What is breast repair (breast reconstruction)?
Breast reconstruction, also known as breast repair, is the process of creating a new breast that resembles the natural breast, performed by specialists in Aesthetic, Plastic, and Reconstructive Surgery, to replace breast loss in one or both breasts caused by breast cancer, burns, work or traffic accidents, serious illnesses, or congenital conditions.
Breast reconstruction is not an aesthetic surgery, but a reconstructive surgery. That is, it is a procedure to replace a limb lost due to cancer or an accident in a way that closely resembles its natural form. Nowadays, in good centers…breast cancerThe patient is treated by a healthcare team consisting of specialists in general surgery, plastic and reconstructive surgery, medical and radiation oncology, and pathology. This team evaluates the patient before surgery and together determines the most appropriate treatment option for the patient.
When is breast reconstruction (breast repair) performed?
- Simultaneous breast reconstruction; The general surgery team performed the mastectomy (MastectomyWhile performing breast reconstruction surgery in the same session, we plastic surgeons call this simultaneous breast reconstruction. Simultaneous breast reconstruction is performed using implants (prostheses), the patient’s own tissues, or a combination of these methods.
- Late-stage breast reconstruction; In patients who have previously had a mastectomy and have not undergone any breast reconstruction, breast reconstruction is called late-stage breast reconstruction. In these patients, breast reconstruction is performed using implants (breast prostheses), the patient’s own tissues, or a combination of these methods.
How is breast reconstruction performed and what are the treatment methods?
Stages of breast reconstruction
The Processes of Creating a New Breast After Removal of a Cancerous Breast in Women
I – The stage of breast tissue formation
II – The stage of nipple and areola formation
III – Ensuring symmetry between the breasts
I – The stage of breast tissue formation
Several surgeries are required to achieve a natural-looking breast. The first surgery is the reconstruction of the breast tissue, which is the most complex. Breast reconstruction can generally be done in three ways:
1. With implants (breast prostheses – silicone implants)
2. With the patient’s own tissues (tissue taken from the abdomen, back, hips, and thighs)
3. A combination of the patient’s own tissues and implants (breast prostheses)
4. Fat grafting (fat injection); this method is generally used to support breast reconstruction methods using implants or the patient’s own tissues.
1 – Breast reconstruction with implants (breast prostheses – silicone implants)
In breast reconstruction, generally two different types of implants are used:
A – Permanent implants (silicone breast prostheses)
B – Temporary implants (tissue expanders)
A – Permanent implants (silicone breast prostheses): There are two types of permanent breast implants in terms of shape:
- Round Prosthesis:These implants are generally not preferred in breast reconstruction.
- Anatomical (Teardrop) Prostheses:In breast reconstruction, anatomical (teardrop-shaped) implants are preferred because the entire breast is removed. The outer shell of these implants is surrounded by silicone material. The inside is filled with silicone gel or liquid (serum).
B – Temporary implants (tissue expanders)
Temporary breast implants (tissue expanders) are used to expand and inflate tissues in patients undergoing radiotherapy or those who have previously had a mastectomy.
Temporary implants have a port through which the deflated implant is inflated with saline solution. A portion of this inflation is done during surgery, and the remainder in several sessions over a few weeks.
There are two types of temporary implants: One group of tissue expanders has its inner cavity completely inflated with saline solution. The second group of tissue expanders has its inner cavity inflated with a combination of silicone gel and saline solution. These prostheses have two cavities: a 35% outer cavity filled with silicone gel, and a 65% inner cavity inflated with saline solution via a port. Temporary breast implants (tissue expanders) are used in patients undergoing radiotherapy or those who have previously had a mastectomy to expand the tissues by inflating them. After radiotherapy or in patients who have achieved tissue expansion through inflation, the tissue expanders, which are completely filled with saline (salt water), are removed and replaced with permanent implants (silicone breast prostheses). In prostheses partially filled with silicone gel and saline (salt water), if there is no deformation after radiotherapy, the port can be removed and the prosthesis made permanent. The reason for the gel on the outer edge of the prosthesis is that silicone provides a texture and feel similar to breast tissue. In saline, however, there may be vibrations, which the patient can feel in their chest. Also, saline reacts more quickly to heat and cold. For this reason, saline (salt water) prostheses are used less frequently. The density of silicone gel is similar to breast tissue.
What are the procedures for breast reconstruction with implants?
