Prof. Fabio Santanelli di Pompeo

Contra-lateral Breast

Breast Reconstruction

About Contra-lateral Breast Adjustment

Sometimes, to achieve symmetry of volume and position of the breasts, a contralateral breast adjustment is necessary. However, in breast reconstruction with autologous tissues (DIEP) this is a minor issue if compared to reconstruction with expander and prosthesis.

Prof. Santanelli di Pompeo is undoubtedly the first surgeon to achieve contralateral breast adjustment immediately along with breast reconstruction, obtaining satisfactory results. This is possible whenever the diseased breast is reconstructed with autologous tissues. Such approach allows sometimes to reduce all surgical steps into a single procedure consisting in the mastectomy, breast reconstruction, nipple reconstruction, and contralateral breast adjustment.

Sometimes this is also possible when mixed techniques, as Latissimus Dorsi flap with prosthesis, are performed, especially if there is a remarkable residual asymmetry.

This approach is less feasible in cases of breast reconstruction with expander and prosthesis.

Reduction Mammaplasty

It is performed whenever the reconstruction does not allow to achieve volume symmetry between the breasts.

The procedure produces a reduction of breast volume along with the lift of the gland and an increase in consistency; this is obtained through a reduction of the gland and of the exceeding skin. There are different degrees of “Breast hypertrophy” that can be corrected with different “Reduction mammaplasty” techniques, with a different extensive scarring results, depending on the amount of tissue to be removed. The ideal technique is discussed and selected during the preliminary visit with the surgeon, also depending on the procedure chosen for reconstruction of the diseased breast.

Drains are usually not necessary, however, in case of abundant bleeding, the surgeon may decide to place a suction drain. Scars resulting from the procedure are a circular shaped scar around the areola, a horizontal scar in the inframammary fold, and a vertical one from the bottom of the areola to the crease. Although all permanent, they tend to become less perceptible over time. Usually the periareolar scar is blurred by the areolar skin, the vertical scar heals well becoming less visible, while the horizontal one, located in the inframammary crease, will be completely hidden underneath the lower breast pole.

Augmentation Mammaplasty

Is performed not only when breast reconstruction does not allow to achieve volume symmetry, but mainly to grant a similar future behavior of the breasts. This is usually true for unilateral breast reconstruction with expander and prosthesis in a small sized breast. Indeed, to avoid that the reconstructed breast, essentially constituted by silicone, would behave differently over time (ptosis, weight variations) from the unoperated one, it is preferred to insert a prosthesis also in the healthy breast.

Thus, the procedure produces an increase in volume and consistency of the contralateral breast through the insertion of a silicone implant. There is a wide variety of prosthesis. Traditional round breast implants or “anatomical” teardrop shaped ones can be used depending on the defect to be corrected. The ideal size is discussed and chosen together with the surgeon during the preliminary visit, taking into consideration several constraining factors: volume and size of glandular/adipose tissue covering the implant, skin elasticity, chest shape.

Depending on the volume and the shape of the chosen prosthesis, and on the needs and individual features of the patient, the implant will be inserted through an incision (around 5 cm) in the inframammary crease or along the inferior border of the areola (round or anatomical implants), or through a trans-axillary incision (round implants). Through the incision the surgeon will place the prosthesis in a pocket developed underneath the mammary gland if glandular/adipose volume is sufficient to cover the implant, or deeply underneath the Pectoralis Major muscle in thin patients with insufficient glandular tissue. Finally, deeper tissues and the skin are sutured, usually is not necessary to position a drain.

Mastopexy

Mastopexy is the procedure aimed at elevating the contralateral breast through a reduction of breast skin, providing also an increase in consistency. Suitable for this correction are breasts that have assumed a lower position on the chest, compared to the original breasts position, due to pregnancy or breast-feeding. There are different degrees of breast ptosis, from 1 to 4, that may be corrected with different techniques, and that may leave variable extensive scarring results due to the degree of the defect to be corrected. The most appropriate procedure is chosen taking into consideration several factors as: extension of the excess skin to be removed, elasticity of the residual skin, and amount of elevation required to achieve breast symmetry.

If not performed contemporaneously to the breast reconstruction, the mastopexy usually lasts 45 minutes, is performed under general anesthesia, and does not require the insertion of suction drains, except when there is abundant bleeding.

About Contra-lateral Breast Adjustment

Sometimes, to achieve symmetry of volume and position of the breasts, a contralateral breast adjustment is necessary. However, in breast reconstruction with autologous tissues (DIEP) this is a minor issue if compared to reconstruction with expander and prosthesis.

