Breast Reconstruction

Breast cancer is the second most common type of cancer in women after skin cancer. Breast reconstruction means reconstructing breasts in patients who experience breast loss after breast cancer treatment. Multidisciplinary advances in early diagnosis and breast cancer treatment shall increase the survival rates of patients. Therefore, breast reconstruction, which aims to physically and mentally improve the quality of life of patients during or after cancer treatment, has been frequently applied recently.

Breast repairing&reconstructing is an important contribution to help women who experience breast loss after breast cancer surgery to normalize their lives again. Loss of breast affects patients negatively physically, socially and psychologically. This type of organ loss reminds the patient of the trauma that they experienced, distorts body perception and creates confidence issues. In women with unilateral breast loss, asymmetries may occur, which can lead to even spinal problems.

Breast reconstruction procedures can be performed on all breast cancer patients who have no medical obstacle for breast repair&reconstruction. The general surgeon, oncologist, plastic surgeon and the patient decide together to whom, the breast repair will be performed.

The stage of breast cancer varies according to the content of the treatment (radiotherapy, chemotherapy) and the general medical condition of the patient. Generally, simultaneous repair is performed in patients with early stage breast cancer. If radiotherapy or chemotherapy is planned after surgical treatment, after the end of these treatments, repair can be done at the end of the first year, indicating that the cancer shall not recur. If it is not clear whether the patient will receive radiotherapy during breast cancer surgery, tissue expanders can be placed on the anterior chest wall to be inflated after the treatment for subsequent repairs. Thus, the first step of the repair is performed simultaneously for patients who are planned to be have breast reconstruction with prosthesis after treatment.

Every patient should have mammography / breast ultrasound before breast reconstruction surgery. The radiological image obtained before the procedure to the breast is very important for subsequent follow-up. Mammography / breast ultrasound shall be repeated 1 year after the operation.

These methods can be reconstruction through breast implants, or using the patient’s own tissues and combining both two methods together.

Silicone prostheses can be placed directly in subcutaneous mastectomy operations where the areola is also protected, and in skin protective mastectomy operations where the entire breast skin is protected. The implant is placed under the breast muscle. However, this procedure is suitable for a limited number of patients.

If there is skin loss during mastectomy, an empty silicone balloon called “Tissue Expander” is placed under the chest muscle. Approximately 3 weeks after the operation and after the healing of the tissues is completed, this silicone balloon is started to be inflated with saline injections. The swelling process takes 2-3 months. As the tissue expander swells, the breast skin over it gradually expands. This enlargement is similar to the enlargement of a women’s belly during pregnancy. The inflation process usually continues until 50% of the targeted breast size is reached. Later, the patient is re-operated, the tissue expander is removed and a silicone prosthesis is placed in its place.

Reconstruction operations are performed by importing the skin and subcutaneous tissues from various parts of the body. Tissues are carried along with the muscle underneath and the vessels that feed it. The importation process is done by carrying the whole muscle to the chest, or the tissue to be transported is completely separated from the body and its vessels are connected to the vessels in the chest. Tissues carried in this way are called “Flaps”. In breast reconstrucion, flaps are mostly prepared from the abdomen and back:

TRAM flap: The abdominal tissue under the belly is carried with the muscle in the anterior abdominal wall.

Latissimus Dorsi flap: The wing muscle on the back is carried to the chest wall from the armpit with the skin on it.

Many factors determine which method will be used, such as the condition of your tissues, your body structure, the treatment you have received, whether you have received radiotherapy, the stage of your tumor, the size of your other breast, your age, and whether you have given birth or not. After all these are taken into consideration, different options shall be evaluated. These options shall be discussed between the patient and the surgeon. Breast reconstruction is a long process and mutual decisions shall be made by talking to each other at each stage. In order to complete this process successfully, it is extremely important for the physician and the patient to understand each other well and to be transparent. Problems may occur at every stage of the process. These problems can only be handled if there is mutual trust between the surgeon and the patient.

Breast reconstruction procedures are usually multi-session operations. The entire process takes up to a year. Among these, the longest and most painful procedure is often the first surgery. Subsequent procedures are shorter and less painful.

If reconstruction is to be made with prostheses, tissue expander is placed in the first operation and if necessary, the other breast is also treated to provide symmetry; In the second session, the prosthesis is placed and symmetry is achieved. If it is to be performed with the patients’ own tissues, the tissue is removed in the first surgery and the opposite breast is shaped according to the situation. Minor revisions are required to provide symmetry in the second surgery.

In all methods, nipple repair is performed in the third surgery. This is a fairly simple procedure and can usually be done under local anesthesia.

Recently becoming popular, fat injection is used for limited removal of breast tissue. Or, if skin-sparing mastectomy is performed, subcutaneous volume can be increased with fat injection in the first session and breast prosthesis can be placed in the next session.