- Simultaneous breast reconstruction with prosthesis: The general surgery team performed the mastectomy (MastectomyWhile performing mastectomy (removal of the breast), we plastic surgeons call the breast reconstruction surgery performed simultaneously with mastectomy a simultaneous breast reconstruction. In this surgery, permanent or temporary implants are used. If the patient will not undergo radiotherapy after mastectomy, a permanent implant is placed in the same surgical session. Breast reconstruction with temporary implant (tissue expander):
If the patient will undergo radiotherapy after mastectomy, a temporary implant is placed in the same surgical session. The most important contribution of the temporary implant is to create volume in the breast area during radiotherapy treatment. If a temporary implant is not placed in this area, the breast area heals as a flat wall during radiotherapy. Radiotherapy makes this area even flatter in the patient, and in the later stages, expanding this area and placing an implant becomes a very difficult step. At that point, the only option left for the plastic surgeon is breast reconstruction using the patient’s own tissue.
With a temporary prosthesis, saline solution can be inflated through a port, and if necessary, the volume of the temporary prosthesis can be adjusted during radiotherapy by injecting or releasing fluid through the port to improve radiation absorption. Approximately 6-12 months after the completion of radiotherapy, the damage to the tissues from the radiation therapy heals, and the temporary prosthesis can be removed and replaced with a permanent prosthesis. The permanent prosthesis can also be supported by fat injection during placement.
- Stage-by-stage (two-session) breast reconstruction with implants:
The staged breast reconstruction method using prostheses is generally preferred by expert plastic surgeons in patients who have previously had a mastectomy and have not undergone any breast reconstruction. In these procedures, a tissue expander (balloon) is used in the first session. In the second session, reconstruction is performed with a permanent prosthesis or the patient’s own tissue. In the first surgical session of staged reconstruction, 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, and a period of 3-6 months is waited. After this, the tissue expander is removed, and reconstruction is performed with a permanent prosthesis or the patient’s own tissue in the second session.
The most frequently asked questions about breast reconstruction with implants.
Are there any risks associated with prosthetic devices?
Breast reconstruction surgery with implants involves the insertion of a foreign object into the body, and therefore, although rare, it may carry some risks and complications:
Infection,
Silicone leakage or deflation,
Development of hard tissue around the silicone implant (capsule contracture), leading to loss of the breast’s natural appearance,
These complications are rarely encountered with today’s high-tech breast implants.
What is the lifespan of prosthetic devices?
All breast implants manufactured with smart technology come with a lifetime warranty from the manufacturers. Modern breast implants, produced with advanced technology, are extremely safe against punctures and leaks. However, after a long period (10-15 years), doctors recommend check-ups of the breasts and implants due to significant changes in body structure. In cases such as weight gain or loss, breast deformation, etc., a new implant is inserted through a re-incision made in the previous surgery.
Can breast implants rupture?
Pressure from things like lying on one’s chest or the seatbelt while driving cannot cause breast implants to rupture. However, rupture is possible in the case of penetrating or cutting external trauma. Today, the gels used in these implants are 6th generation FDA (US Food and Drug Administration) approved gels. Even if the material inside ruptures, it does not spread throughout the body and does not leak. Whether or not it has ruptured can only be detected by ultrasound or radiological examinations such as MRI. Furthermore, these implant gels do not cause or trigger breast cancer.
2- Breast reconstruction using the patient’s own tissue (autogenous tissue)
Breast reconstruction using the patient’s own tissue is a more complex operation requiring surgical expertise. The patient’s own tissue (autogenous tissue) can be obtained from different parts of the body. Autogenous tissues are more similar in composition to breast tissue. Thanks to these characteristics:
- They show more resemblance to natural breasts in terms of physical behavior.
- Sensory perception returns to a better level compared to prosthetic applications.
- The fading of the scars and the softening of the tissues used over time increase the feeling of satisfaction.
- The breasts respond to the body’s weight gain and loss reactions in the same way as normal breasts. Thus, even in cases of extreme weight gain or loss after reconstruction, or sagging due to aging, the symmetry between the two breasts remains more natural.
- It does not interfere with radiotherapy and chemotherapy treatments.
- The skin, subcutaneous fat tissue, and one of the muscles from the lower abdomen or the anterior abdominal wall are transferred using a stalked or free tissue transfer method, allowing the doctor to perform surgical procedures that cannot be done with the naked eye, with the help of an operating microscope.microsurgery The breast reconstruction is performed by transferring tissue to the breast area. During this reconstruction, the patient also undergoes an aesthetic tummy tuck surgery.
