Breast reconstruction after breast cancer

Breast reconstruction after breast cancer at the Geisenhofer Clinic

After surviving breast cancer with a mastectomy (breast removal), the body sensation is unfamiliar and represents a psychological burden for many women. Breast reconstruction can therefore be an important way for those affected to regain their natural body image. Breast reconstruction restores a sense of femininity, self-confidence and wholeness that the disease has taken away.

At the Dr Geisenhofer Women's Clinic in Munich, we offer you modern, gentle methods of breast reconstruction - with the patient's own tissue or with implants. In many cases, breast reconstruction is even possible at the same time as a mastectomy, in a single surgical procedure. Our head physicians Moritz Schoeneich and Marc Englbrecht are among the most experienced surgeons in Europe in the field of breast reconstruction with autologous tissue. They will accompany you competently and sensitively on this personalised path and take time for your individual needs.

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Advantages of reconstructive surgery at the Geisenhofer Clinic

The Geisenhofer Clinic Munich offers senological surgical procedures at the highest medical level. Our patients can rely on a high level of quality and safety as well as empathetic care.H3: Interdisciplinary treatment concept

A perfectly harmonised team accompanies you in our company:

• Close cooperation with the treating oncologists and gynaecologists in breast cancer treatment
• Specialised anaesthetists with experience in long-term microsurgical procedures
• Highly qualified surgical team with expertise in breast reconstruction
• Specially trained nursing staff for post-operative care
• Cooperation with physiotherapists for optimal rehabilitation after the procedure

This interdisciplinary collaboration ensures optimal results and maximum safety in breast reconstruction following tumour removal.

Individual counselling & aftercare

• Detailed initial consultation without time pressure
• Detailed information about procedures, processes and risks
• Support with questions about cost coverage by the health insurance company
• Close aftercare and availability after the procedure
• Long-term support and adjustments if required

Various breast reconstruction procedures

Breast reconstruction following breast cancer treatment with mastectomy (breast removal) is one of the most common operations at our clinic. Various procedures are used depending on the medical indication and the patient's individual wishes.

In addition to classic breast reconstruction with implants, we also offer the option of breast reconstruction with the patient's own tissue (known as DIEP and PAP flap surgery).

The choice of method is made together with you, on the basis of a detailed consultation and careful treatment planning. Below we give you an initial overview of the various options.

Implant reconstruction 

Implant reconstruction with silicone implants is a proven method of breast reconstruction, particularly for patients for whom tissue flap techniques are not an option due to a lack of tissue or previous surgery. It offers a quick and effective way of restoring lost breast volume.

Advantages of implant reconstruction:

• Rapid restoration of breast volume
• Aesthetically pleasing results with a natural shape of the reconstructed breast
• No surgical interventions in other areas of the body
• Shorter operating time and faster healing compared to flap plasty

Our surgeons have extensive experience in implant reconstruction and use modern methods to achieve the best possible result. They cater to the individual wishes of each patient and take their personal needs and anatomical conditions into account. This ensures that the reconstruction is not only functional but also aesthetically pleasing.

Natural breast reconstruction with autologous tissue

Breast reconstruction with the body's own tissue (autologous reconstruction) offers numerous advantages over implant reconstruction. The transplanted autologous tissue feels natural, ages with your body and offers a long-term stable result - without the risks associated with silicone implants or any later need for replacement surgery.
We rely on modern microsurgical procedures in which skin and fatty tissue are transplanted from other areas of the body. The supplying blood vessels are reconnected to ensure optimal blood circulation and vitality of the tissue.

DIEP flap method: reconstruction with abdominal tissue

The DIEP flap method (Deep Inferior Epigastric Perforator) is today the undisputed gold standard in the field of natural breast reconstruction using the body's own tissue. This highly specialised procedure makes it possible to remove excess skin and fatty tissue from the lower abdomen - without damaging the abdominal muscles - and use it precisely for aesthetically pleasing breast reconstruction.

