Figure 3. The main type of breast prosthesis, silicone prosthesis, was popular in 1980s. It consists of a silicone elastomer shell, which is usually filled with silicone or soft viscous silicone with shape memory function. At present, silicone prosthesis is limited to patients with small breast size, good local soft tissue coverage and unwilling to use autologous tissue from other parts of the body. The method is to put the silicone prosthesis on the deep surface of pectoralis major. If this gap in the deep surface of pectoralis major cannot accommodate this prosthesis, it needs to be expanded with a dilator. In recent years, most breast prostheses are filled with saline solution. Silica gel and salt solution are the most researched and widely used fillers at present.
Figure 4. Schematic diagram of silicone prosthesis implantation In the past 10 years, the development of breast reconstruction technology has enabled women to choose plastic surgery with autologous tissue reconstruction. Autologous myocutaneous flap transplantation is to cut a certain volume of skin, subcutaneous fat and muscle tissue from the patient's lower abdomen, back or buttocks and transplant it to a specific part for plastic surgery. Because there are often redundant tissues in the above three parts, which are the most common sources of autologous tissue in breast reconstruction, the donor site will get a more beautiful appearance after removing some tissues. The most commonly used is rectus abdominis myocutaneous flap. The advantages of rectus abdominis myocutaneous flap are large amount of transferred tissue, good blood supply and good plastic effect of abdominal wall, which is especially suitable for obese patients with abdominal bulging.
The following is an introduction to the operation process represented by the horizontal rectus abdominis flap transplantation: Normal female breasts are composed of mammary duct tissue and fat with lactation function, and breast cancer is one of the common cancers in women. The main pathogenic factors are family inheritance and menopause. Mastectomy is often used for patients with breast cancer. Sometimes, people with breast cancer in the family will have bilateral mastectomy to prevent future tumors. Breast reconstruction is often used for mastectomy or preventive mastectomy caused by small tumors. Abdominal skin flap transplantation A certain volume of tissue, including skin, subcutaneous fat, muscle tissue and blood vessels, is taken from the patient's lower abdomen and transplanted to the breast for plastic surgery (Figure 5B). Finally, nipple reconstruction, one method is to transplant the contralateral nipple part to the reconstructed breast; Another method is to add a small piece of skin to the reconstructed breast, and then use the technique of intradermal tattoo after the reconstructed wound heals, which is helpful to obtain more realistic nipples and areola. Although this kind of breast reconstruction is not perfect, it can also make women get natural, realistic and lasting breasts (Figure 5C).
Figure 5. Schematic diagram of horizontal rectus abdominis flap transplantation
(a) cutting a certain volume of tissue from the lower abdomen; B: Transplant to breast plastic surgery C: Operation completed)