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Breast Reconstruction

What does Breast Reconstruction mean?

Breast reconstruction is surgery to reconstruct the breast in women whose breasts have been removed due to breast cancer. Breast cancer is one of the most frequent cancers seen among women. Is observed at a rate of about one in nine women. A person with breast cancer, is faced with not only the fear of cancer, but also the loss of the breast, which is a very important object of sexuality and milk production. In the treatment process of cancer, coping with the psychological problems arising from the removal of the breast is attempted.

When can breast reconstruction be carried out following mastectomy?

There are two approaches to this. Instant repair or late repair. The gains of instant or simultaneous repair in aesthetics is much better. It is usually applied in early stage cancers. However it is also applied in advanced stages of cancer. Breast built using the person’s own tissues are not an issue in the application of additional treatments such as radiation and chemo therapy. Late repairs, is the reconstruction of the breast following the completion of treatment following the removal of the breast.

What methods are used in Breast Reconstruction?

Basically, there are two different methods.

1) The creation of the breast using silicone prosthesis or tissue expanders.

2) Breast reconstruction using the person’s own tissue (autologous tissue).

Which technique will be selected varies on the general condition of the patient, the structural properties of the chest wall, the amount of tissue loss, and the preference of the patient and doctor.

Under what conditions is it possible to reconstruct the breast using only silicone prostheses?

If the tissue loss on the mastectomy (under size of the breast) is less than 5cm and there is sufficient skin and subcutaneous tissue to cover the prostheses in the mastectomy area then it is a method which can be selected. It is an easier solution compared to other methods. It may not be very natural in terms of appearance. If the chest muscle (pectoralis major) is still remaining then it is carried out with the placement of a silicone prosthesis of the appropriate volume under a space created below this muscle.

When is breast reconstruction by tissue expansion (balloon method) possible?

When the loss of tissue on the mastectomy side is 7-8 cm, and the tissue quality on the chest wall is sufficient for not causing problems during tissue expansion, in other words when the chest muscle was not removed during mastectomy, it can be selected. First a tissue expander is placed under the chest muscle (balloon), then the balloon is inflated at certain intervals to obtain the desired expansion. This period is about 3 months. When the expansion reaches maximum point, the balloon is deflated a certain amount, and 4-6 months is waited. Later the tissue expander is removed and a silicone prosthesis is placed permanently in the remaining gap. In recent years as some tissue expanders contain both the balloon and the silicone prosthesis, there is no need for them to be replaced at the end of treatment. 

What is breast reconstruction with abdominal tissue?

Abdominal tissue (rectus abdominis) flap breast reconstructionis the most commonly used and most popular technique for breast reconstruction in recent years. In this technique, the tissue which is to be disposed of during a tummy tuck is taken (this tissue contains abdominal skin, subcutaneous fat tissue and a small amount of flat abdominal muscle) it not thrown away and is used in breast reconstruction. With this surgery the patient’s tummy is also tucked. When the breast is reconstructed using abdominal tissue flap, there is no need for any other material to be used, the flap alone is enough to create even a large volume breast.

What is breast reconstruction with Latissimus dorsi?

If the lack of tissue at part with mastectomy is more than 7-8 cm, latissimus dorsi in the dorsum and some part of the skin on it are used to provide the necessary tissue support. Usually, this muscle solely is not enough to make a proper breast tissue and silicon prosthesis is needed to be used with it. If the breast will be made in a small size, only the muscle can be enough.

How many sessions are needed to recreate the breast?

2 or 3 sessions are necessary to complete the recreation of the breast taken off because of the breast cancer. In the first surgery, the recreation of the breast taken off as a mass in the surgery is done. In the third, both of the breasts are equalized in terms of shape and size. In the third session, the nipple is prepared for the breast that is recreated. We can think of the first surgery as a big surgery, the second as an average surgery and the third as small surgery.

 What is the creation of breast via microsurgery (Free Transplantation)?

It is the most sophisticated option of the reconstruction of a breast. The tissue is taken off from a far part of the body with its arteries and venae. After that, the tissue is brought to chest and it is planted into the arteries and venae in this region under a microscope and given the shape of a breast. Options for the transplanted tissues are belly phleb (Rektus abdominis), hip phleb (gluteal phleb), thigh phleb (anterolateral thigh phleb). Sometimes these phlebs can be prepared via the perforator veins that only go to the skin.

When and how are the nipple and areola reformed?

The recreation of the breast is the final stage of the surgeries. Usually, it is made with local anesthesia.  There are a lot of methods such as the local phlebs used in the reconstruction of the nipple, the usage of the half of the opposite nipple. For the creation of areola, skin vaccines or tattooing can be applied.

How much time is needed for the complete recreation of the breast?

People who are thinking of breast reconstruction surgery have to accept at the beginning the truth that they have to be patients in this process, this process will not be completed in one session and 2 or 3 sessions will be necessary. The first one of these surgeries is the biggest and the longest one. Other sessions are the equalization of the reconstructed breast with the other one which is a shorter process and sometimes the ones with local anesthesia (nipple reconstruction). The completion of this process can generally take from 9 months to 1 year. Sometimes it can be longer.

What is the best method for the reconstruction of the breast?

The condition that specifies which technique is the best and the most suitable one depends on the method used to take off the breast. In other words, after the breast is taken off, the decision depends on how much tissue is left in the breast wall and how the condition of this tissue is. The plastic surgeon will decide which method will be applied after examined you. While the appliance of silicon prosthesis is the best option for some patients, tissue expander surgery is applied to some and tissue transplantation is applied to some patients from the other parts of their bodies.

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