Reconstruction R3
Delayed implant reconstruction
The existing mastectomy incision, a pocket under the muscle, abdominal skin recruited upwards and a new fold rebuilt. The technique most often indicated in delayed reconstruction.
- Anaesthesia
- General
- Incision
- 5 cm, existing scar
- Stay
- 2 to 4 days
- Skin relaxed
- 2 to 3 months
Figures confirmed by the surgeon; they vary from case to case and are specified in consultation.
The essentials
The four questions that come up
- What does the operation involve?
- A pocket is created behind the muscle through the existing mastectomy incision, abdominal skin is recruited upwards to gain height, a new inframammary fold is rebuilt and fixed, and the definitive anatomical implant is then placed.
- Who is it for?
- This technique can be indicated in almost every case. Over the past decade it has taken over from flap techniques, thanks to anatomical cohesive gel implants and to the contribution of combined fat grafting.
- How long is the hospital stay?
- From 2 to 4 days depending on drain output. The bra is fitted in the operating room and pain relief is injected locally at the end of the operation, then continued intravenously.
- When is the result stable?
- The result is immediate, but the skin of the reconstructed breast will relax over two to three months. From three months onwards, secondary lipomodelling can be offered to refine the natural feel.
The technique that took over from flaps
This technique can be indicated in almost every case. Over the past decade it has taken over from reconstruction by flap transfer.
Three advances explain this: the use of anatomical cohesive gel implants, the refinement of the advancement and fixation of the inframammary fold, and the contribution of fat grafting combined with implants, before and after reconstruction.
How the operation proceeds
The existing mastectomy incision is used along its lateral portion, over a length of 5 cm. No new scar is created.
A pocket for the implant is made behind the muscle, taking care to remove the deep fibrous tissue that often prevents the skin from relaxing. The dissection extends well below the level of the inframammary fold in order to recruit abdominal skin: sliding the abdominal skin up onto the breast often gains 2 to 3 cm of height.
The fascia is incised leaf by leaf within the fat, which increases the flexibility of this advancement flap and improves the construction of the new fold.
Rebuilding the fold, a technique of the surgeon’s own
This reconstruction of the fold and its fixation are a personal technique of Dr Azencot.
The new fold is fixed along its whole length with a running absorbable monofilament suture, passed through the skin, leaving no scar. Once the fold is fixed and the skin gained through abdominal advancement, the definitive anatomical implant with extra-high projection is introduced into the pocket. A suction drain is placed and the scar is closed with a running suture.
The inframammary fold is the line that gives the breast its anchorage and its shape. On an operated chest, it has disappeared. Rebuilding it and fixing it at the right height is what separates an implant that has been placed from a breast that has been rebuilt.
Recovery
The result is immediate. The bra is fitted in the operating room, and pain relief is injected locally at the end of the operation, then continued intravenously.
The hospital stay is 2 to 4 days depending on drain output. Recovery is marked by pain at the inframammary fold, well controlled by simple painkillers, by swelling and by bruising.
The skin of the reconstructed breast will relax over two to three months. What you see on discharge is therefore not the final result.
Possible complications
They are listed here in order of frequency, as the practitioner presents them in consultation. Knowing them is part of informed consent.
- Peri-prosthetic lymphatic effusion.
- Delayed healing.
- Inflammatory cellulitis.
- Wound dehiscence with implant exposure.
- Infection.
In the longer term, capsular contracture, also called a capsule, or malposition of the implant may occur.
Frequently asked questions
What patients ask
These answers reflect the content written and validated by the surgeon. Each one is written to stand alone, question by question.
Is a new scar needed?
How is skin gained on a flat chest?
How long is the hospital stay?
When does the final shape appear?
Go further
Related procedures
Meet us
Consultation
A first consultation is there to understand your request and tell you what is possible — including when the answer is that it is better to do nothing.
Clinique Esthétique Ferrère
16 ter rue Ferrère
33000 Bordeaux
In cosmetic surgery, French law requires a detailed written quote and a cooling-off period of at least fifteen days between the consultation and the operation. No deposit may be requested during that period. Two consultations are required before any operation.