IT TOOK SURGEONS 14 HOURS TO RESTORE THE BEAUTY OF THE MOST PROMINENT PART OF A WOMAN’S BODY

For two years, Elena, a resident of the Smolensk region, has been trying to find doctors who would take on her case. The story of our heroine’s treatment began back in 2022, when she was diagnosed with breast cancer. As it should be, the patient was referred to the regional oncologic dispensary, where she underwent complex treatment with chemotherapy, radical mastectomy and radiation therapy. At that time Elena was 58 years old, and it was important for her doctors to save her life and get rid of the tumor, and aesthetic results were out of the question at that time.

Elena admits that life with a prosthesis was unbearable for her. “I decided that I would not walk like that and I would still get plastic surgery, although my doctors discouraged me. “Why do you need it? Live your life as it is! You have large breasts, it will take several surgeries to restore symmetry“. Time passed, but our heroine still could not cope with the loss of breasts. She admitted that she went to psychologists in the hope of overcoming this complex, but she could not accept herself in this form.

Then began numerous searches for clinics and doctors, which did not bring results. The fact is that the operation was performed so radically that there were no resources left for the integration of an artificial implant, in addition, the surrounding tissues were total fibrosis. “I began to look for doctors by reviews on the Internet, and the first one who “caught” my eye was Evgeny Alexeyevich Troshenkov, Head of the Department of Oncoplastic Surgery with Chemotherapy at the P. Hertsen Moscow Oncology Research Institute (MORI) – branch of the FSBI “National Medical Research Radiological Centre” (NMRRC) of the Ministry of Health of the Russian Federation.

I decided to consult him, and my intuition didn’t let me down!” recalls Elena.

“Due to the severely pronounced deformity, we thought for a long time about the possible reconstruction option, explains Evgeny Alekseevich. The fact is that in Elena’s case the only option for breast reconstruction was reconstruction with a free flap on microsurgical anastomoses. The operation is exclusive, complex, but even it did not guarantee a favorable outcome, because the vessels to which we connect this flap were very compromised.”

“Before the operation, we performed the entire necessary set of instrumental and laboratory diagnostics to make sure that it was possible to perform microsurgical reconstruction and safe for this patient, adds the attending physician, plastic surgeon Azarias Koutsouradis. The undeniable advantage of such an operation is not only the restoration of the shape and performance of abdominoplasty, but also the absence of foreign material, softness and warmth of their own tissues”.

After thoroughly studying the results of all the tests, possible escape routes, the surgeons decided to perform the operation, which lasted 14 hours.

“At the first stage we had to perform abdominoplasty and allocate a flap, which in itself is a very meticulous process, on which, to a large extent, depends on the success of the operation, says Evgeny Alekseevich, who led the surgical team. However, all the subsequent stages were incredibly difficult. The fact is that the tissue surrounding the vessels of the chest, where initially we were to implant a flap on the vascular legs, blood supplying it, were replaced by fibrosis, which affected the diameter of the vessels themselves. Through complex technical manipulations, we were able to sew the vessels together, but the anastomosis (the place connecting the vessels) did not work precisely because of the difference in their size”.

Unfortunately, this manipulation resulted in venous blood outflow from the flap being impeded, which could eventually lead to thrombosis and loss of the flap. Surgeons then attempted to suture the anastomosis higher up, but this too failed due to their damage. The microsurgeons had to find an alternative donor site.

“We started looking for vessels in the axillary region, and the only salvation option was to connect this flap to the thoracodorsal artery, which branches from the axillary artery. But even there, after radiation therapy and colossal fibrosis, we were disappointed,” adds Azari Falesovich.

These failed attempts became a real challenge for the surgical team. There was less and less time to keep the flap viable. Then the surgeons went to the extreme step and decided to connect the donor vessels with the recipient vessels on the other side of the chest, that is, on the side of the healthy breast. “To do this, we subcutaneously formed a tunnel in which we elegantly laid the vascular bundle and connected it to the vessels on the other side,” explains Evgeny Alekseevich.

“The patient’s vein was so thin, practically transparent. And of course, the skills of microsurgeons play a huge role in working with it. This is the case when you work not with what you see, but what you literally feel on your fingertips, adds Dimitri Mantaridis, reconstructive plastic surgeon, microsurgeon. When we put these anastomoses in place, there was no final certainty that they would work because the vessel walls were so thin that the threads were cutting through.”

However, the surgeons’ supreme skill and their desire to help Elena allowed them to achieve excellent results. The flap that the surgeons transplanted to Elena took root. “We are happy that we were able to help the patient and we succeeded!” concluded Azarii Falesovich.

“I am a very happy person, because I got into the hands of amazing doctors who not only took the risk of taking on my complicated case, but also made me even more beautiful. I have dreamed of a flat tummy all my life, and now I not only have gorgeous breasts, but also a trim body. I love the sea and for more than two years I denied myself this pleasure. And now, finally, I will definitely go on a trip, but already completely healthy and confident in myself!”