Breast Reconstruction

Breast reconstruction, which is also known as reconstructive mammoplasty or postmastectomy surgery, involves various procedures aimed at restoring the breast to its original shape after mastectomy or lumpectomy surgery, where the breast is removed due to a tumor or another disease. Factors such as the anatomy of the individual, aesthetic expectation and the need for chemotherapy treatment after surgery are determinants. Since the proposed cancer removal surgery can significantly affect the selection and results of any type of breast reconstruction, it is absolutely necessary to consult with your plastic surgeon before mastectomy.

When Should Breast Reconstruction Be Considered?

- After mastectomy procedure is performed and the cancer is completely eliminated with mastectomy,

- If you believe that this reconstruction process will make you feel whole and better psychologically,

- If you feel that you have lost your sense of femininity and self-confidence,

- If only one of your breasts is affected and you want to achieve symmetry,

- If you feel constrained in your choice of clothing.

Pros

- Not having to use chest form or pads,

- Reducing/removing traces of your mastectomy and breast cancer process and experience,

- Regaining your self-confidence in terms of your appearance and sexual activity.

Cons

Breast reconstruction can affect the natural process of your body to regain its health.

Reconstructed breast will not feel the same as before, it will not have senses.

These are the situations that individuals, who want to undergo this procedure, should consider before the deciding on the procedure.

What are the Necessary Conditions to Achieve Healthy Results in Breast Reconstruction Surgery?

Body mass index below 30,

Absence of serious health problems with circulation, high blood pressure and etc.,

Not smoking,

Having completed the radiation treatment,

Having completed the chemotherapy after mastectomy,

If you meet the detailed conditions mentioned above, if your overall health is good and you have realistic expectations, if you feel ready and have a positive attitude about this procedure, you can be an excellent candidate for this procedure.

Breast reconstruction procedure?

Breast reconstruction can be performed using several different techniques. Among these, the most preferred technique is the skin expansion procedure. The techniques used are as follows:

Implant reconstruction

This technique has two or three steps.

- In the first step, your surgeon places a tissue expander that creates a skin-muscle envelope under the skin and chest muscle. The tissue expander is a modified saline implant with a valve that allows more saline to be added after the initial surgery. Serial injections of saline through the skin into the valve slowly fill the implant, and then expand your breast pocket. By repeating this process every two to six months, the skin-muscle envelope is slowly stretched until it reaches the desired size for the implant.

- In the next step, the procedure involves the removal of the expander and the placement of the breast implant (saline or silicone).

Sometimes, saline implants and the expander is held in place for a longer period of time, allowing the reconstructed breast to be resized (increasing or decreasing the amount of saline) without removing the implant.

- It is rare to place the implant (saline or silicone) directly, without tissue expansion. This requires the size of the skin-muscle envelope to be large enough to cover the final desired implant at the time of mastectomy.

Skin expansion

The most commonly used technique is expanding the skin and placing a prosthesis. After mastectomy, a tissue expander is placed under your skin and chest wall muscle. A valve-operated port is placed under your skin, and from there, your surgeon injects saline to inflate your tissue expander for weeks or months after surgery. When your skin has expanded enough, the tissue expander is removed with a second surgical procedure, and a more permanent prosthesis is placed. Some tissue expanders are designed to be left on permanently. The areola (brown round skin around the nipple), and the nipple are treated afterward. Some patients do not need skin augmentation, and a prosthesis can be placed with mastectomy.

Flap reconstruction

As an alternative to the prosthesis technique, a breast can be formed by obtaining tissue from the back, abdomen or hip. This is called flap reconstruction. In one type of flap surgery, the skin, subcutaneous fat layer and muscle tissue remain connected to the original attachment area by a vessel stem, and they are relocated to the area where the breast will be formed with the help of a tunnel made under the skin. It can form the breast alone, or a prosthesis can be placed under this tissue. In another type of flap surgery, the tissue is completely separated from the abdomen, back or hip area to which it is attached, and its vessels are sutured to the vessels in the recipient area to survive (reconstruction with a free flap). In order to perform this procedure, the plastic surgeon must be experienced in microvascular surgery. Because; thin vessels can be sutured to each other under the microscope.

Both surgical techniques are more complex procedures compared to the prosthesis technique. There will be incision marks in the areas where tissue is removed and the breast is formed, and the healing process is longer. However, in breast reconstruction made with your own tissue, the result is more natural, and there is no concern about silicone.

Secondary surgeries

Breast reconstruction requires several surgical procedures over time. The first one is the most complex procedure, and secondary surgical procedures are easier. If the tissue expander reconstruction technique is selected, the tissue expander can be removed and a prosthesis can be placed, or the nipple and areola can be reconstructed. In most cases, the normal breast may need to be slightly reduced, lifted or augmented in order for the newly made breast to adapt to the normal breast on the opposite side. However, it should be considered that scars occur in these procedures.

Risks

Serious risks are rare, and the post-operative satisfaction rate is high in breast reconstruction surgeries.

Yet, all surgical procedures have a certain degree of risk. Some of the possible complications of all surgical procedures include:

- Reaction to anesthesia

- Hematoma or seroma (accumulation of blood or fluid under the skin, which requires removal)

- Infection and bleeding

- Changes in skin sensation

- Scarring

- Allergic reactions

Process After The Surgery
Patients are usually discharged within 2 days depending on the surgical technique. During this period, possible pain experienced after the surgery is taken under control, and the general recovery status of the patient is observed. Since the stitches are dissolvable, patient comfort increases, and it takes 4 weeks for patients to return to their normal lives. Before that, it is possible to perform the daily routine without spending too much effort; however, patience is needed for a full recovery. Although the breast is very realistic in terms of appearance, it may take some time for patients to get used to the feeling. Some patients with prosthetic breasts have stated that they gain some sense over time.