Breast cancer is the most common malignant disease among women in Israel and in the Western world in general. Approximately one out of seven women is diagnosed with breast cancer.
When the disease is diagnosed, many women must undergo partial or complete breast removal in order to stop the spread of the disease. Women who undergo mastectomy often describe the process as traumatic, affecting among other things their sense of femininity and sexuality.
The importance of breast reconstruction after mastectomy is therefore very high for maintaining body image and a sense of wholeness. Breast reconstruction is performed by a plastic surgeon in full coordination and cooperation with the breast surgeon who performs the mastectomy.
Breast reconstruction may be performed immediately, during the same surgery in which the breast is removed, or at a later stage. Today, most reconstructions are performed immediately, which contributes to recovery and the patient’s sense of bodily integrity.
Reconstruction procedures are divided into autologous reconstructions, using the patient’s own tissues including fat, and implant-based reconstructions, in which a silicone implant is inserted similarly to aesthetic breast augmentation surgery.
The most common reconstruction in the world today is implant-based reconstruction. The main reasons are that there is no need to use tissue from another area of the body, thereby avoiding scars and complications in the donor area.
In addition, many women do not know at the time of mastectomy whether they will require additional radiation therapy. Radiation damages tissues, and therefore it is not logical to perform a complex reconstruction using the patient’s tissue if the area will subsequently be irradiated.
One-Stage Breast Reconstruction
Prof. Gronovich believes that every effort should be made to achieve the best possible result already at the first stage of the mastectomy surgery, thereby giving the woman the greatest possible sense of completeness already on the day of surgery.
When the mastectomy does not involve the nipple and areola, reconstruction can often be completed during the same operation. In cases where the breast tissue is large and reduction is required, it may also be performed during the mastectomy. Consideration of the opposite breast is also central. Whenever possible, the goal is to perform balancing surgery on the opposite breast (lifting, augmentation, or reduction) during the same operation.
As part of this approach, Prof. Gronovich strives to perform immediate reconstruction with a permanent implant placed above the pectoralis muscle, meaning without lifting or injuring the muscle. The final decision can be made only after the mastectomy is completed and the condition of the tissues is evaluated. When conditions allow, reconstruction is performed this way, enabling a shorter operation, faster recovery, and excellent aesthetic results even in cases where radiation therapy is required.
Fat Grafting Breast Reconstruction
Another type of reconstruction, usually performed as delayed reconstruction, is reconstruction using autologous fat with the BRAVA system. Prof. Gronovich is among the few surgeons in Israel who perform breast reconstruction using this technique.
In this reconstructive approach, fat is harvested from areas such as the thighs or abdomen and injected into the mastectomy area to create new breast tissue. In order to allow the injection of a large amount of fat and rebuild a breast, the area must first be prepared to receive the fat by creating space and new blood vessels, particularly after radiation therapy.
This preparation is performed using the BRAVA external vacuum device, which is worn on the chest in the mastectomy area for several hours each day for about three weeks prior to surgery.
The advantages of this type of reconstruction are numerous: the surgery itself is short and relatively simple, the aesthetic result is excellent, and it is suitable for many situations including cases after radiation therapy. Another advantage is the improvement in the body areas from which fat is harvested.
The main disadvantages are the need to wear the BRAVA device daily before surgery and the fact that several surgical stages may be required to achieve the optimal result.
Restoration of Breast Sensation
One of the significant changes following mastectomy is the loss of sensation in the breast area. During mastectomy, sensory nerves are damaged. Therefore, even after a successful aesthetic reconstruction, the reconstructed breast may remain without sensation or with reduced sensation.
In recent years, surgical techniques have developed that allow attempts to restore sensation during breast reconstruction. During the operation, sensory nerves in the chest wall can be identified and connected to the reconstructed tissue using delicate microsurgical nerve grafts.
This approach allows gradual return of sensation in the reconstructed breast over several months. The success of this process depends on many factors including tissue quality, oncological treatment, and nerve regeneration capacity.
In Israel, Prof. Gronovich is among the first and few plastic surgeons integrating sensory reconstruction as part of breast reconstruction surgery.
What is your challenge?
For you, the challenge is not only medical but also emotional. Mastectomy changes body perception and self-image.
Sometimes there is an expectation to immediately return to the previous appearance. However, it is important to understand that breast reconstruction is a process and may require several surgical stages.
Factors such as radiation therapy, skin quality, and body structure may influence the possible reconstruction options.
Prof. Gronovich will accompany you throughout the process. Patience is essential, as this journey may involve several stages before the final result is achieved.
