Reconstruction of the breast after breast cancer

Mastectomy surgery is shown as one of the most widely used and most reliable methods in the treatment of breast cancer. Stating that the deformation caused by the removed breast tissue can be effectively treated with plastic surgery, Dr. Reha Yavuzer told about the new treatments. The breast has been and continues to be one of the most important elements of the female body from past to present. In addition to femininity, breast tissue, which is a symbol of productivity, motherhood and sexuality, can suffer from various diseases. Perhaps the most frightening of these diseases, breast cancer is of course.

Breast cancer is increasingly observed in the society, and it occurs in one of every eight women at some point in her life, especially in Western societies. Despite advanced chemotherapy and radiotherapy methods, the best method that medicine knows is still surgical removal of breast tissue for breast cancer. Depending on the type, extent or other criteria of breast cancer, breast tissue is partially or completely removed.

This surgery, called mastectomy, is still the most widely used and safest method for the treatment of breast cancer. Whether it is partially removed or the entire breast tissue is removed, the remaining physical deformation can have very heavy psychological repercussions. We tried to explain what plastic surgery can offer about breast reconstruction, which is a breast reconstruction operation, for women whose breast tissue was removed due to breast cancer.

What is breast reconstruction?

What kind of surgery does it require?

Breast reconstruction is the process of reconstructing the breast tissue of a woman whose breast tissue was removed for mastectomy. Breast repair can be done in two periods in terms of timing. One of them is simultaneous or immediate repair.

In this case, in patients diagnosed with breast cancer, breast reconstruction is required after mastectomy in the session in which breast cancer surgery was performed. Early-stage breast cancer patients are suitable candidates for simultaneous repair. It may be a more accurate approach to apply repair after a few years without disease for patients who are diagnosed at an advanced stage or who will undergo radiation therapy (radiotherapy). This is called late repair.

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. Thus, the most appropriate decision for the patient will be determined by discussing in detail in every aspect. This council should be decisive in both the form and timing of cancer treatment and the type and timing of breast reconstruction. While all these processes are running, the patient’s wishes and priorities are also taken into consideration, but the treatment needs are always at the forefront.

One of the methods that can be used to reconstruct the breast is breast reconstruction with the patient’s own tissues. The first preferred area for breast repair performed with the patient’s own tissue is the abdominal tissue in the lower part of the navel. The abdomen is a soft, malleable area that is very similar to a normal breast and provides adequate tissue. The complication rate is low when the right patient selection is made and the right techniques are used.

Aesthetic results are quite good. In the use of abdominal tissue for breast repair; It is desirable that the abdominal tissue is in sufficient condition for such an application, that it is a little saggy and oily. During the examination of the patient, the plastic surgeon will give information about whether the patient’s abdomen is suitable.

Among the weaknesses of the surgery are the length of the operation time, 3-8 hours depending on the technique, and the length of stay in the hospital (5-7 days) after the operation. In addition, this method is not a suitable option for patients who do not have subcutaneous adipose tissue, who have very thin and very small breasts. Since the vessels feeding the abdominal skin may be damaged in patients who have had tummy tuck or liposuction surgery before, the chance of its application in these patients is negligible. In patients who are very obese or smoke a lot, this method should be avoided since the risk of complications is high.

Other tissues that can be used in patients for whom abdominal tissue is not suitable are found in the back, hip and waist regions. Among these, the latissimus dorsi muscle, which we can also call the back muscle, is used together with the skin, and sometimes silicone prostheses are placed for support purposes. If a breast prosthesis will be used with this method, the prosthesis is placed under the muscle and a better breast shape is tried to be obtained. The surgery is performed under general anesthesia.

Depending on the details of the technique to be applied, the duration of the operation is around 4-6 hours in unilateral surgeries and 10-12 hours in bilateral surgeries. Compression stockings are put on the legs to avoid embolism and similar problems during this surgery.

In surgeries where the patient’s own tissue is used, the success of the surgery depends on the nutrition of the tissue carried to the anterior chest wall to make breasts. If there are problems with tissue nutrition, partial or complete death of the tissue (necrosis) may occur. In this case, the area may need to be cleaned and operated again. In appropriately selected patients, it may be possible to make breast tissue with only a silicone prosthesis.

In this method, the operation time is shorter and recovery occurs faster; however, it may not be suitable for every patient. While a silicone prosthesis can be placed directly, in patients who do not have enough tissue, first balloons called tissue expanders are placed and the balloon is inflated over time. After the inflation process is completed by injecting liquid into the balloon and tissue flexibility is achieved, the balloon is removed and a permanent silicone prosthesis is placed.

