Microsurgery: the elegance of invisible precision

There is an invisible world made up of blood vessels as thin as silk threads and nerves measuring less than a millimeter. It is within this microscopic space that microsurgery operates, a technique combining technology and precision to make breast reconstruction possible using the patient’s own tissues.

«Microsurgery is a technique that can be applied to various areas of medicine. It’s called that because it involves using magnifying glasses, microscopes, and dedicated instruments to work on very small structures, under one centimeter. In fact, we can operate on blood vessels, lymphatics, and nerves with diameters between 0.3 and 0.8 millimeters. In that case, we speak of super microsurgery», explains Dr. Silvia Germano, Specialist in Plastic and Reconstructive Surgery, Senior Physician at the Department of Plastic, Hand, and Microsurgery, Maria Vittoria Hospital, Turin.

Microsurgery is also used in breast reconstruction, as it allows for the recreation of the breast using the patient’s own tissues. «We take the tissues from areas where the woman has more adipose tissue, typically the abdomen or inner thighs, where the scar can be better hidden – says Germano – These tissues are harvested from distant regions and transplanted to the chest to recreate the breast. We call it microsurgery because, during transplantation, we perform anastomosis, that is, we stitch together two arteries and two veins so that blood can once again flow through the tissue in its new location».

Microsurgery and breast reconstruction

After a mastectomy, reconstruction is an essential part of the treatment journey, helping restore psychological and emotional balance.

«We know that the most common and widespread breast reconstruction technique is based on implants or expanders later replaced with implants. Unfortunately, implants are not suitable for all patients. Infections may occur, making removal of the prosthesis necessary. There can also be hardening of the implant, known as capsular contracture, which can cause irreversible changes to the aesthetic result as well as pain».

Dr. Germano continues: «A history of prior radiotherapy is also a contraindication for implants, and some patients themselves may prefer not to use prosthetics for reconstruction».

In all these situations, microsurgery offers a valid alternative, allowing for a natural reconstruction with more harmonious and long-lasting results. One major advantage of this technique is the stability of the result: while implants often need to be replaced at least once during a lifetime, a breast reconstructed with the patient’s own tissue follows the body’s natural changes, adapting to weight fluctuations and the aging process.

Restoring anatomical integrity

Naturally, microsurgery also presents some challenges. «It’s a technically more complex and longer procedure compared to prosthetic reconstruction. Its technical difficulty explains why it’s not yet widely available across Italy; only a few centers perform this type of surgery, as it requires a long learning curve».

Another consideration is that this technique leaves scars not only on the breast but also on other parts of the body, such as the thighs or abdomen, and involves a longer recovery time than prosthetic reconstruction.

«The type of reconstruction must be carefully evaluated case by case, there is no single technique that suits every patient. The choice should arise from a thorough discussion between patient and surgeon».

Beyond the technical and aesthetic aspects, breast reconstruction profoundly impacts patients’ lives, especially for those who had to undergo implant removal due to complications. «When the skin retracts over the chest, it creates an aesthetically unpleasant result, so restoring anatomical integrity to these patients is both a professional and human success».

Innovation in breast reconstruction

Medicine and surgery are constantly evolving fields, and microsurgery is currently experiencing a phase of great innovation. Among the most promising advances is the introduction of robots dedicated to microsurgery. «They allow us to work on increasingly smaller structures and help reduce surgical invasiveness. Each surgical specialty naturally evolves toward minimising scars and invasiveness, and robots can significantly contribute to this goal. The future objective is also to enhance super microsurgery, which is particularly useful in treating lymphatic diseases, conditions that are undeniably significant and disabling».

Microsurgery therefore plays an important role in treating such conditions, which are also closely linked to breast reconstruction. Many women still undergo axillary dissection during oncologic surgery.

«This procedure may lead to secondary lymphedema, and being able to improve the quality of life for these patients is certainly an important goal we aim to pursue in the near future».

For more information and further details, you can write to:
chirurgiaplastica.omv@aslcittaditorino.it