textured or polyurethane-coated implants. Scientists are constantly discussing theoretical reasons though.

Is there a bigger risk for Autoimmune diseases?
No! Up til now no connection has been found between silicone-filled implants and Autoimmune disease.

Can silicone gel seep through the implant?
In comparison to earlier implants there is a constant gel consistency because of the improved outer layer and only a small percentage of gel in the connective tissue capsule around the implant has been found.

Your clinic mednord doctor will decide how often a check-up is necessary.

We suggest postoperative check-ups after one month, three months, six months ending with a regular check-up every half year or full year depending on the situation.

It is possible to have a mammography with implants, with the help of the so-called “Eklund technique”. In the case of a tumour modern screening methods like Sonography, Magnetic resonance imaging (MRI) or computerised tomography help to detect the tumour in the early stages.