19 August 2021 Thursday / Published in Mammoplasty (Boob Job), Plastic Surgery

Breast Reconstruction

What is breast reconstruction?

Breast reconstruction is the treatment process of breast loss that occurs in both or one of the breasts due to breast cancer, burns, work-traffic accidents, severe diseases and congenital reasons by Aesthetic, Plastic and Reconstructive Surgeons.

Breast reconstruction is reconstruction surgery, not aplastic surgery. In other words, it is the work of replacing a lost due to cancer or an accident in a way that is close to its natural. Today, breast cancer is treated by a healthcare team consisting of general surgery, plastic and reconstructive surgery, medical and radiation oncology, pathology specialists in good centres. This team evaluates the patient before surgery and together determines the most appropriate treatment option for the patient.

When is breast reconstruction done?

Simultaneous breast reconstruction; While the general surgery team performs the breast removal surgery (mastectomy), plastic surgeons simultaneously reconstruct breast(s) in the same session. Simultaneous breast repair is performed with implants (prosthesis), patients’ own tissues or a combination of these methods.
Late breast reconstruction; Late breast reconstruction is performed at a later stage in patients whose breasts have been removed before and who have not undergone any breast reconstruction. In these patients, breast reconstruction is performed with implants (breast prostheses), patients’ own tissues or a combination of these methods.

How is breast repair done and what are the treatment methods?

Breast reconstruction stages

New Breast Formation Process After Removal of Cancerous Breast in Women

I – Formation of breast tissue

II – Creation of the nipple and areola

III – Ensuring symmetry between the breasts

I – Formation of breast tissue

Several surgeries are required to achieve a natural breast image. The first operation is the creation of the most complicated breast tissue. Reconstruction of the removed breast can generally be done in three ways:

With implants (breast prostheses-silicone prostheses)
With the patient’s own tissues (tissues taken from the abdomen, back, hips and thighs)
Implants (breast prostheses) can be combined with the patient’s own tissues
Fat injection. This method is generally used to support breast reconstruction methods with implants or their own tissues.

Breast reconstruction with implants (breast prostheses-silicone prostheses)

Two different types of implants are generally used in breast reconstruction:

A – Permanent implants (silicone breast prostheses)

B – Temporary implants (tissue expanders)

A – Permanent implants (silicone breast prostheses):

There are two types of permanent breast prostheses:

Round Prosthesis: These prostheses are generally not preferred in breast repair.
Anatomical (drop) Prostheses: Since the breast is completely removed, anatomical (drop-shaped) prostheses are preferred in in breast reconstruction. The outer wall of these prostheses is surrounded by silicone material. It is filled with silicone gel or liquid (serum).

B – Temporary implants (tissue expanders)

Temporary implants have a port, with the help of this port, the deflated implant is inflated with saline. Some of this swelling is done during the surgery and the remaining is done in a few sessions a few weeks after the surgery.

There are two types of temporary implants: The inner cavity of a group of tissue expanders is completely inflated by giving physiological saline. In the second group of tissue expanders; the inner cavity is inflated by combining both the silicone gel and the serum (salt water) content. There are two cavities in these prostheses. The outer space of 35% is filled with silicone gel, and the inner space of 65% is inflated by giving serum (saline) with the help of a port. Temporary breast implants (tissue expanders) are used to expand the tissues by inflating them in patients who will undergo radiotherapy or in patients who have had their breasts removed before. In patients with tissue expansion after radiotherapy inflated tissue expanders filled with serum (saline) are removed and permanent implants (silicone breast prostheses) are placed in their place. In prostheses that are partially filled with silicone gel and serum (saline), if there is no deformation after radiotherapy, the port can be removed and the prosthesis can be made permanent. The reason for the gel on the outer wall of the prosthesis is that the silicone gives the texture and feeling close to the breast tissue. In the serum, there may be vibration and the patient can feel it in the rib cage. In addition, the serum reacts more quickly to hot and cold. For this reason, serum (salt water) prostheses are used less frequently. The density of the silicone gel is close to the breast tissue.

What is the procedure for breast reconstruction with implants?