The lower abdomen is a very suitable tissue area, as there is often enough skin and fatty tissue in this area to rebuild one or even both breasts. The removed tissue is precisely connected to the blood vessels in the chest wall with its own blood vessels under the microscope. This ensures that the tissue continues to be optimally supplied with blood.

The advantages of the DIEP flap method

• Natural look and feelThe reconstructed breast feels soft and natural and also looks particularly natural, as the body's own tissue is used
• Permanently stable resultUnlike implants, there are no problems such as capsular fibrosis, displacement or the need for replacement surgery years later. The transplanted autologous tissue ages with your body and adapts to natural weight fluctuations
• Positive cosmetic side effect: By removing tissue from the lower abdomen, you also obtain a tummy tightening effect, comparable to an abdominoplasty
• Maintaining the abdominal musclesUnlike older procedures (TRAM flaps), the DIEP method completely spares and preserves the abdominal muscles, as only skin and fatty tissue are transplanted
• Excellent mouldabilityThe transplanted tissue can be optimally shaped and enables excellent symmetry adaptation to the natural breast
• No foreign body reactionsSince only the body's own tissue is used, allergic reactions or rejection reactions are ruled out

PAP flap surgery: The alternative for missing abdominal tissue

A DIEP flap method is not suitable for every patient, for example if there is too little abdominal tissue or previous operations no longer permit this. In such cases, PAP (Profunda Artery Perforator) flap surgery offers an excellent alternative for natural breast reconstruction using the patient's own tissue.

In PAP flap surgery, skin and fatty tissue from the posterior thigh region is used for breast reconstruction. This area typically contains sufficient tissue for an aesthetically pleasing reconstruction, even in very slim patients. The tissue is supplied with blood via its own vessels, which are carefully prepared and microsurgically connected to the blood vessels in the breast area.

The advantages of PAP flap surgery:

• Ideal solution for very slim patients: Unlike the DIEP method, the PAP technique enables natural tissue augmentation even in women with little lower abdominal tissue
• Discreet scarring: The incision runs along the inside of the thigh and/or in the crease of the buttocks, making the scars barely visible in everyday life
• Shapeability and adaptability: The thigh tissue offers excellent properties for modelling a natural breast shape
• Natural appearance: The transplanted tissue provides an authentic look and feel of the reconstructed breast, the transplanted tissue ages naturally with the breast.
• No influence on the abdominal muscles: as the tissue is removed exclusively from the thigh area, the abdominal wall remains completely unaffected
• Safe alternative to DIEP flap surgery for: previous abdominal surgery (e.g. bowel surgery, caesarean section, abdominoplasty), scars in the abdominal area or existing abdominal wall hernias

Breast removal and breast reconstruction in a single operation

Highly specialised microsurgical expertise

Procedure for breast reconstruction with DIEP and PAP flap surgery

1. Preliminary examination and counselling:
   Before the operation, a comprehensive consultation and examination will take place, during which your medical history, your wishes and the condition of the tissue will be discussed. This is where we decide whether DIEP or PAP flap surgery is the most suitable method for your breast reconstruction. State-of-the-art pre-operative imaging (CT angiography) enables us to visualise the vascularisation exactly and plan the operation precisely.
2. Anaesthesia:
   The operation is performed under general anaesthetic so that you are pain-free during the entire procedure.
3. Tissue removal:
   The surgeon removes skin and fatty tissue - from the lower abdominal area in DIEP flap surgery and from the thigh in PAP flap surgery - whereby the muscles are not affected in either case.
4. Microsurgical technique:
   The blood vessels of the removed tissue are microsurgically connected to the blood vessels of the chest wall to ensure sufficient blood flow to the flap. This is done using the finest sutures and is the most demanding part of the procedure.
5. Breast reconstruction:
   The removed tissue is transferred to the breast region and moulded there to achieve the desired breast shape and size. Here too, the tissue is positioned in such a way that it looks as natural as possible.
6. Wound closure and aftercare:
   Once the tissue has been successfully transplanted, the area is closed in several layers. This is followed by intensive aftercare measures to ensure optimal healing. This also includes monitoring the blood supply to the new tissue.
7. Hospitalisation and recovery:
   The hospital stay usually lasts between 5 and 7 days (for the DIEP method) or 4 to 6 days (for the PAP flap procedure). During this time, healing is monitored and you will be given pain-relieving medication. After discharge, regular follow-up examinations must be carried out.

