Because breasts are a fundamental part of the female body, the aim of reconstruction surgery is to maintain or reconstruct the breast after a tumour removal.
Dr. Alexander T. Hamers is Head of the Reconstructive Division within the QuirónSalud Breast Center. Together with his renowned colleagues, he provides the best possible care in oncologic breast surgery and reconstruction, together with the best possible aesthetic outcome.
Whether reconstruction is performed simultaneously with excision of the tumour, or deferred, after necessary radio- and/or chemotherapy depends on the individual situation of each patient and will be discussed in the personal consultation.
The most common option for autologous breast reconstruction is tissue transfer from the belly, thigh or back. A DIEP flap is preferred, using skin and subcutaneous tissue from the belly. This provides a tummy tuck as donor side and transfers this tissue to the breast by a microsurgical connection of small arteries and veins to those corresponding in the breast. Other options are skin, subcutaneous tissue and the latissimus dorsi muscle in the back, to reconstruct the breast form, in most cases in combination with a small silicone gel implant.
In cases where is no need for chemotherapy the breast can be reconstructed with silicone gel implants in combination (or not) with an ADM (acellular dermal matrix). ADM is a special acellular tissue to strengthen the body’s own skin and subcutaneous tissue. The surgery is comparable to a normal breast augmentation with silicone gel implants.
In some cases, the skin needs to be prepared and expanded to restore its old volume. The surgeon then implants a tissue expander at the time of surgery to excise the tumour. This expander is filled step by step in the follow-up visits with normal saline to the required volume.
In a second step and after few months Dr. Hamers removes the expander, exchanging it for a permanent implant. The secondary surgery can be combined with fat grafting. This means that a patient’s own fat cells from other areas of the body are transferred to the breast. The added fat grafting helps to smooth the implant borders, enhance the cleavage area and fill the gap between the breasts.
To harvest the fat Dr. Hamers uses a gentle water-jet assisted liposuction, and transplants the fat cells to the breast with EVL expansion – vibration – lipofilling. EVL is an innovative technique to expand the recipient tissue with vibration during the fat transfer procedure. Compared with traditional lipofilling techniques the result is both a higher transplant volume and a higher fat take rate. After reconstruction of the breast shape and volume, the nipple and areola are also reconstructed using minimal surgery. In most cases it can be performed under local anaesthetic.
A prophylactic mastopexy with breast reconstruction (of the contralateral breast or both) may be an option for patients who carry an increased risk of breast cancer. Dr. Alexander T. Hamers offers personal consultation to discuss your individual situation.
Duration of the surgery:
approximately 2-6 hours (depending on the type required)
general anaesthetic, inpatient for minimal 1 night
No sports, lifting and heavy workout for 6 weeks, compression bra and garments
Normally fit for flying after 1 week
Minimally invasive, tiny incisions of about 3-5 millimeters are needed for fat to be washed out of the body. Various techniques exist. The most advantageous and gentle is water-jet assisted liposuction, using just a small cannula with a pulsation water-jet on the tip. The water-jet’s gentle loosening and washing action makes it possible for large amounts of fat to be atraumatically removed. Compared with conventional liposuction, the sculpting of tissue is more precise and there is less trauma, pain and recovery time. Apart from being, gentle and more precise, the quality of the fat cells is superior to that resulting from other techniques, meaning that a higher survival rate of the transplanted fat cells is achieved.
Having a special clinical interest in natural body contouring, Dr. Hamers can reuse the patient’s own extracted fat to shape, fill or augment various parts of the body where it might be needed (for instance face, breast and buttock, but also calves or scars).
Dr. Alexander Hamers has specialised in Water-jetstream assisted fat transfer technology since 2012.
The transplanted fat needs to grow in. That is why it needs to be treated gently. Smoking, nicotine, pressure and cold all harm the freshly transplanted fat and should be avoided in the period immediately after surgery. Once the fat is grown in, it is part of the body and just part of normal aging.
Expansion vibration lipofilling (EVL) is the latest innovation in fat transfer. Using a vibrating cannula, the recipient tissue is gently expanded while grafting the fat. This results in both, a higher graft-able volume and a better take rate of the fat (higher percentage of fat cells growing in and remaining). Thus, if desired, more fat cells can be transferred to the same recipient area compared with conventional techniques. Dr. Hamers is the first surgeon to have established the EVL technique in Europe.