Simultaneous breast reconstruction with implants:

While the general surgery team performs the breast removal surgery (mastectomy), plastic surgeons perform simultaneous breast reconstruction in the same session. Permanent or temporary prostheses are used in this surgery. If the patient will not receive radiotherapy after mastectomy (removal of the breast), a permanent prosthesis is placed in the same surgical session.

Breast repair with a temporary prosthesis (tissue expander):

If the patient will receive radiotherapy treatment after mastectomy (removal of the breast), a temporary prosthesis is placed in the same surgical session. The most important contribution of the temporary prosthesis is to create a volume in the breast area during the radiotherapy treatment. If the temporary prosthesis is not placed in this area, the breast area heals as a flat wall during the radiotherapy treatment period. Radiotherapy makes this area even flatter in the patient, and it becomes very difficult to place a prosthesis by expanding this area in the future. In that case, breast reconstruction with the patient’s own tissue remains the only option for the plastic surgeon.

The temporary prosthesis can be inflated with serum by entering through the port and, if necessary, the volume of the temporary prosthesis can be changed by taking and giving fluid from the port in order to better receive the beam during radiotherapy. Approximately 6-12 months after the radiotherapy treatment ends, the damage to the tissues is healed and the temporary prosthesis can be removed and the permanent prosthesis can be inserted. It can also be supported by fat injection while placing the permanent prosthesis.

Staged (two step) breast reconstruction with implants:

The breast reconstruction method, which is performed gradually with implants, is generally preferred by plastic surgeons in patients whose breasts have been removed before and who have not undergone any breast reconstruction. In this procedure, a tissue expander (balloon) is used in the first session. In the second session, a permanent implant is inserted or reconstruction with the patient’s own tissue is performed. In the first surgical session of the staged repair, a tissue expander is placed in the patient’s breast area. The tissue expander is like a balloon and is inflated; Thus, the breast area gains volume for a period of 3-6 months. After that, the tissue expander is removed and reconstruction is made with the permanent implant or the patient’s own tissue in the second session.

Breast Reconstruction with Implants Frequently Asked Questions

Do implants have risks?

Since a foreign body is placed in the body in prosthetic breast reconstruction surgery, it may rarely involve some risks and complications:

Infection,
Silicone leakage or deflated implant,
Loss of the natural appearance of the breast with the development of hard tissue around the silicone prosthesis (capsule contracture).

These complications are rarely encountered in breast prostheses produced with today’s high technology.

What is the lifespan of implants?

All breast implants produced with smart technology are given a lifetime warranty by the manufacturer. Breast prostheses used today are produced with advanced technology and extremely safe against punctures and leaks. However, after a long time (10-15 years) due to excessive changes in body structure, it is recommended by doctors to check the breasts and silicones. Weight gain-loss, breast deformation, etc. in such cases, a new prosthesis is placed by re-entering the previously operated incision area.

Can an implant burst?

Pressure situations such as the patient’s lying on her chest or the seat belt while driving cannot burst the breast prostheses. However, when a penetrating external trauma is experienced, it is possible for the breast prosthesis to burst. Today, the gels that make up the prosthesis are 6^th generation FDA (US Food and Drug Administration) approved gels. Even if the material inside bursts, it does not spread to the body and does not flow. Whether it has burst or not can only be seen with ultrasound or radiological examinations such as MRI. In addition, these prosthetic gels do not have any effect such as causing breast cancer or triggering this disease.

Breast reconstruction with the patient’s own tissue (autogenous tissue)

Breast reconstruction with the patient’s own tissue is more complex and requires surgical experience. The patient’s own tissue (autogenous tissue) can be obtained from different parts of the body. Autogenous tissues (the patient’s own tissues) are more similar in content to breast tissue. Thanks to these features:

They show more similarity to the natural breast in terms of physical behaviour.
Sensation returns better than prosthetic applications.
Fading of the scars and softening of the tissues used increase the feeling of satisfaction over time.
It responds to the body’s weight gain and loss reactions like a normal breast. Thus, the symmetry between the two breasts becomes more natural in case of excessive weight gain or loss after reconstruction or in cases of sagging due to aging.
It does not prevent radiotherapy and chemotherapy applications.
The skin in the lower part of the abdomen, subcutaneous adipose tissue and one of the muscles in the anterior abdominal wall are transferred to the breast area by means of microsurgery, which is the method of applying surgical procedures that the surgeon cannot do with the naked eye, with the help of the operating microscope. During the reconstruction, the patient also undergoes aesthetic tummy tuck surgery.
The muscle on the side of the back and the skin is transferred to the breast area by microsurgery and reconstruction is performed. In this method, the surgical scar on the back is usually hidden under the bra. In cases where the back is used to reconstruct the breast, the back tissue may not provide sufficient volume on its own. In this case, the back tissue is combined with a breast prosthesis (implant).
The skin and subcutaneous fat tissue in the hip and leg area is transferred to the breast area by free tissue transfer microsurgery method and breast repair is performed. When breast reconstruction is performed with the free tissue transfer method, the subcutaneous adipose tissue is completely separated from the abdomen, back or hip region to which it is connected together with the nourishing vessels. Then, these veins are stitched to the veins in the recipient region to live. In order to perform this surgery, the plastic surgeon must be experienced in microsurgery as suturing thin veins together is only possible under a microscope.

Autogenous Tissue Breast Reconstruction Frequently Asked Questions

What criteria do plastic surgeons look at in patients for breast reconstruction with autogenous tissue?

General health status, age, body characteristics of the patient,
Characteristics of the breast removal procedure,
Whether the patient received radiotherapy,
Condition of the other breast,
Patient preferences,
The surgical experience and skills of the plastic surgeon.

In the breast repair performed with the patient’s own tissue, from which parts of the patient’s body are the tissues obtained?

Abdominal region: Plastic surgeons who are experts in the field of breast reconstruction generally use the patient’s abdominal tissues as the first choice in the repair procedures performed with the patient’s own tissue. Because the amount of tissues in the abdomen is sufficient for the reconstruction and it is one of the body regions closest to the breast tissue in terms of consistency. It is accepted as the most ideal body region by plastic surgeons, since sagging in the abdomen of the patient will also be eliminated in the procedure performed with this autogenous tissue.
Back region: The second body region preferred by surgeons in breast reconstruction performed with the patient’s own tissue is the patient’s back region. The breast is also reconstructed by using only the excess skin in that area of the patient without the use of back muscle. In cases where the dorsal region is used to reconstruct the breast, the dorsal tissue may not provide sufficient volume on its own. In this case, the back tissue is used in combination with a breast prosthesis (implant).
Hip region: Another body region preferred by specialist plastic surgeons in reconstruction process using the patient’s own tissue is the hip region. Reconstruction is also performed by moving the skin in the hip area with or without muscle using the microsurgery method.
Leg region: The leg region is the least preferred body region by plastic and reconstructive surgeons in tissue transfer procedures in the reconstruction of the breast taken after cancer with autogenous tissue. If the patient’s abdomen, back and hip regions are not suitable, that is, in previous surgeries, these regions, for example, tummy tuck surgery, etc. If it is used for reasons such as, then breast repair procedures can be performed by carrying tissue from the leg area.

Fat injection method applied in breast reconstruction:

In recent years, implants and fat injection have been used in combination in breast reconstruction surgery. We plastic surgeons call these combined applications “hybrid breast reconstruction”.

Why is fat injection used in breast repair?

In breast reconstruction procedure with implants, fat injection is applied to make the breast skin look healthier and smoother or to thicken the remaining skin and eliminate its irregularities. The use of fat injection method in breast reconstruction is increasing.

When is fat injection used in making new breasts?

Fat taken from the appropriate areas of the patient’s body is usually transferred in another session after the implant is placed on the breast. Sometimes, when the temporary prosthesis is removed and the permanent prosthesis is transferred, fat can be transferred in the same session.

II – Creation of the nipple and areola area

It is the stage of reconstructing the nipple and areola area, that is, the dark area around the nipple, in the new breast. This procedure can be performed under local anaesthesia depending on the preference of the doctor.

Nipple: It is usually made by giving a new nipple shape by using the breast skin where the nipple should be.
Areola (dark round area around the nipple): If there is no problem in the other breast of the patient, the area around the nipple can be done with skin taken from the nipple, if there is a problem, from the groin skin or by tattooing.

