Breast Reconstruction in Women – How Does The Treatment Process Work?
Breast Reconstruction
Breasts, which are one of the most important organs in the female body both visually and physically, also prioritize the self-confidence of the woman. Today, breast cancer is one of the diseases that women are most afraid of and most affected by.
Breast surgery followed by breast reconstruction is very important for a woman with breast cancer. Psychology of every woman is greatly affected after surgery.
After surgery in some women; Introverted problems such as depression, lack of sexual appetite, anxiety for recurrence of the disease, difficulty in finding suitable clothes, and inability to adapt to the clothes they wear are observed.
Thanks to scientific innovations and technological developments in the medical world, breast surgeries can be performed that provide a natural appearance instead of the breast taken. As a result of breast reconstruction, many women start their lives with a new page.
Women who have undergone breast reconstruction; While they provide a better appearance to themselves physically, they also display a mood that is at peace with both their surroundings and themselves. Women who have breast reconstruction fight the disease stronger.
Therefore, breast reconstruction surgery is more of a reconstruction (repair) surgery than a cosmetic surgery.
Before the breast reconstruction operation, the patient; It is evaluated by a team of experts from fields such as general surgery, plastic and reconstructive surgery, medical and radiation oncology, and the operation process is managed by determining the most appropriate treatment option.
What is the Right Timing for Breast Reconstruction?
Breast reconstruction can be performed on many women whose breasts have been removed due to cancer. Breast reconstruction operation is performed when the breast is removed (simultaneously) or in the next process (late repair) as deemed appropriate by the doctor.
Simultaneous Breast Reconstruction
It is usually performed in breast cancer detected at an early stage. Simultaneous breast repair; It helps to minimize the possible psychological problems of the patient whose breast is removed by protecting the breast skin.
Simultaneous breast repair is when general surgeons perform mastectomy and plastic surgeons perform breast repair at the same time.
Late Breast Repair
In some cases, it may be necessary to wait for a breast reconstruction operation. Patients may need to admit cancer, not want breast reconstruction or other surgical procedures, or wait for a while on the advice of their doctor.
Late breast repair is called surgery performed after a certain period of time (such as 6 months or 10 years) after the mastectomy procedure.
Creating Breast Tissue
Regeneration of the removed breast can usually be done in two ways. Breast tissue is created with breast prostheses and parts taken from the patient’s own tissue (autogenous tissues).
Certain criteria are followed in order for the patient to perform breast repair with prosthesis or his own tissue. After these methods are explained to the patients, if the patient prefers his own tissue, repair with his own tissues is preferred.
If the skin tissue and muscle tissue in the area where the breast will be repaired are insufficient, the patient’s own tissue is preferred instead of implant (prosthesis) repair in such cases.
These;
Age of the patient
General condition of the patient
Mastectomy performed on the patient (skin, muscle, removal of the nipple and the condition of the opposite breast)
Whether or not to receive radiotherapy
Body composition (such as weight and height)
The proportion of breasts (the size or sagging of the opposite breast)
In the selection of the operation, issues such as the patient’s health status, age-weight characteristics, when the breast removal and repair will be performed, whether the patient will be applied radiotherapy or not are taken into consideration.
Breast Repair with Prosthetics
Breast implants are of two different types: saline and gel formula. The outer surface of the prosthesis consists of a silicone layer. Prosthetic breast repair operation is a shorter and simpler method compared to other methods.
Thanks to this operation, a breast repair operation is performed by placing a prosthesis on the removed breast. Although it is not common in such breast repairs, conditions such as prosthesis deflation or rarely infection may be encountered.
One of the rare disadvantages in breast repair with prosthesis is that the breast is far from natural appearance in cases such as tissue hardening around the prosthesis.
- Round Denture:
Round prostheses are generally preferred for cosmetic operations, not breast repair. - Anatomical (Drop) Prostheses:
Anatomic prostheses are preferred in breast repair because the breast is completely removed. The outer wall of these prostheses is covered with silicone material. It is filled with silicone gel or liquid (serum).
Are There Risks of Prosthesis?
Although rare, some risks may develop due to foreign body placement in prosthetic breast repair operations:
Infection
Lowering the prosthesis
Complications such as the loss of the natural appearance of the breast due to the development of hard tissue around the silicone prosthesis are rarely encountered in prostheses produced with high technology.
Do Dentures Have a Life?
The life span of prostheses in breast repair varies between 15 and 20 years, so the prostheses must be replaced after a while. Depending on the body structure, the life and duration of the prosthesis varies.