What is the recovery period like?

On the first day after the surgery, after bowel movements have started, you are allowed to eat and drink something, and you will be allowed to stand up. From the moment you stand up, the urinary catheter can now be withdrawn. In the first days, walking in a slightly bent position from the waist will reduce the tension in the abdomen (in patients who have breasts with abdominal tissue). When the amount of drainage decreases, the drains are withdrawn and your movements are allowed to increase gradually.

During this period, wearing an abdominal corset for about 6 weeks is beneficial for the healing process. Providing symmetry with the other breast can be done with retouching surgery, which may be required for the reconstructed breast in a second surgery. The procedures to be applied to the healthy breast can be breast reduction, breast lift or breast augmentation.

Making the nipple is performed under local anesthesia in the 3rd and 4th sessions, which will be held 2-3 months after the first operation. The most common method for this procedure is to form the nipple by sliding small tissues on the new breast. In the meantime, a skin patch can be taken from another part of the body and the brown part of the nipple called areola can be made. Another frequently used method is to create the areola with the tattoo method 2-3 months after this session. The stage of making the nipple and its surroundings is mostly performed under local anesthesia and does not disrupt the daily life of the patient much. However, the nipple and its circumference are of great importance for the reconstructed breast to gain its true naturalness and beauty.

What are the risks of this operation?

Apart from the risks that may occur in every surgical intervention, the following situations may occur:

  • Change in skin sensation: Bringing the abdominal tissue to the breast area is not sufficient to create sensation in this region. The tissue that is brought in is a tissue devoid of sensation. Even the skin feels numb for a very long time. It will take months or even years for the full sensation of the breast tissue to occur in patients using silicone prostheses. The main reason here is the removal of the breast tissue, that is, the removal of the skin during mastectomy and its complete evacuation.
  • Scars: Scars remain in the lower abdomen and around the newly formed breast. Usually, these scars fade to indistinct within a year, but never completely disappear. On the chest, there are traces of mastectomy. If the back tissue is used, then a scar will remain in the back area.
  • Tissue loss or wound opening: Sometimes, depending on the tension and circulatory disorder, we may encounter separations and healing delays in the wound, and a part of the breast formed from the abdominal tissue may not be fed. This risk increases even more in breast tissue that has undergone radiotherapy.
  • Fat necrosis: Tissue death may occur and volume may be lost.
  • Extreme hardness: We may encounter long-lasting stiffness due to malnutrition in the tissue brought in those who undergo radiation therapy, smokers and those with circulatory problems.
  • Incompatibility with the opposite breast, asymmetry: The newly created breast may not be in perfect harmony with the breast on the opposite side.
    Problems in the abdominal wall: It is normal to have numbness in the abdominal skin, which is expected to improve within 3-6 months.

How is nipple reconstruction done?

Nipple reconstruction refers to the reconstruction of the nipple and areola after breast cancer and other conditions. There are different methods for reconstructing the brown area called the areola around the nipple and its surroundings.

Among these, skin patches taken from other parts of the body, tissue shifting from the breast skin to the nipple or sharing the tissue taken from the other nipple can be used. Other techniques, such as tattoos, can be applied to give color to the tissue.

How should my breast exam be?

Every woman is her own breast examinationshould know what to do. It should be checked by an obstetrician and general surgeon to be informed about this issue. It is very important for the patient to show a doctor any stiffness or change that occurs during his own examination without neglecting or delaying it.

What causes breast cancer? Symptoms, treatment and palpation

It is important to have both ultrasonography and mammography checks done at intervals that the doctor deems appropriate. Treatment success is very high in early diagnosed breast cancer. Previously, I had silicone implants to enlarge my breasts.

So what is my situation?

Silicone breast prostheses do not cause cancer. The placed silicone prostheses are located behind the breast tissue or muscle tissue. Therefore, it does not constitute an obstacle for breast examination, ultrasonography and mammography. Periodic examination and radiological examinations should be performed in individuals with silicone breast prosthesis, as in other women.

It is worth emphasizing once again that silicone breast prostheses do not cause cancer. There has been a misconception due to the news about a French company recently. In the evaluation made by the International Society of Aesthetic Surgery (ISAPS), it was observed that the prostheses produced by this company in only one period were more easily torn than normal, but no finding that it caused cancer in any way could be detected.

Silicone breast prostheses have a long history all over the world. All studies have shown that silicone breast prosthesis is not associated with cancer. For this reason, it is used safely not only in Turkey but also in all countries around the world. Women who have a silicone breast prosthesis also need regular control and examination of their breast tissues, but no further precautions or examinations are necessary.

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