Breast Reconstruction
Breast reconstruction is a general description of surgical procedures for reconstructing the breast in the case of partial or complete removal of the breast due to cancer or other cause. After mastectomy, some women may feel an incomplete integrity or loss of femininity. The loss of the breast, which is a very important organ for women, or the impairment in its shape, causes serious negative effects on the woman’s psychology.
Surgical operations for reconstruction of the breast do not affect the surgical intervention of the individual for cancer and the subsequent oncological treatment and follow-up period. For this reason, it is absolutely necessary to tell patients that their breasts can be reconstructed.
When is breast reconstruction performed?
Breast reconstruction can be performed simultaneously or later with the cancer surgery, depending on the general condition of the patient, the size and stage of the mass. Simultaneous breast reconstruction with the cancer surgery allows the patient to wake up with the breast after the same operation. Reconstruction may also be performed after an oncological treatment is completed, in cases where simultaneous reconstruction is not possible or the patient does not prefer. The timing and the technique to be used are determined by the body structure, general health condition and expectations of the patient and whether or not the patient will receive radiotherapy after the cancer surgery.
What are the methods of the breast reconstruction?
There are many options for patients who decide that the breast reconstruction after mastectomy is the right decision for themselves. The breast reconstruction can be performed by using the individual’s own tissues, silicone prostheses specially produced for these surgeries or combination of both of these. Breast reduction methods are also a frequently used technique for the breast reconstruction after the removal of the tumour area in patients with large breasts.
It may be necessary to perform additional surgical interventions for the newly created breast or other breast to provide a symmetry and correction of the appearance after the breast reconstruction. Such as the reconstruction of the nipple and the areola (the dark part around the nipple) and provision of the symmetry of other breast after the newly formed breast tissue is healed.
The method to be used is determined by taking the stage of the patient’s disease, the possibility of receiving subsequent radiotherapy, life style and desires, the shape and size of the breast and the presence of a systemic disease into consideration. Those with small or medium-sized breasts are the best candidates for the breast reconstruction.
1) Breast Reconstruction Performed with Silicone Prostheses
It is performed at one stage or two stages depending on the mastectomy technique to be used and the shape and size of the breast.
In the single-stage breast reconstruction, the breast surgeon removes the breast tissue and then the breast implant is placed by the cosmetic surgeon. This procedure is usually preferred in patients whose breast tissue has been conserved and who will not receive radiotherapy afterwards.
In the first stage of the two-stage breast reconstruction, a tissue expander (a balloon-like syringe prosthesis that can be inflated and deflated from outside) is placed. The tissue expander is placed in the deflated position and inflated at regular intervals with a physiological saline solution. As the tissue expander is inflated, the surrounding tissue expands. Thus, a pouch is formed on the chest wall to place the breast prosthesis. A few months later the tissue expander is removed and the silicone breast prosthesis is implanted. The tissue expander can also be placed during mastectomy or months or years after the mastectomy.
This method is also preferred for the simultaneous or late-term breast reconstruction in patients whose breast tissue is conserved and who will receive radiotherapy afterwards.
Depending on whether the surgery is lateral or bilateral and depending on the area where the prosthesis will be placed, the duration of surgery may take one or several hours. The length of hospital stay depends on the type of the surgery, development of postoperative complications and the general health condition of the patient.
2) Breast Reconstruction Performed with Autologous (Patient's Own) Tissue
It is surgical techniques that allow to complete the completely or partially removed breast and to reconstruct a new breast with the tissues transplanted from the patient’s own body. The breast reconstruction is performed by transplanting a piece of a tissue consisting of skin, fat and muscle from one side of the body to another. This transplanted tissue is called a flap.
The flap tissue is either transplanted by moving through a tunnel to the breast area (pedicle flap) without incising the self-supplying vein or by incising the supplying vein completely and anastomosing to another vein in the breast area using microsurgical methods (free flap). Although the tissue to be transplanted to the breast area is supplied from many regions of the body, the most commonly used regions are the abdominal region and back region. The most commonly used muscle-skin flaps are TRAM flap taken from the abdominal region and the latissimus dorsi flap taken from the upper part of the back.
Flap surgeries take longer than the prosthetic surgery and require longer periods of hospital stay. It is the first choice in patients who will receive post-operative radiotherapy and in patients whose chest wall tissue is damaged due to radiotherapy.
Patients who have a systemic disease, overweight problems, smoke and patients who underwent a previous surgery in the flap area and who have circulatory problems are not eligible for flap procedures. Again very weak patients who do not have a sufficient amount of a tissue in their abdomen and back, are not eligible for this method or a combination should be made with prosthetic procedures for these patients.
Postoperative Period
A little postoperative pain, oedema, bruise and tenderness will occur. These complaints usually regress within a few weeks. Bleeding, hematoma and infection are the complications that may occur in the early term.
In the long term, complications due to chemotherapy and radiotherapy may be occur.
The outcome to be obtained depends on many individual factors:
- General health condition of the patient
- The structure of chest wall and body shape
- Radiation, chemotherapy, smoking, alcohol and drug use
- Skills and experience of the surgical team
- The type of the surgical method
- Type and size of the prosthesis