Rebuilding the breast removed due to cancer or other similar causes is called “breast reconstruction”. Today, it ranks first among surgeries, which are important in terms of making the patient happy. Thanks to the progressive new technologies, today it is possible to make reconstructed breast very similar to the other breast. In most patients, reconstruction can be made immediately after removal of the breast (mastectomy). Doing the two surgeries during the same session allows for the patient to avoid an extra surgery, and also provides psychological support to the patient, by ensuring that the place of the removed breast will not remain empty. In these patients, depression developing after removal of the breast, called “postmastectomy depression”, is more rarely encountered.
Breast surgery done after mastectomy is not a simple intervention. There are various options, and the surgeon and patient decide together on the procedure to be carried out.
Who are Suitable for this Surgery?
In the majority of patients, who have undergone mastectomy, there is no medical impediment to this operation, and the operation can be done in conjunction with mastectomy during the same session.
In some cases, there may be reasonable reasons for delaying the reconstruction. Some women may not want a reconstruction to be added to the spiritual and physical load created by a cancer surgery. Overweight people, hypertension patients, or smokers may need to wait. Even if they need to wait, discussing the reconstruction options before mastectomy would raise the moral of the patient to be operated.
There is no known effect of breast reconstruction on the recurrence of breast cancer. In addition, it does not affect chemotherapy (drug therapy) or radiotherapy (radiation therapy) that can be done after mastectomy.
Delaying the reconstruction would bring more psychological load. In patients, who have not undergone reconstruction immediately after mastectomy, additional psychological traumas develop as a result of trying to get used to the sense of insufficiency caused by both breast and tissue losses, and then to get used to the new breast after reconstruction.
Surgery
Reconstruction alternatives must be assessed immediately after the diagnosis of breast cancer. Ideally, the plastic surgeon who will do the reconstruction should determine the best option for you, in consultation with the plastic surgeon that will do the mastectomy.
The patient’s overall health status, anatomical structure, texture properties and objectives have an effect on the procedure to be determined.
Because breast reconstruction is not a surgery done for aesthetic purposes, many health insurances cover the costs completely or at least partially.
Breast reconstruction surgery is sometimes done in two sessions instead of one session.
Reconstructions Performed with Tissue Expansions or the Use of Breast Implants
It is the most commonly applied breast reconstruction option. This surgical is done using implants (breast prosthesis). Implants are materials filled with silicone gel, which are enclosed by a silicone sheath. Today, the procedure can be completed in a single session, thanks to the breast implants that both expand the tissues and serve as an implant, besides the procedures that involve the application of tissue expander in the first session, and the placement of breast implants in the second session. The process of expanding the tissue can take 2-3 months after surgery and at the end of this period, the newly constructed breast reaches its exact size. This is the period of time needed for the expansion of the tissue. Reconstruction of the nipple and the surrounding dark area (nipple-areola) can be made under local anesthesia in another session. In some patients, an adequate amount of breast skin may remain after mastectomy. In such a case, there is no need to change the tissue, and the procedure can be completed with simpler implants in a shorter period of time.
Reconstructions made with tissue transplantation
Reconstructions can also be made with the transfer of tissues, taken from some regions such as the abdomen or back, into the breast reconstruction.
Tissue transplantation can be done in two ways. The tissue (called flap) to be transplanted is transferred while it is still connected to its original blood vessels from one of its edges. But any flap that contains skin, fat or muscle is transferred while it is free from its connections, and then the blood vessels are repaired in its new place. For this second method, the plastic surgeon needs to have the experience required for breast reconstruction, as well as a good command of microsurgery.
In reconstructions made with tissue transplantation, mostly breast implants are not used, and the fullness of the newly constructed breast is provided by the patient’s own tissues.
The patient needs to stay in the hospital for a period of two to three days, depending on the type and duration of the surgery. Returning to normal daily activities takes up to two weeks. This period is shorter in reconstruction operations made with implants alone.
After Surgery
The shapes and characteristics of the newly constructed breast tissue may not be the same with that of the other breast. The aim is to achieve a similar result as much as possible. But the minimal changes will be noticeable by only you, not the people around you.
Breast reconstruction is a surgical procedure that makes significant changes in both the appearances of patients and their outlook on life. In a research conducted on patients who have undergone breast reconstruction in the United States, it has been stated that 98% of patients would want to have a breast reconstruction again in case of recurrence of the same problem.
Surgeries to be Performed on the Other Breast
With intent to provide a better symmetry, the other breast can also be intervened in conjunction with breast reconstruction in the same or another session. The other breast can be reduced, augmented or lifted, for ensuring it to be harmonious with the newly constructed breast. In some patients, who have undergone breast cancer surgery and are at a high risk, the tissues of the other breast can be discharged and then a breast implant can be applied, even if it is not cancerous. In this way, the risk of future cancer development in the other breast is eliminated.