III – The stage of ensuring symmetry between the breasts

In cases where reconstruction surgery is performed on one breast, it cannot be expected 100% that both breasts are symmetrical at the end of the surgery. Such situations are valid for cases where the other breast is large or drooping. In order to ensure symmetry and similarity between the breasts, reduction, lift, augmentation or plastic surgery related to the nipples can be performed on the other breast that has not been repaired, depending on the patient’s condition and the analysis of the reconstructive surgeon. For the details of these surgeries, you can reach Prof. Dr. Şükrü Yazır’s ➩ breast aesthetics page.

Cost of breast reconstruction surgery

It is against the law in Turkey for the healthcare organisations including private practices to indicate prices online for procedures, treatments or consultations. Please contact us by calling or texting ?+90 541 334 3484 (WhatsApp available) or ☏ +90 212 257 1515 for the average cost of the procedure or any other enquiries related to the procedure. You need to send some photos to the Patient Care Coordinator to be examined by Professor Yazar to get the exact price.

Breast Reconstruction Frequently Asked Questions

What is the right timing for breast reconstruction after breast cancer?

Almost every woman who has lost her breast due to breast cancer can undergo reconstruction procedure as a result of the evaluation of plastic surgeons who are experts in this field. While breast reconstruction can be performed simultaneously while removing the cancerous breast, it can also be performed in later periods. The cosmetic results of simultaneous repair are much better and it is generally performed in early-stage breast cancers.

The most important benefit of early breast reconstruction is the simultaneous repair of the breast in the patient whose breast was removed by preserving the skin. With this method, specialist surgeons consider reducing the psychological trauma experienced by the patient whose breast has been removed. In some cases, there may be important reasons for the patient to wait for breast reconstruction procedure. In such cases, breast repair can be applied later. For example, some patients do not want another surgical procedure, while some patients have difficulty accepting the diagnosis of cancer and cannot consider breast reconstruction options. Plastic and Reconstructive Surgeons may advise that it would be better for some patient to wait for reasons such as obesity, high blood pressure and smoking.

Is breast reconstruction surgery only for breast cancer patients?

No. Breast reconstruction is used in the treatment of all problems such as congenital anomaly problems, breast deficiency problems, severe burns in the breast, deformations that occur in the breast due to severe diseases that develop later, traffic accidents and various work accidents.

In how many sessions is the breast reconstruction procedure completed?

The process of making the new breast is a process that needs to be spread over time and must be followed perfectly. Depending on the planning of the Aesthetic and Plastic Surgeon, it may take at least 2-3 sessions. In this process, it is tried to create a breast with a similar structure to the patient’s other breast and nipple to a degree that will make the patient very happy.

Can breast reconstruction surgeries be combined with fat injection?

Fat injection can be combined in order to achieve a more successful aesthetic result for a patient whose breast has been reconstructed with his own tissue. Fat injection acts as a camouflage in breast reconstruction surgery.

Sometimes the implant and the skin are very close, especially in some weak patients, so the implant can be felt under the skin of the breast. Especially in people who have received radiotherapy, the skin may become thinner and the implant may be more prominent. In these cases, fat is taken from the abdomen or back area of the patient with injectors in order to eliminate the prominent state of the prosthesis, to eliminate some deformations such as collapse and pitting, and to provide a more aesthetic appearance to the patient. This fat is processed in the operating room and injected into the most prominent areas of the implant in the patient’s reconstructed breast.

What are the processes after breast repair procedures and surgeries?

Post-operative pain is mostly relieved with painkillers. The Plastic and Reconstructive Surgeon who performed the surgery may want the patient to stay in the hospital for 2-5 days, depending on the difficulty of the breast reconstruction surgery. Usually, surgeons use drains (vacuum-forming plastic tubes) to remove the blood collected in the patient’s surgical area after the surgery, and after the necessary auxiliary treatment procedures, these drains are removed after 1-2 weeks.

Can breast reconstruction prevent cancer formation and its treatments?