Reconstruction may be required in cases such as deformities in the breast, weight gain and loss. In this case, the prosthesis is changed by re-entering the existing incision.
Can Breast Prosthesis Ramp?
Breast implants; The prosthesis does not burst during lying down or pressure on a seat belt or similar pressure. However, any piercing or cutting can be punctured after trauma. Perforation in such cases
Since the gels used in breast prostheses are 4th generation FDA (US Food and Drug Administration) approved gels, there is no harm to the person. Even if the material inside the prosthesis is pierced, it does not spread, flow and damage the body.
Ultrasound can be checked to see if the prostheses are punctured. In addition, situations such as puncture of prostheses do not contain risks such as cancer or triggering cancer.
Breast Repair with Patient’s Own Tissues (Autogenous Tissues)
Breast reconstruction, made from the patient’s own tissue, is a more complex operation that requires more surgical experience than prosthetic breast repair.
Operations performed with the patient’s own tissues (autogenous tissue) are generally applied in late period breast repairs. It is preferred in patients who have received chemotherapy and radiotherapy, who have not undergone breast repair after mastectomy or who have undergone unsuccessful procedures.
Implant (prosthesis) and breast repair in the area where radiotherapy is applied often cannot provide the desired success in terms of both aesthetics and naturalness. For this reason, breast repair is performed with tissues taken from the abdomen, back, hips and legs to give the breast a more natural appearance.
If the operation fails in patients who have had implants (prostheses) before, breast repair with the patient’s own tissue is preferred.
In some patients, breast repair can be performed using both the patient’s own tissue and the implant (breast prosthesis). Especially if the back tissue is to be used in breast repair, it is often used with an implant (breast prosthesis) due to the thinness of the back tissue.
Autogenous Tissues;
Breast repair operation is performed by moving the skin and subcutaneous fat tissue located in the lower part of the abdomen and one of the muscles located in the anterior abdominal tissue (transverse rectus abdominis muscle (TRAM)) to the breast area. With this operation, the patient is also performed a tummy tuck operation.
The skin above the muscles on the side of the back and the muscle underneath it are carried to the breast area and used for breast repair. However, since the skin and underlying tissues in the back area are thin, these tissues are used together with an implant (breast prosthesis) to provide volume. At the end of this operation, the surgical scar in the back area is hidden under the underwear.
By transferring the skin or subcutaneous fat tissue in the leg and hip area, that is, microsurgery, the breast area is repaired.
Treatment Methods
Microsurgery
First of all, the plastic surgeon performing these operations must be experienced in microsurgery. With free tissue transfer (microsurgery), the skin and subcutaneous fat tissue in the abdomen, back and buttocks are transferred to the reconstructed breast area together with the vessels that feed these structures.
In order to create the breast, the vessels of the tissues brought from the abdomen, back or hip area and the nourishing vessels in the area where the breast will be made are successfully stitched together using a microsurgical technique under a surgical microscope.
Thus, the nourishment of the transferred tissues is ensured to form new breast tissue. Surgeons who will perform such operations must be experts in microsurgery. It is possible to sew thin veins stitched together only under a microscope.
Since the repairs performed with autogenous tissue are similar to breast tissue, breast operations performed with the patient’s own tissue are more similar to the natural breast. In terms of physical and sensory feel, it is better than prosthetic breast repair operations.
The softening of the tissues used after the operation and the reduction of the scars over time increase the feeling of satisfaction in the person. Breast operations performed with autogenous tissues respond more appropriately to situations such as weight gain and loss, such as natural breasts.
In this case, if the person experiences weight gain or weight loss after breast repair or sagging due to age, the symmetry difference between both breasts will be more natural.
Can Breast Reconstruction Surgeries Be Combined With Fat Injection?
In some cases, fat injections can be applied to the breast during breast reconstruction operations. While breast prosthesis is placed for breast repair in the same surgical operation, fat injection can also be performed in the same session.
In a breast that was previously made with a breast prosthesis for breast repair, fat injection can then be applied to the breast in order to achieve a better aesthetic result.
Fat injection can be applied to a breast that has been repaired with the patient’s own tissue (autogenous) in order to achieve a more successful aesthetic result. The oil acts like a camouflage for breast repairs.