- Muscle and skin from the side of the back are transferred to the breast area using microsurgery, either via pedunculated or free tissue transfer, to perform the reconstruction. In this method, the surgical scar on the back is usually hidden under a bra. In cases where the back is used for breast reconstruction, the back tissue alone may not provide sufficient volume. In this case, the back tissue is combined with a breast prosthesis (implant).
- Breast reconstruction is performed by transferring skin and subcutaneous fat tissue from the hip and thigh area to the breast area using microsurgical techniques such as free tissue transfer. In breast reconstruction using free tissue transfer, the subcutaneous fat tissue, along with its nourishing vessels, is completely separated from its original location in the abdomen, back, or hip area. These vessels are then sutured to the vessels in the recipient area to ensure their survival. Performing this surgery requires the plastic surgeon to be experienced in microsurgery, as suturing these delicate vessels is only possible under a microscope.
The most frequently asked questions about breast reconstruction using the patient’s own tissue.
- What criteria do plastic surgeons look for in a patient when performing breast reconstruction with autologous tissue?
- The patient’s general health status, age, and physical characteristics,
- The characteristics of the breast removal procedure performed,
- Whether or not the patient has received radiotherapy,
- The condition of the other breast,
- The patient’s preferences,
- The plastic surgeon’s surgical experience and skills
- In breast reconstruction using the patient’s own tissue, from which parts of the patient’s body are the tissues obtained?
- Abdominal area:Plastic surgeons specializing in breast reconstruction often prefer using tissue from the patient’s abdomen for reconstruction procedures. This is because the amount of abdominal tissue is sufficient for the reconstruction and it is one of the body regions closest in consistency and texture to breast tissue. Since procedures using this autologous tissue also eliminate sagging in the abdominal region, it is considered the most ideal body region by plastic surgeons.
- Back region:In breast reconstruction using the patient’s own tissue, the second body area preferred by specialist doctors is the patient’s back. Breast reconstruction can be performed using back muscles or by using only excess skin from that area without using back muscles. However, when the back is used for breast reconstruction, the back tissue alone may not provide sufficient volume. In this case, the back tissue is used in combination with a breast prosthesis (implant).
- Hip area:Another body area preferred by expert plastic surgeons for reconstruction using the patient’s own tissue is the buttocks, also known as the distant region. Reconstruction is also performed by transferring skin from the buttocks, with or without muscle, using microsurgical techniques.
- Leg area:In breast reconstruction procedures using autologous tissue after cancer removal, the leg is the least preferred body region for tissue transfer by plastic and reconstructive surgeons. However, if the patient’s abdomen, back, or hips are unsuitable – meaning these areas have been used in previous surgeries such as abdominoplasty – then tissue transfer from the leg can be used for breast reconstruction.
Fat injection method used in breast reconstruction:
In breast reconstruction surgeries, implants and fat injection are frequently used in combination in recent years. We plastic surgeons refer to these combined procedures as “hybrid breast reconstruction” or “hybrid breast repair”.
- Why is fat injection used in breast reconstruction?
In breast reconstruction procedures using implants, fat injections are applied to the breast skin outside the volume of the implant to make it look healthier and smoother, or to thicken the remaining skin and correct irregularities. The use of fat injection as a method in breast reconstruction is increasing. - When is fat injection used in breast reconstruction?
Fat taken from suitable areas of the patient’s body, such as the abdomen and hips, is usually transferred in a separate session after the breast implant is placed. Sometimes, fat transfer can be done in the same session when the temporary implant is removed and a permanent implant is put in place.
II – The stage of creating the nipple and areola area.
Nipple (nipple) andareolaThis is the process of reconstructing the dark-colored area around the nipple in the new breast. These procedures can be performed under local anesthesia, at the doctor’s discretion.
- Nipple:This is usually done by reshaping the nipple using the breast skin where the nipple should be.
- Areola (the dark, circular area around the nipple):If the patient has no problems with the other breast, skin can be taken from the nipple; if there are problems with the other breast, skin can be taken from the groin area, or the area around the nipple can be reshaped using tattooing techniques.
III – The stage of achieving symmetry between the breasts.
In cases where reconstructive surgery is performed on only one breast, 100% symmetry of both breasts cannot be expected at the end of the operation. This is especially true when the other breast is large or sagging. To achieve symmetry and similarity between the breasts, the other breast, which is not reconstructed, may undergo reduction, lifting, augmentation, or aesthetic procedures related to the nipples, depending on the patient’s condition and the reconstructive surgeon’s analysis. Surgical procedures can be performed. Details of these surgeries can be found in Prof. Dr. Şükrü Yazar’s article ➩breast aestheticsYou can access it from this page..
