Partial breast reconstruction

After a lumpectomy (partial removal of the breast due to cancer), surgery and complementary treatments like radiotherapy can result in aesthetic sequelae.

These aesthetic changes following breast cancer treatment may include:

• Decreased breast volume, where the operated breast retains a natural shape but is smaller due to surgery and radiotherapy. In such cases, breast reduction of the unaffected breast may be performed to match the size and shape of the treated breast.
• Partial breast deformity with areolar retraction. The types of deformities vary widely, and different techniques such as breast plastic surgery and breast lipofilling may be used based on the type of deformity.
• Global breast deformity associated with significant signs of radiodermatitis (radiotherapy sequelae). In such cases, a mastectomy (breast removal) and immediate breast reconstruction may be simpler.

Various techniques of breast plastic surgery can be employed to correct these deformities:

• Breast plastic surgery
• Fat injection (lipofilling)
• Breast reconstruction using flaps

Sometimes, a combination of different techniques is necessary to achieve a natural result.

It is always possible to consider corrective procedures for patients with sequelae from breast cancer surgery.

Regarding the guidelines for fat grafting to correct breast deformations following breast cancer treatment:

In 2014, the French National Authority for Health (Haute Autorité de Santé) convened a national committee of experts in breast surgery and fat grafting (lipofilling).

The goal was to establish best practice guidelines for this technique. Dr. Benjamin Sarfati was part of this expert committee, and national recommendations were published in January 2015:

“In the context of reconstructive surgery after breast-conserving surgery (partial mastectomy) for breast cancer, the contraindications to autologous fat grafting in the breast identified by the working group are:

• Absence of local remission, evidenced by clinical examination and/or an abnormal preoperative radiological breast assessment (ACR 3, 4, 5, or 6);
• Uncontrolled metastatic disease;
• Tumor resection with positive margins (not in sano);
• Less than 2 years since completion of local treatments;
• Incomplete conservative treatments, whether surgical, radiotherapeutic, or medical (including hormone therapy).”