The second most common type of cancer in women is the breast cancer. According to the statistics, one in every eight women is caught in breast cancer throughout their life and all or part of the breast is taken by surgery called “mastectomy". Considering this ratio, millions of women lose some or all of their breasts due to cancer every year.
The breast is an organ which is of great importance in making the person feel attractive, beautiful, normal and full. Breast loss leads to very deep psychological and sexual distress in women. For this reason, it is necessary to get the patient to talk to a plastic surgeon and to get information about simultaneous and delayed reconstruction after the decision of mastectomy surgery which causes loss of this organ which is the symbol of motherhood and femininity. This stage is usually overcome by the stress and hastiness of receiving a diagnosis of cancer and the patient is expected to cope with the negative effects of being left without breast after mastectomy. If adequate information is given to the patient before the mastectomy operation, many women prefer mastectomy with simultaneous breast reconstruction, and physical and psychological difficulties due to the organ loss may be prevented.
Thanks to the technological advances, it can also be determined whether some individuals have familial breast cancer genes (such as BRCA1, BRCA2). These patients have mastectomy because of their high risk of developing breast cancer. Since the removal of the breasts at an early age due to the possible risk will also lead to physical and psychological problems in this particular group of patients, the importance of performing a simultaneous breast cannot be denied.
When can breast repair be done?
The patient with breast cancer should be evaluated by a team of disciplines of general surgery, oncology, radiography oncology, pathology and of course plastic surgery. Breast repair time is decided after the evaluation of many factors such as the stage of the disease, the possibility of radiotherapy or chemotherapy, the patient's age and body structure.
1. Simultaneous Repair: Repair is performed in the same session with the mastectomy operation. This method is preferred in patients who are in early stages and who will not receive radiotherapy/chemotherapy.
2. Late Repair: After mastectomy, repair is performed at a later time (after radiotherapy/chemotherapy).
3. Delayed - Concurrent: After the mastectomy operation, an expander (= balloon) is placed under the breast muscle. This balloon is inflated to reach the required volume to obtain the area where we can place the implant. After radiotherapy/chemotherapy, the expander is removed and repaired with permanent implant.
What are breast repair techniques?
There are three basic repair methods in breast repair:
1) Repair of the patient's own tissues (autologous breast repair): It is usually done using the patient's back or abdominal tissue. These operations can be planned by microsurgical method (DIEP, free TRAM) or microsurgery (pedicled TRAM). This method of repair should be preferred especially in patients undergoing radiotherapy. Because it is a living tissue, it is more resistant to the negative effects of radiotherapy. However, if the patient's own tissue is used for the feeding 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.
2) Repair with implant: According to the stage of the cancer, the entire breast can be removed with the skin or the breast tissue, or even the nipple, can be removed in such manner to contain only the breast tissue for the treatment of breast cancer. Breast cancer has begun to be diagnosed at early stages since early diagnosis has increased due to breast cancer screening and the development in awareness. Therefore, nipple/breast skin protection methods are frequently used. When there is sufficient breast skin, concurrent breast prosthesis repair results will be quite successful. If there is not enough skin tissue, a silicone balloon is placed under the chest. After a while, this balloon begins to inflate. Once sufficient volume is reached, balloon is removed and replaced by permanent silicone implants.
3) Repair by two methods at the same time: In general, the back muscle is taken into the region where there is lacking in the chest wall tissue. A silicone implant must be placed in order to reach the sufficient size.
How to repair with the abdominal tissue?
These tissues can be used in breast repair in women with adequate tissue excess in the abdomen. In this method, the abdominal tissue is taken as in the abdominal tension surgery and used to create a new breast by microsurgical methods. A portion of the abdominal wall muscle may also be incorporated into the tissue. In this way, both the abdomen stretching and breast repair are performed simultaneously. In patients who have had abdominal tummy or liposuction surgery, the vessels supplying the abdominal skin may be damaged, so there will be little chance of application for these patients.
How to repair with the implants?
These operations are usually performed in two sessions if there is not enough skin tissue during mastectomy operation. In the first session, silicone tissue expander balloon (the expander) is placed under the chest muscle. After 3 weeks, this balloon is started to be inflated by giving physiological saline solution. After reaching the desired volume, the balloon is removed and the permanent silicone breast implant is placed in the second session.
Women with a large and non-drooping breast and the women who will not be treated with radiotherapy and the women whose breast are removed at an early stage or before the development of breast cancer will have greater benefit with this method.
It is a partly more painless, less traceable method and it does not require tissue removal from other parts of the body. Patients can return to their normal lives faster.
How to make breast repair with back tissue?
The latissimus dorsi muscle on the back is one of the most commonly used tissues in breast repair. However, the volume of this muscle is insufficient to provide new breast size. Therefore, when this muscle is used, a prosthesis is usually placed underneath and the required volume is provided.
How to make nipple?
After completion of the breast repair, the breast takes the last form after at least 6 months. Then, the new nipple is made from the patient's own skin tissue under local anesthesia. The nipple is usually tattooed to give it the natural color.
Does it need to be retouched?
Breast repair usually involves multiple sessions of surgery. After the actual repair, it is tried to obtain the ideal shape with small surgeries such as making the nipple and correcting the marks. For this purpose, fat injections are made and a better form and appearance is tried to be provided. Therefore, breast repair is a process that the surgeon and the patient should cooperate with understanding and patience.