Important informative videos about breast reconstruction:
(28 Videos)
Professor Dr. Şükrü Yazar, who is intimately familiar with the psychological trauma experienced by women who have had mastectomies due to breast cancer, has prepared these videos based on the most frequently asked questions by breast reconstruction patients. It is very important for newly diagnosed individuals to watch these videos.
To start watching these informative videos about the breast reconstruction process, either sequentially or in shuffle mode, visit the link below.
PLEASE CLICK TO WATCH. Breast Reconstruction Videos
Prices for breast reconstruction procedures and surgeries.
In Turkey, it is prohibited for hospitals, aesthetic and treatment centers approved by the Ministry of Health to list prices for breast reconstruction procedures, surgeries, and treatments on their websites. For all your questions, requests, and needs regarding breast reconstruction, please contact an Aesthetic and Plastic Surgery Specialist. Prof. Dr. Şükrü Yazar You can request an appointment immediately by using the following communication channels to evaluate the situation.
Shukru Yazar Clinic Contact Information
- Phone: +90 212 257 1515 Pbx (Mon – Sat: 09:00 – 19:00)
- WhatsApp:+90 541 334 3484(You can send messages 24/7.)
- Pre-Appointment Form (You can use the “Submit a Question” option.)
- info@sukruyazar.com (You can send an email.)
- Live Support Line (You can send your questions to the assistants.)
- Contact us(You can submit your requests using the contact form on the Contact Us page.)
- Address (Harbiye Mah. Valikonağı Cad. Marmara Apt. No:16 Kat:1 D:2 P.K 34367 Nişantaşı – Şişli / İstanbul)
We wish you a cancer-free, healthy, and happy tomorrow.
Breast ReconstructionFrequently Asked Questions
The most frequently asked questions about aesthetic procedures before, during, and after.
What is the right timing for breast reconstruction after a breast cancer removal?
Almost every woman who has lost a breast due to breast cancer can undergo reconstructive surgery after evaluation by expert plastic surgeons. Breast reconstruction can be performed simultaneously with the removal of the cancerous breast, or it can be done at a later stage. Simultaneous reconstruction yields much better cosmetic results and is generally applied in early-stage breast cancers.
The most important benefit of early breast reconstruction is that the breast is reconstructed simultaneously with the removal of the breast, while preserving the skin. With this method, expert surgeons aim to reduce the psychological trauma experienced by the patient who has had a mastectomy. In some cases, there may be significant reasons why a patient wants to wait for breast reconstruction surgery. In such situations, breast reconstruction can be considered later. For example, some patients do not want another surgical procedure, while others have difficulty accepting the cancer diagnosis and cannot consider breast reconstruction options. In some cases, Plastic and Reconstructive Surgery Specialists advise that it would be better for the patient to wait due to reasons such as obesity, high blood pressure, and heavy smoking.
Are breast reconstruction surgeries only for breast cancer patients?
No. Breast reconstruction is used in the treatment of problems such as congenital breast deficiency, severe burns to the breast, deformities caused by serious illnesses that develop later in life, and problems resulting from traffic accidents and various workplace accidents.
How many sessions does it take to complete the reconstructive breast implant procedure that replaces the removed breast?
The process of creating a new breast is a meticulously planned process that requires careful attention over time. Depending on the aesthetic and plastic surgeon’s plan, it may take at least 2-3 sessions. During these sessions, the goal is to create a breast that closely resembles the patient’s previous breast and nipple, to the point of complete satisfaction.
Can breast reconstruction surgeries be combined with fat grafting?
In order for a patient whose breast reconstruction has been achieved using their own tissue to have a more successful aesthetic result…fat injection It can be combined with other methods. Fat injection serves as camouflage in breast reconstruction procedures.
Sometimes, the implant and skin are very close, especially in some thin patients, so the implant can be felt under the breast skin. Skin can become thinner and the implant more noticeable, particularly in individuals who have undergone radiotherapy. In these cases, to eliminate the noticeable implant, correct any deformities such as depressions and hollowing, and provide a more aesthetic appearance, fat is harvested from the patient’s abdomen or back using injectors. This fat is processed in the operating room and injected into the most prominent areas of the implants in the reconstructed breast.
What are the processes like after breast reconstruction procedures and surgeries?
