Breast Reconstruction

The second most common type of cancer in women is breast cancer. According to statistics, one out of every eight women is diagnosed with breast cancer throughout her life, and all or a part of the breast is removed with an operation called “Mastectomy”. Considering this rate, millions of women lose some or all of their breasts due to cancer every year.

The breast is an organ that is of great importance for a person to feel attractive, beautiful, normal and full. Breast loss causes deep psychological and sexual problems in women. For this reason, after the decision of mastectomy surgery, which causes the loss of this organ, which is the symbol of motherhood and femininity, is made, the patient must be consulted with a plastic surgeon and it should be ensured that he receives information about both simultaneous and delayed reconstruction, that is, the reconstruction of the breast. With the stress and haste of being diagnosed with cancer, this stage is usually skipped and after mastectomy, the patient is expected to cope with the negative effects of being breastless on his own. If sufficient information is given before mastectomy, many women can choose breast reconstruction simultaneously with mastectomy and wake up from the surgery and continue their lives without experiencing the physical and psychological difficulties of organ loss.

Thanks to technological advances, it can also be determined whether some people have familial breast cancer genes (such as BRCA1, BRCA2). After genetic examination, these people have a mastectomy because they have a high risk of developing breast cancer. In this special group of patients, the importance of simultaneous breast implantation cannot be denied, since removing breasts at an early age due to possible risks will also cause physical and psychological problems.

When can breast repair be done?
The patient with breast cancer must be evaluated together by a team that includes the disciplines of general surgery, oncology, radiation oncology, pathology and, of course, plastic surgery. To the time of breast repair; The decision is made after evaluating many factors such as the stage of the disease, the possibility of receiving radiotherapy or chemotherapy after breast removal, the age and body structure of the patient.

Simultaneous Repair: Repair is performed in the same session as mastectomy surgery. This method is generally preferred in patients who are in the early stage and will not receive radiotherapy/chemotherapy.
Late Repair: After mastectomy, repair is performed at a later time (after radiotherapy/chemotherapy).
Delayed – Simultaneous: At the end of the mastectomy operation, an expander (= balloon) is placed under the breast muscle. By inflating this balloon, it is ensured that it reaches the required volume to obtain an area where we can place the prosthesis. After the radiotherapy/chemotherapy is finished, the expander is removed and the main permanent prosthesis is repaired.

What are breast repair techniques?
There are three basic repair methods in breast repair:
Repair with the patient’s own tissues (autologous breast repair): It is usually performed using the patient’s back or abdominal tissue. These surgeries can be planned with microsurgical method (DIEP, free TRAM) or without microsurgery (pediculated TRAM). This repair method should be preferred especially in patients who will receive radiotherapy. Since it is a living tissue, it is more resistant to the negative effects of radiotherapy. However, if the patient’s own tissue is used in surgeries, if there are problems with the nutrition of the tissue carried to the chest wall, partial or complete loss of the tissue (necrosis) may occur. In this case, the dead (necrotic) tissues may need to be cleaned and re-operated.

Repair with prosthesis: For the treatment of breast cancer, the entire breast with its skin, according to the stage of the cancer; or by protecting the breast skin or even the nipple, it can be taken to contain only the breast tissue. Recently, breast cancers have started to be diagnosed at an early stage, as early diagnosis has increased thanks to breast cancer screening and awareness development. Therefore, nipple/breast skin protective methods are frequently used. When there is sufficient breast skin, the results of repair with simultaneous breast prosthesis are quite successful. If there is not enough skin tissue left, a silicone balloon is placed under the chest muscle. After a while, this balloon begins to inflate. When sufficient volume is reached, the balloon is removed and a permanent silicone prosthesis is placed.
Repair in which two methods are used together: In general, the back muscle is taken and the tissue on the chest wall is turned into the missing area. A silicone prosthesis must be placed underneath to achieve sufficient volume.

How is the repair done with abdominal tissue?
These tissues can be used in breast repair in women with excess tissue in the abdomen. In this method, the abdominal tissue is taken as in abdominoplasty and used to create the new breast using microsurgical methods. Depending on the situation, some of the abdominal wall muscle may also join this tissue. Thus, the patient has both tummy tuck and breast repair at the same time. Previous tummy tuck or liposuction