While performing breast construction with autogenous tissue or implants, the patient may undergo chemotherapy, radiotherapy, etc. receive treatment. During the follow-up period, the patient can easily have other radiological examinations, along with periodic mammography, for normal breast and reconstructed breast. The stages of breast reconstruction do not interfere with other treatments. Breast reconstruction also has no effect on cancer recurrence or the patient’s prognosis.

Which patients are not suitable for breast repair surgeries?

In fact, every mastectomy patient is a candidate for reconstruction surgery. But when the patient is very old, has heart failure, excessive blood pressure, etc. unfortunately, this surgery cannot be performed if the patient is unable to handle anaesthesia and surgery.

Can the patient’s radiotherapy treatment be completed during breast reconstruction?

In suitable patients, “single dose radiotherapy” is applied after the breast is removed and permanent fixed prosthesis is used for such patients since they will not receive radiotherapy again after the surgery. In other words, in a single surgical session, the patient receives radiotherapy without waking up and a permanent breast prosthesis is placed in the same session.

Is it possible to breastfeed with a breast reconstructed following breast cancer?

Although the appearance of the breast is not much different from the old one, the tissue inside will be completely changed in a patient who has had both breasts removed (total mastectomy) due to breast cancer. With the total mastectomy surgery, the nipples were preserved, but since the patient’s milk ducts and mammary gland were removed, it is no longer possible for the breastfeeding function to continue. However, if breast-sparing mastectomy (segmentary mastectomy) is performed to the extent permitted by the cancer stage and type of the patient, taking into account the patient’s age and desire to have a child, it is possible to maintain the breastfeeding function in the breast with the remaining mammary gland and milk ducts. In addition, in cases where only one breast is removed after breast cancer, the patient can provide breastfeeding from one breast.

What is delayed breast reconstruction surgery?

Breast reconstruction surgery can be performed months or years after mastectomy surgery, that is, breast removal surgery. We call such late breast repairs as “Delayed Breast Repair Surgery”. We generally use patients’ own tissues or implants together with the patient’s own tissues for breast reconstruction in patients whose breasts have been removed before.

Method selection in breast reconstruction

Reconstruction process can be started at the early stage of the disease, immediately after mastectomy surgery. If this is not possible, reconstruction process is planned according to the course of cancer treatment. The method to be applied in breast reconstruction is determined according to many factors such as the condition of the tissues in the patient, body structure, treatments received, whether or not to receive radiotherapy, the stage of the tumour, the size of the other breast, age, whether the patient gave birth or not.

Breast reconstruction can be done with implants, the patient’s own tissues or fat fillings. Sometimes breast reconstruction is performed with “hybrid breast repair” methods, where these methods are combined with each other.

Recovery after breast reconstruction

After the reconstruction procedure, the patient should stay in the hospital for 1-5 days. Patients can take a bath 2-5 days after the surgery. After 1-2 weeks, the patient can return to daily activities. A sports bra should be worn for 4-6 weeks after the surgery. After 6-8 weeks, sports activities can be done easily. Healing process may vary depending on the breast reconstruction method performed.

How long do silicone prostheses last?

Today, breast prostheses are produced with advanced technology to be extremely durable and comfortable. Silicone prostheses used in reconstruction and breast augmentation surgeries are extremely safe against punctures and leaks. These prostheses, which can be used for life, are guaranteed against undesirable situations such as deformations.

Sensation in the reconstructed breast

After breast removal surgery, loss of sensation occurs in the breast. This situation does not disappear completely following breast reconstruction surgery. However, some of the senses may return over time. Reconstruction made with the patients’ own tissues is more advantageous in terms of restoring the senses.

Ultrasound, mammography, MRI in the reconstructed breast

The methods and materials used in the reconstruction process are important for the regular maintenance of inspections and controls. It is critical to perform the required radiological examinations at regular intervals according to the recommendation of the physician, in terms of the condition of the cancer and early intervention against possible recurrences. Therefore, regardless of the method of breast reconstruction repair, examinations such as ultrasound, mammography and MRI can be performed without any problems in the follow-up process of the patients.

Does breast reconstruction interfere with chemotherapy or radiotherapy?

Breast reconstruction should be considered as part of breast cancer treatment. Reconstruction made with patients’ own tissues or breast prostheses do not interfere with radiotherapy and chemotherapy after surgery.