Prof. Santanelli di Pompeo is undoubtedly the first surgeon to achieve contralateral breast adjustment immediately along with breast reconstruction, obtaining satisfactory results. This is possible whenever the diseased breast is reconstructed with autologous tissues. Such approach allows sometimes to reduce all surgical steps into a single procedure consisting in the mastectomy, breast reconstruction, nipple reconstruction, and contralateral breast adjustment.

Sometimes this is also possible when mixed techniques, as Latissimus Dorsi flap with prosthesis, are performed, especially if there is a remarkable residual asymmetry.

This approach is less feasible in cases of breast reconstruction with expander and prosthesis.

Reduction Mammaplasty

It is performed whenever the reconstruction does not allow to achieve volume symmetry between the breasts.

The procedure produces a reduction of breast volume along with the lift of the gland and an increase in consistency; this is obtained through a reduction of the gland and of the exceeding skin. There are different degrees of “Breast hypertrophy” that can be corrected with different “Reduction mammaplasty” techniques, with a different extensive scarring results, depending on the amount of tissue to be removed. The ideal technique is discussed and selected during the preliminary visit with the surgeon, also depending on the procedure chosen for reconstruction of the diseased breast.

Drains are usually not necessary, however, in case of abundant bleeding, the surgeon may decide to place a suction drain. Scars resulting from the procedure are a circular shaped scar around the areola, a horizontal scar in the inframammary fold, and a vertical one from the bottom of the areola to the crease. Although all permanent, they tend to become less perceptible over time. Usually the periareolar scar is blurred by the areolar skin, the vertical scar heals well becoming less visible, while the horizontal one, located in the inframammary crease, will be completely hidden underneath the lower breast pole.

Augmentation Mammaplasty

Is performed not only when breast reconstruction does not allow to achieve volume symmetry, but mainly to grant a similar future behavior of the breasts. This is usually true for unilateral breast reconstruction with expander and prosthesis in a small sized breast. Indeed, to avoid that the reconstructed breast, essentially constituted by silicone, would behave differently over time (ptosis, weight variations) from the unoperated one, it is preferred to insert a prosthesis also in the healthy breast.

Thus, the procedure produces an increase in volume and consistency of the contralateral breast through the insertion of a silicone implant. There is a wide variety of prosthesis. Traditional round breast implants or “anatomical” teardrop shaped ones can be used depending on the defect to be corrected. The ideal size is discussed and chosen together with the surgeon during the preliminary visit, taking into consideration several constraining factors: volume and size of glandular/adipose tissue covering the implant, skin elasticity, chest shape.

Depending on the volume and the shape of the chosen prosthesis, and on the needs and individual features of the patient, the implant will be inserted through an incision (around 5 cm) in the inframammary crease or along the inferior border of the areola (round or anatomical implants), or through a trans-axillary incision (round implants). Through the incision the surgeon will place the prosthesis in a pocket developed underneath the mammary gland if glandular/adipose volume is sufficient to cover the implant, or deeply underneath the Pectoralis Major muscle in thin patients with insufficient glandular tissue. Finally, deeper tissues and the skin are sutured, usually is not necessary to position a drain.

Mastopexy

Mastopexy is the procedure aimed at elevating the contralateral breast through a reduction of breast skin, providing also an increase in consistency. Suitable for this correction are breasts that have assumed a lower position on the chest, compared to the original breasts position, due to pregnancy or breast-feeding. There are different degrees of breast ptosis, from 1 to 4, that may be corrected with different techniques, and that may leave variable extensive scarring results due to the degree of the defect to be corrected. The most appropriate procedure is chosen taking into consideration several factors as: extension of the excess skin to be removed, elasticity of the residual skin, and amount of elevation required to achieve breast symmetry.

If not performed contemporaneously to the breast reconstruction, the mastopexy usually lasts 45 minutes, is performed under general anesthesia, and does not require the insertion of suction drains, except when there is abundant bleeding.

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Healing is a process that can be considered complete when, finally, you might recognize yourself into your own body, despite unavoidable changes...

In the last decades Plastic Surgery, has become part of the oncologic treatment protocol, as the importance of the reconstructive stage following resection of a diseased body part has been universally recognized. Concerning breast tumor, most advanced hospitals set up a “Breast Unit”, multidisciplinary functional unit composed by different specialists who cooperate to offer to the patient the best opportunity available from medical science, to contrast tumor disease and return to normal life.

There are several breast reconstructive procedures, even though expander and prosthesis is the most known. This web-site is dedicated to women undergoing mastectomy and willing to know all reconstructive opportunities. Main goal is to present “autologous” procedures using live tissues from the patient itself as a sort of “auto-transplant”. Advances in vascular microsurgery and in peri-operative patient care have allowed for outstanding steps forward to restore the female body image.

Once all aspects have been taken into proper consideration, a woman should be assisted during choice with broad information, evaluating pro and cons among any surgical procedure, so she can decide what is best for her.