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Thoracic and breast surgery

Thoracic and breast surgery

THORACIC AND BREAST SURGERY

The shape of the mammary gland and/or chest can be altered with plastic surgery in both women and men after congenital deformities, disease (e.g. inflammations or tumors), or trauma.

Correcting the shape of the breasts or chest is planned individually, taking into consideration the shape, location, and size of the tissue defect, the general condition of the patient and associated diseases, physical stress at work and in leisure time, and factors affecting the use of an autograft (sufficient amount of tissue and condition of the harvest site).

The shape can be corrected using the patient's own tissue or an implant. Smaller shape defects can often be corrected with free fat grafting. Fat is removed through small incisions, usually on the thighs, flanks, or the abdominal area, and the graft is injected with a syringe into the tissue defect in the breast area. The procedure can be performed using local or general anesthesia, depending on the case.

After the procedure, the patient is monitored at the hospital for between two and 24 hours. Sick leave varies from one day to 14 days. The outcome of the fat graft will be evaluated at an office visit about three months after the procedure.

Missing breast tissue or a shape defect can sometimes be corrected with an implant. A silicone prosthesis or an expander prosthesis filled with sodium chloride can be placed under the skin or under a local graft, as needed. When skin is expanded with an expander prosthesis, several office visits are necessary during the weeks following the surgery to fill the prosthesis with sodium chloride. It is often replaced with a regular silicone prosthesis after a few months. Fat grafting can also be used to make the shape of the implanted breast fuller.

Autografts can be used to correct larger tissue defects or when a breast is missing completely. A graft can be taken from the chest (TAP, AICAP, LICAP, IMAP), the back (LD), the abdomen (DIEP, SIEA, TRAM), a thigh (TMG), and sometimes from the buttocks or flanks. A suitable graft will be selected individually. If a breast cancer patient has disturbing upper limb swelling caused by a mastectomy and removal of the axillary lymph nodes and possibly by radiotherapy, a lymph node transplant can be performed in connection with a flap reconstruction of the breast.

After a flap reconstruction, the patient is monitored at the hospital for one to three days (local flaps) or five to seven days (micro flaps, i.e. distant flaps demanding microvascular suture). Sick leave varies from two to six weeks. The need for follow-up procedures can be evaluated approximately six months after the surgery, when the swelling has gone down and the flap has begun to settle. Nipple reconstruction by moulding the surrounding tissue is performed under local anaesthesia when the breast is otherwise ready.

Corrective breast surgery using the patient’s own tissue is often a larger operation than implant surgery (graft reconstructions) or requires more procedures (fat grafting) but, on the other hand, the result lasts longer.

Plastic surgery can be used to correct the following, for example:

  • congenital developmental disorders of the mammary gland and chest
  • tuberous breasts, breasts of different sizes (underdevelopment of one mammary gland)
  • Poland's syndrome
  • funnel chest (pectus excavatum), pigeon chest (pectus carinatum)
  • breast growth disorder caused by trauma or disease
  • burn injury, thoracic cavity surgery or radiation therapy as a child
  • gynecomastia, i.e. enlargement of the mammary gland in males
  • feminine chest in males or masculine chest in females
  • sequelae of inflammation, removal of tumors and possible radiotherapy
  • breast cancer

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