Optimised aftercare and reduced recovery time

Thanks to our modern and optimised treatment protocols, we have been able to significantly shorten the recovery time after DIEP and PAP flap procedures. Our holistic aftercare concept includes

• Specialised pain therapy
• Early mobilisation to promote blood circulation
• Close monitoring of the transplanted tissue using state-of-the-art monitoring procedures
• Personalised care from our specially trained nursing staff
• Seamless transition management to outpatient aftercare

Frequently asked questions about breast reconstruction (FAQ)

For whom is breast reconstruction with autologous tissue suitable?

Breast reconstruction with autologous tissue is generally an option for most patients who have had a mastectomy. It is particularly suitable for women who:

• A breast reconstruction that is as natural as possible
• Aiming for stable results in the long term
• want to avoid silicone implants
• After breast cancer treatment has been completed (ideally)
• Have a sufficiently good general condition

However, there are also factors that need to be taken into account and not every procedure is suitable for every patient. Certain pre-existing conditions, BRCA mutation, increased risk of breast cancer, smoking or severe obesity can play a role. In a detailed consultation, we will clarify which method is most suitable for you on an individual basis.
Reconstruction can be performed either directly as part of the breast cancer operation (primary reconstruction) or at a later stage (secondary reconstruction). Many women opt for secondary breast reconstruction after all oncological treatments for the cancer have been completed.

Is breast reconstruction covered by health insurance?

Yes, the costs of medically indicated breast reconstruction after breast cancer are generally covered in full by statutory and private health insurance companies. This applies to the actual operation as well as any necessary follow-up adjustments and the bra after the operation. Nevertheless: Discuss your case with your health insurance company to obtain specific information.

How long does breast reconstruction surgery with autologous tissue take?

Breast reconstruction with DIEP or PAP flap surgery takes around four to six hours. This is longer for bilateral reconstruction. The operation is performed under general anaesthetic.

How long is the hospital stay?

After an autologous tissue reconstruction, you will usually stay in our clinic for between 5 and 7 days (for the DIEP method) or 4 to 6 days (for PAP flap surgery). During this time, you will receive intensive care and be prepared for your return home.

How natural is the result?

The reconstructed breast made from the patient's own tissue feels very natural and also looks natural. The shape and size can be customised during the operation to achieve symmetry with the healthy breast. The nipple and areola can be reconstructed in a later minor procedure.

How long is the recovery time?

You can normally resume your usual activities after about 4-6 weeks. Full recovery and the final appearance of the reconstructed breast take several months to develop.

Is breast reconstruction painful?

Thanks to modern pain therapy, we can control the discomfort well after the operation. Most patients report moderate pain, which is treatable and decreases quickly.

Can I still have a breast cancer screening after the reconstruction?

Yes, all necessary examinations for follow-up care and early detection are also possible after a reconstruction. We will liaise closely with your treating doctors.

What is the difference between a prosthesis and breast reconstruction?

While an external breast prosthesis is inserted into the bra from the outside, breast reconstruction is an operation in which the breast shape is restored using either the body's own tissue or implants. In contrast to a prosthesis, the reconstructed breast becomes part of your body.

Can breast reconstruction also be performed with a BRCA mutation?

Yes, breast reconstruction can be performed, especially in women with a BRCA mutation who have an increased risk of breast cancer and decide in favour of a prophylactic mastectomy. In many cases, reconstruction takes place directly after breast removal.