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Primus inter pares

Mastectomy is no longer a torture


For the first time in Russia in the University Clinic № 1 the First MSMU Department of Plastic Surgery performed a unique surgery aimed at minimally invasive breast reconstruction after mastectomy (breast removal).

Today, the breast cancer is the most common female oncology issue. Annually, more than 50,000 cases are diagnosed in Russia, while in 70% of these, anyway, surgical removal of breast, partial or complete, is inevitable for medical grounds. The average patients’ age 45–50 years, ie we face relatively young women, who after the breast amputation suffer from severe psychological trauma, whilst somehow prolonged treatment deprives them of career and social life. Modern science is constantly in search of new techniques and approaches not only intended for diagnosis and treatment of breast cancer, but also for subsequent restoration of the breast. The brand new chemotherapy drugs and targeted therapy have allowed to improve the index of patient survival. But modern women are inclined not just to achieve disease-free 5 or 10-year survival rates, it is important to regain the quality of life, and to restore it as soon as possible. All previously known and widespread all over Russia breast reconstruction techniques presume mandatory recovery period of 2–3 weeks.

For the first time in Russia the FMSMU physicians performed the surgery aimed at breast restoration using the SIEA flap technique, which allows the patient to return to normal life after a week or so after the operation without discomfort and exhausting recovery period! The restored mammary gland, quite comparable with the indigenous one in terms of perception, looks absolutely natural and 100% normal. So far, it seemed impossible, but has become the reality, thanks to surgical team of the FMSMU Plastic Surgery Department.

For years, breast reconstruction after cancer surgery was reduced to installation of an implant, although it was hard to achieve symmetry, and most importantly — natural feeling of breast softness.

The techniques, which are widely known and most popular all over the world, providing more or less sustainable outcome are based on using own tissues, for example, from chest, buttocks or abdomen. The abdominal tissue is perfect donor material, structurally much similar to the breast, and microsurgical techniques allow extracting the tissue of this kind, giving it a new life in a new place. However, such operations are quite traumatic; the sensitivity of the reconstructed breast is usually reduced due to impossibility of restoration of minute nerve fibers. This approach significantly prolongs the hospital stay and postoperative rehabilitation, as another part of the body is involved in the operational process, which, under current conditions, is the crucial negative factor for both physicians and the majority of women.

The uniqueness of the operation performed by plastic surgeons of First MSMU lies in the fact that only subcutaneous fat and skin were transplanted without aggressive invasion into deeper tissue structures. The result of 6 hours of hard work is transplantation of tissues from the front surface of abdominal wall (SIEA flap), whilst the healthy breast was lifted to maximize aesthetic effect. The mechanics of this operation (and its complexity) is the exposure of smallest vessels (less than 1 mm in diameter) to be transferred with the perfused area of the skin and adipose tissue onto the breast area. Then the vessels are ligated to those recipient, restoring thus the blood flow in the newly-formed mammary gland. The operation is performed under multiple optical zoom and requires coordinated action, not only of surgeons, but the anesthesiologist and nurses. Despite the technical complexity, this way of reconstruction minimizes the donor area trauma, which significantly accelerates and facilitates the postoperative rehab, reduces the pain syndrome, let alone the hospital stay. The additional advantage is fully uninjured muscle aponeurotic frame, which makes rehabilitation much prompt. Thus, no more than a week passes from the moment of hospitalization until discharge. At the time of this publication the patient has already been discharged home, and she is absolutely happy.

«It is remarkable that we are capable of sophisticating our surgical technique for breast reconstructive surgery with the use of SIEA flap featuring live superficial epigastric vessels. This is a new step in improving the life quality of patients after mutilating breast surgery. And for many women, who underwent mastectomy, such breast reconstruction making the gland warm and soft by touch, in fact no different from natural one, becomes real liberation from the disease, or if you ask me, true recovery», commented on the unique operation the leading researcher of the Plastic Surgery Research and Educational Clinical Center under First MSMU Dmitry Melnikov.