Delayed breast reconstruction with expander-implant and autologous dermal matrix. An alternative applicable therapeutic in non irradiated tissues.

Abstract

Introduction and Objective.

Delayed breast reconstruction or post mastectomy has a transcendental importance in women´s life as well as part of the comprehensive and multidisciplinary treatment of breast cancer. Such aggression impacts on self-esteem and social functionality in women who for some reason were not undergoing immediate reconstruction. The objective is to describe the results achieved in mastectomized patients, through the expander-implant technique, autologous dermal matrix, fat graft and reconstruction of the nipple areola complex ( NAC) with autologous tissues.

Material and method.

It is a retrospective, longitudinal, observational and descriptive study of a small group of 5 non-irradiated mastectomized private patients who were not subjected to an immediate reconstruction at other medical centers. They came to the private practice referred by other mastologists-oncologists medical surgeons to be submitted to a delayed breast reconstruction with expander prosthesis in a 3 surgical times technique between April 2015 and October 2018.

Results.

The delayed breast reconstruction is usually performed with expander prosthesis and for those injured breasts that had been irradiated, we use autologous flaps. In 4 out of  5 patients we performed the reconstruction of the NAC, 3 were submitted to unilateral reconstruction and 2 were bilateral, 2 women had anatomical double lumen prosthesis, 3 had expander implant with remote port at which 2 were round and one anatomical. We presented only one case of deflation 3 years later after reconstruction. We didn´t report cases of fat necrosis nor infectious symptoms. We didn´t have any case of capsular contracture but only a single case of late seroma after 7 months’ post implant in a patient with unilateral reconstruction due to a traumatic incident.

Conclusion.

The delayed breast reconstructive technique with expander-implant, uses of autologous dermal matrix or own tissues for reconstructing the NAC, represents a good therapeutic option of low morbidity to patients who have not undergone post-mastectomy irradiation. We briefly believe that at a  National level there is  a lack of health policies and therapeutic behaviors that  could benefit women with breast cancer on this long path from a complete treatment of this disease to breast reconstruction and its social, labor and emotional reintegration, to unify criteria and protocols between public services, private services,  ministry of health, regional secretaries of  health and scientific societies such as Mastology and Plastic Surgery to support the few teams in breast reconstruction and optimize medical protocols to benefits the sick patient.