In some weak patients, the prosthesis and skin are very close to each other and can be felt under the skin. Especially if the person has had radiotherapy, the skin becomes thinner and the prostheses become more prominent. In this case, the fats taken from the abdomen or back area with the help of cannulas are injected into the necessary areas in order to eliminate the collapsing, dimpled or prominent appearance of the prostheses and to have a more aesthetic and softer appearance.
Repair of Nipple and Areola
After the breast is removed, more than one operation is required to obtain a natural breast. The first operation is the most complicated. In the first operation, the process of creating breast tissue is performed.
In the second operation that follows, the areola (dark circular area around the breast) and the nipple are formed. These operations are usually performed under local anesthesia from the tissues in the nipple area.
The areola (dark areas around the breast) can be tattooed, and the skin taken from the other nipple or groin can also be used.
Ensuring Symmetry Between Breasts
In cases where unilateral breast repair operations are performed, it should not be expected that the breast is at a symmetrical angle with the other breast after the operation. Breasts made in breast repair (with prosthesis or their own tissue) are more upright, smaller and younger than the existing breast.
For example, the patient’s breast may be sagging due to age or birth, but the newly made breast does not. In these and similar cases, various operations can be applied to the other breast to ensure symmetry.
It is compared to the newly made breast with different operations such as lifting, reducing or enlarging the other breast. If the breast is small, the implant (prosthesis) is placed and the other breast is enlarged, or if it is a sagging breast, a lift is performed. If the breast is both sagging and large, then lifting and reduction is performed.
After Breast Reconstruction Operation
After the operation, pain can be prevented to a great extent thanks to the medications approved by the doctor. It may be necessary to stay in the hospital for a period of 2 or 5 days after the operation.
Drains placed in the breast area as a barrier to prevent accumulation of fluids during the operation are removed within a few days after the operation. Returning to daily work after breast reconstruction may vary depending on the operation.
If the doctor deems appropriate, the patient can return to his normal life usually within 2 to 4 weeks. In breast repair operations performed with prosthesis, this period may take less time than breast repair operation with autogenous tissues.
The loss of sensation in the breast with the removal of the breast does not completely return to normal after breast repair surgery, but some sensation is regained over time. Most of the post-operative scars may decrease over time.
Although this period varies between 1 and 2 years, the scars will not disappear completely. The higher the quality of the breast repair operation performed, the less the patient cares about the scars.
Which Complications May Occur After Breast Reconstruction?
Problems that may occur during surgery are called complications. Some of these problems may be bleeding in the early period, prolongation of the healing process in the skin tissues, seroma (fluid) accumulation in the breast or surrounding tissues, and tissue incompatibility.
However, wound healing problems are the most common in patients. Although every operation has a risk, some situations may increase the risk of complications.
These Situations
To smoke
Obesity
Diseases such as blood pressure, diabetes and heart disease
Chemotherapy patients
If several risk factors are combined in patients, the physician can predict that there may be wound healing problems. In such cases, surgeons plan the surgical strategy to reduce the risk.
What is the Recovery Process?
The healing process may vary depending on the surgery performed. If the breast was repaired with an implant (prosthesis); the patients are resting in the hospital for two days and at home for about two weeks.
Necessary controls of the patients are made during this two-week period. At the end of this process, they can continue their daily lives and go to work. If the patient is doing sports, they can start walking or jogging after 2 or 3 weeks.
After six to 8 weeks, they can do sports that require more effort, such as pilates and yoga. If the breast is repaired with the patient’s own tissue, the process works differently.
The hospitalization period of the patients can vary from 3 to 5 days. Usually three weeks of rest is given. After the third and fourth weeks, they can return to their daily life and work.
In the fourth week, they can start brisk walks and jogging again. After the six to eight weeks, they can do sports that require more effort. After the third month, they can return to their normal lives.
Can Exercise Be Performed After the Surgery?
Using the arms on the operated side on the next day of the surgery, the patient’s ability to do his own hygiene and care, helps him return to his daily life in a short time.
Having daily routines after the operation; He can do daily and simple exercises such as eating, brushing teeth, collecting hair or combing. If the patient has been repaired with an implant, it is recommended to start light-paced walks after two days, if the breast is repaired with his own tissue, and after 5 days.
These walks are not for sports, but for accelerating the healing processes and providing psychological support. According to the stages of recovery, after about a week, some exercises are recommended according to the patient’s condition.
After three or four weeks, light-paced walking and jogging are recommended. Depending on the operation performed, after 6 to 8 weeks, more strenuous sports (such as pilates or yoga) can be increased by starting from the lowest level. After three months, they can return to their daily lives.
