Improving breast reconstructions
Sometimes the aesthetic results of a breast reconstruction may not be satisfactory. It is usually possible to improve them using procedures that are minimally invasive and virtually pain-free.
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Les lipofillings mammaires en reconstruction
Dr Isabelle Sarfati
Chirurgie reconstructrice et esthétique
To improve a breast reconstruction, it is necessary to analyze its defects:.
- Volume: breast width, height and projection
- Symmetry with the other breast
- The sub-mammary fold: is it at the right level, is it sufficiently marked?
- Is the curve of the breast harmonious?
- Is the neckline symmetrical?
- How natural does it look? can you see the prosthesis under the skin?
- The areola and the nipple: color, size, position…
Several techniques can be combined:
The fillings, or auto grafts of fat
They have transformed the quality of reconstructions. The greater the thickness of the fat covering the prosthesis, the more natural the result.
The fillings also allow the shape of the breast to be sculpted.
The fat is removed by liposuction and reinjected into the tissues using a fine cannula. Each procedure allows only limited quantities of fat to be grafted.
It is sometimes possible to completely replace a prosthesis with fat, but this often requires several procedures.
Change the prosthesis
The choice of the implant is essential to the quality of a reconstruction.
Improve the sub mammary fold
It is possible to bring up skin and fat that are under the breast in order to gain laxity and to fix the sub mammary fold to the chest wall.
Making a flap
Sometimes it is necessary to convert certain reconstructions by prosthesis by bringing natural tissues coming most often from the back or the belly onto the breast (Link with the DIEP and the Gd Dorsal).
Improve symmetry
It may be necessary to modify the contralateral breast in order to have a good symmetry. It can be raised if it is a bit droopy, or it can be reduced or increased in volume.
When the result cannot be improved by the techniques described above, it is sometimes simpler to resort to flaps such as the greater dorsal or DIEP.
Right reconstruction by prosthesis
Defect analysis
The prosthesis is too big and too far out, the sub mammary fold is too low and there is a gap above the breast.
Terms and conditions
On the right: change of prosthesis, correction of the sub mammary fold and filling of the neckline.
On the left: augmentation of the left breast with a prosthesis.
Left reconstruction by prosthesis and right augmentation by prosthesis
Defect analysis
The left prosthesis is visible in the neckline and the right areola looks down a bit.
Terms and conditions
Left reconstruction: filling of the neckline, tattooing of the areola and nipple graft.
Right breast: lift with a scar around the areola and a vertical scar between the areola and the sub mammary fold.
Bilateral breast reconstruction
Defect analysis
The left breast is too big and too low.
Terms and conditions
On the left: removal of the prosthesis, replacement by a filling and remodeling of the flap.
Left reconstruction by prosthesis and right reduction breast surgery
Defect analysis
The left breast is too small and the sub mammary fold is too high.
Terms and conditions
Change of prosthesis and lowering of the sub mammary fold.
Right reconstruction by prosthesis and left reduction breast surgery
Defect analysis
The right breast lacks projection and a natural look.
Terms and conditions
Improvement of the contours and projection by fillings. Areola tattooing and nipple grafting.
Bilateral breast reconstruction
Defect analysis
Adhesion of the scar on the right breast. The prostheses are too small and lack a natural look.
Terms and conditions
Bilateral filling, scar removal and prosthesis replacement.
Right reconstruction with latissimus dorsi muscle flap and prosthesis
Defect analysis
Prosthesis too narrow, lack of volume in the neckline
Terms and conditions
Filling by lipofilling
Reconstruction by left prosthesis
Defect analysis
The prosthesis is too high, too small and too far in.
Terms and conditions
Change and lowering of left prosthesis and lipofilling. Remodeling of the right breast.
Right breast reconstruction using a dorsalis flap and prosthesis
Defect analysis
The reconstruction is too flat and too low.
Terms and conditions
Removal of the prosthesis, replacement by lipofilling and remodeling of the flap.
Right reconstruction by prosthesis
Defect analysis
The prosthesis is too big and too high. There is a painful shell.
The tissue that covers the implant is too thin.
Terms and conditions
Progressive replacement of the prosthesis by fillings. Tattooing of the areola and nipple graft.
Immediate left reconstruction with a long dorsal flap and prosthesis
Defect analysis
Asymmetry.
Terms and conditions
Raising of the areola of the right breast. Left breast lipofilling.
Left reconstruction by prosthesis
Defect analysis
The prosthesis is too bulky and is drawn under the skin.
Terms and conditions
Change of prosthesis for a less high and less wide one, improvement of the contours by fillings and tattooing of the areola and the nipple.
Bilateral breast reconstructions
Defect analysis
Asymmetry of volume, shape and grooves
Terms and conditions
Bilateral lipofilling. Change of left prosthesis and tattooing.
Right reconstruction by prosthesis
Defect analysis
Lack of volume in the right reconstruction and the sub mammary fold is too high.
Terms and conditions
Change of right prosthesis, areola tattooing and nipple graft.
Left reconstruction by prosthesis
Defect analysis
The inner part of the left breast lacks volume and the right breast looks down.
Context
The patient does not want to touch the right breast.
Terms and conditions
Filling of the internal defect by two fillings and tattooing of the areola and nipple graft.
Bilateral breast reconstructions
Defect analysis
The prostheses are too low.
Terms and conditions
Change of prosthesis, reconstruction of sub mammary folds.
Reconstruction on the right by prosthesis and on the left by gracilis free flap
Defect analysis
On the right the prosthesis is too high, on the left the breast is flattened.
Terms and conditions
Bilateral prosthesis change, bilateral lipofilling.
Bilateral breast reconstructions
Defect analysis
Right prosthesis too high, left breast has ptosis
Terms and conditions
Change of right prosthesis, left prosthesis, right filling.
Right reconstruction by prosthesis
Defect analysis
Right prosthesis too high, too small.
Terms and conditions
On the right, change of prosthesis, reconstruction of the sub mammary fold, lipofilling. On the left, treatment of ptosis.
Bilateral breast reconstructions
Defect analysis
Prostheses are too small with waves. Poorly defined sub mammary folds.
Terms and conditions
Change of bilateral prostheses, reconstruction of sub mammary folds, lipofilling.
Left reconstruction by prosthesis
Defect analysis
Right breast too small, lack of filling of the neckline on the left.
Terms and conditions
Prosthesis on the right, lipofilling on the left.
Left reconstruction by prosthesis
Defect analysis
Left prosthesis too small and too high.
Terms and conditions
Change of left prosthesis, lipofilling, reconstruction of the left groove.
Bilateral prosthetic reconstructions
Defect analysis
Left prosthesis too high, the sub mammary fold is poorly defined.
Terms and conditions
Prosthesis change and reconstruction of the left sub mammary fold, bilateral filling, reconstruction of the PAM
Left reconstruction by prosthesis and right reduction breast surgery
Defect analysis
Left prosthesis too high and too small.
Terms and conditions
Change of prosthesis, reconstruction of the sub mammary fold, lipofilling.
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