Postoperative pain is largely managed with pain medication. Depending on the complexity of the breast reconstruction surgery, the plastic and reconstructive surgeon may request a hospital stay of 2-5 days. Generally, surgeons use drains (plastic tubes that create a vacuum) to remove blood that collects in the surgical area, and these drains are removed again after 1-2 weeks following necessary supportive treatments.
Can breast reconstruction prevent cancer formation and treatments?
During breast reconstruction using autologous tissue or prosthesis, the patient can continue receiving chemotherapy, radiotherapy, and other treatments. During the follow-up period, the patient can easily undergo periodic mammograms and other radiological examinations of both the normal and reconstructed breasts. 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 reconstruction surgery?
In fact, every patient who undergoes a mastectomy is a candidate for reconstructive surgery. However, if the patient is too old or has conditions such as heart failure or high blood pressure that prevent them from tolerating anesthesia and surgery, unfortunately, this surgery cannot be performed.
Can a patient complete radiotherapy treatment during breast reconstruction surgery?
In suitable patients, a “single dose of radiotherapy” is applied after mastectomy, and since these patients will not need further radiotherapy after the surgery, a permanent fixed prosthesis is used. In other words, the patient receives radiotherapy and has a permanent breast prosthesis implanted in a single surgical session without waking up.
Is it possible to breastfeed after a breast is reconstructed following a breast removal surgery due to breast cancer?
In a patient who has undergone total mastectomy (removal of both breasts) due to breast cancer and reconstruction with implants or the patient’s own tissue, the appearance of the breast may not be drastically different from its previous state, but the tissue inside will be completely altered. While the nipples are preserved during the total mastectomy, breastfeeding is no longer possible because the milk ducts and mammary glands are removed. However, considering the patient’s age and desire to have children, and provided the cancer stage and type allow, breast-conserving mastectomy (segmental mastectomy) may be performed, allowing for continued breastfeeding with the remaining mammary glands and milk ducts. Furthermore, in cases where only one breast is removed after breast cancer, breastfeeding can still be performed from that single breast if the other breast is healthy.
What is delayed breast reconstruction surgery?
Breast reconstruction surgeries can be performed months or years after a mastectomy, which is the removal of the breast. These late-stage breast reconstructions are called “Delayed Breast Reconstruction Surgeries.” In patients who have previously had a mastectomy, we generally use the patient’s own tissues or a combination of the patient’s own tissues and breast implants to reconstruct the breast.
Method selection in breast reconstruction
Reconstruction procedures can begin in the early stages of the disease, immediately after mastectomy. If this is not possible, reconstruction procedures are 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 patient’s tissues, body structure, treatments received, whether or not radiotherapy will be performed, the stage of the tumor, the size of the other breast, age, and whether the patient has given birth.
Breast reconstructions can be performed with implants, the patient’s own tissues, or fat grafts. Sometimes, breast reconstruction is performed using “hybrid breast reconstruction” methods, which combine these methods.
Recovery after breast reconstruction
Following the repair procedure, the patient needs to stay in the hospital for 1-5 days. Patients can shower 2-5 days after the surgery. Daily activities can be resumed after 1-2 weeks. A sports bra should be worn for 4-6 weeks after the surgery. Sports activities can be comfortably resumed after 6-8 weeks. Recovery times may vary depending on the breast reconstruction method used.
How long do silicone implants last?
Today, breast implants are manufactured with advanced technology to be extremely durable and comfortable. Silicone implants used in reconstructive and augmentative breast surgeries are highly resistant to punctures and leaks. These implants, designed for lifelong use, are guaranteed against unwanted conditions such as deformations.
Sensation in the repaired breast
Sensation loss in the breast occurs after mastectomy surgery. This loss does not completely disappear with breast reconstruction surgery. However, some sensation may return after some time. Reconstructions using the patient’s own tissues are more advantageous in terms of regaining sensation.
Ultrasound, mammography, and MRI scans of the reconstructed breast.
The methods and materials used in the reconstruction process are important for ensuring regular examinations and check-ups. Performing radiological examinations at specific intervals, as recommended by the physician, is critical for monitoring the cancer’s status and enabling early intervention against possible recurrence. Therefore, regardless of the method used for breast reconstruction, examinations such as ultrasound, mammography, and MRI can be performed without any problems during the patient’s follow-up process.
Does breast reconstruction prevent chemotherapy and radiotherapy?
Breast reconstruction should be considered a part of breast cancer treatment. Reconstruction using the patient’s own tissue or breast implants does not interfere with post-operative radiotherapy and chemotherapy.
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