Breast reconstruction

Le Dr Thomet est spécialisée en reconstruction mammaire. Elle est habilitée à pratiquer toutes les techniques de reconstruction et pourra au mieux vous renseigner.
La reconstruction mammaire se pratique après ablation complète du sein (mastectomie) ou de plus en plus fréquemment après ablation partielle du sein (tumorectomie) en remodelant le sein grâce aux techniques bien connues de chirurgie plastique. On parle alors de chirurgie onco-plastique. La reconstruction mammaire englobe également le traitement des séquelles de tumorectomie.
La reconstruction mammaire fait partie intégrante du traitement du cancer du sein. Lorsque cela est possible, nous tentons de reconstruire le ou les sein-s lors de la même intervention que la mastectomie. Dans certains cas, une symétrisation du sein opposé peut être pratiquée, immédiatement ou dans un deuxième temps. Quelle que soit la technique utilisée, la reconstruction du sein s’effectue en plusieurs étapes et se termine par la reconstruction du mamelon et de l’aréole. De manière générale, une reconstruction mammaire complète prend entre 9 et 12 mois.

Dr Thomet specialises in breast reconstruction. She is licensed to carry out all reconstructive techniques and will be best able to advise you.
Breast reconstruction is carried out after the complete removal of the breast (mastectomy) or more and more often after partial removal of the breast (tumorectomy), by restructuring the breast using techniques which are well-known in plastic surgery. In this case, we talk about onco-plastic surgery. Breast reconstruction also covers the treatment of the after-effects of a tumorectomy.
Breast reconstruction is an integral part of the treatment of breast cancer. Where possible, we try to reconstruct the breast or breasts during the same procedure as the mastectomy. In some cases, symmetrisation of the other breast may also be done, immediately or subsequently. Whichever technique is used, breast reconstruction is carried out in several stages and is completed with the reconstruction of the nipple and the areola. Generally speaking, full breast reconstruction takes between 9 and 12 months.
The choice of the type of reconstruction depends on several factors, including your morphology, your wishes, and also the type of oncological surgery practised by your gynaecologist. Your surgeon will advise you of the different possibilities which are suited to your case.
For more information on the techniques: brochure de la reconstruction mammaire des HUG.
Link to the GUH website on breast reconstruction: https://www.hug-ge.ch/reconstruction-mammaire

BEFORE SURGERY

The first consultation with Dr Thomet will allow you to get to know your surgeon, to present your situation and your wishes to them. In order to fill in your medical records, she will ask you about your medical history, any operations you have had in the past, as well as the list of any medication you are taking or allergies you may have.
A physical exam will be carried out and your measurements taken, and in some cases photos will be taken, which will remain confidential and will only be used for your medical records.
At the end of the consultation, Dr Thomet will give her diagnosis and will advise you whether you are a good candidate for surgery. She will explain to you the technique she plans to use, the position of the scars, the recovery time and the risks of complications.
After you have had time to think it over, a second consultation will be scheduled, in order to answer any questions you may have and to set a date for the operation. It is important that your plastic surgeon and your gynaecologist work well together in order for you to receive the best care.

INSURANCE

All types of breast reconstruction are covered by health insurance

TYPE OF ANAESTHESIA

Breast reconstruction procedure requires general anaesthesia. A preoperative consultation with an anaesthetist will therefore be organised before surgery. Nipple reconstruction surgery is performed under local anaesthesia.

HOSPITALISATION

Regardless of which technique is used, breast reconstruction usually requires hospitalisation for 3-6 nights. This allows to better manage the pain medication and monitor you closely. Drains (small plastic tubes attached to a bottle) will be placed during the surgery. These will be removed without causing pain before your discharge from the clinic.

On discharge, you will just have dressings which will be changed the following week for the first time at the practice. You are allowed to shower around 5-7 days after surgery. You will need to wear a sports bra (without underwire, with a wide elastic band, if possible with front opening for greater comfort) day and night for 6 weeks.

CONVALESCENCE

It is not recommended to drive and carry weight (more than 2-3 kilos) when leaving the clinic. Activity resumption may be considered after 3-4 weeks depending on the type of activity. It is necessary to wait 8-12 weeks before doing sports.
If the surgery is covered by health insurance, Dr Thomet will issue you with a medical certificate for the duration of your incapacity for work.

IMPLANT-BASED BREAST RECONSTRUCTION

This is the technique which is most commonly used. In the case of immediate breast reconstruction (during the same operation as the mastectomy), the gynaecologist will first remove the breast and then the plastic surgeon will use the same opening to insert a silicone prosthesis. As a general rule, the prosthesis is placed under the pectoralis major muscle.
It is a relatively quick and simple procedure, which does not cause any additional scarring.

LATISSIMUS DORSI BREAST RECONSTRUCTION

This technique consists of reconstructing the breast using a part of the back (the greater dorsal muscle and skin from the back), by taking advantage of the tissue in the back and moving it forward in order to give volume, thus recreating a breast. This technique means that you can avoid the use of a prosthesis by using your own tissue. It also allows the skin to be used, if the existing skin should need to be removed during the mastectomy. It enables a natural result to be achieved. There is no long-term impact on function, as all arm movements remain the same. It will mean a scar in the back area (either horizontally along the bra-strap line, or vertically on the side) where the tissue has been removed.

LIPOFILLING OR FAT TRANSFER

Lipo-filling is a technique which involves removing fat from another part of the body (usually the abdomen, the buttocks or the thighs) and re-injecting it into a different part of the body. This technique is widely used in plastic surgery, and namely in breast surgery.
In fact, it allows unevenness to be “corrected”, but also enables the volume of the reconstructed breast to be increased. It is a less onerous procedure and does not require admission to hospital in most cases.