According to the definition of World Health Organization; health is a state of complete physical, mental and social well-being
For this reason, breast reconstruction is an operation that should be done in order for the patient to regain her health.
Who is the best candidate for breast reconstruction?
For almost all mastectomy patients, there is not a medical obstacle to breast reconstruction and most patients are appropriate for simultaneous reconstruction with mastectomy operations. However, the best candidates for breast reconstruction are patients whose cancer has completely disappeared thanks to mastectomy.
There may be many reasons to wait; for example, some patients want to have another surgery, some of them hardly accept the cancer diagnosis and cannot think about breast reconstruction options. Some patients may have been recommended to wait by their surgeons, especially when the breast is reconstructed with the patient’s own tissue (flap transfer). In some cases, such as obesity, hypertension, and smoking, patients can be recommended to wait for a while.
Who performs breast reconstruction?
Breast surgery requires teamwork. This team includes general surgeons, plastic surgeons, medical and radiation oncologists, radiologists, and physiotherapists. Tumour surgery of the breast is performed by general surgeons while reconstruction procedure is performed by plastic surgeons.
Planning of the surgery
As from the diagnosis of cancer, it can be started to discuss reconstruction options. Ideally, a general surgeon and plastic surgeon should make the planning and operation together. After the health analysis, the best options are evaluated considering the patient’s age, anatomical structure, tissues, and wishes.
The procedure to be applied can be divided into two as simultaneous or late in terms of timing.
As a method, it can be summarized as the use of core tissue and tissue expander or prosthesis (silicone), or both of them.
There are many options and you need to consult your surgeon.
Expansion of the skin
The most common technique is to expand the skin and then to place prosthesis. After mastectomy operation, a tissue expander is placed under your skin and chest wall muscle. A port functioning with a valve mechanism is placed under your skin from which your surgeon inflates your tissue expander by injecting saline for weeks or months after surgery. After it is realized that your skin has expanded enough, the tissue expander is removed with a secondary surgery and a more permanent prosthesis is placed. Some tissue expanders are designed to stay under the skin permanently. Areola (brown round skin around the nipple) and nipple are intervened later. In some patients, there is no need for skin expansion, and a prosthesis can be placed with mastectomy.
Breast reconstruction can be carried out by extracting tissue from the back, abdomen, and hips as an alternative to the prosthesis method. This is called flap reconstruction. In one type of flap surgery; the skin, subcutaneous fat layer, and muscle tissue remain connected to the originally adhered area by a vascular stalk and are shifted to the area, where the breast will be formed, with the help of a tunnel made under the skin. As it can form the breast alone, a prosthesis can be placed under this tissue. In another type of flap surgery, the tissue is completely separated from the abdomen, back or hip area where it is attached, and its vessels are sutured to the vessels in the recipient area, allowing it to live (reconstruction with free flap). In order to perform this surgery, the plastic surgeon must also be experienced in microvascular surgery. Because it is possible to stitch thin vessels only under the microscope.
Both of the surgical methods mentioned above are more complicated operations than the prosthesis method. There will be scars in both areas where the tissue is removed and the breast is formed, and the recovery period is longer than in the prosthesis method. On the other hand, results are more natural in the breast reconstruction that is done from the patient’s own tissue and there is no concern about silicone. Sometimes, improving the shape of your abdomen and getting rid of excess skin and fat can be another benefit for you.
Several surgeries are required over time in breast reconstruction. The first surgery is the most complicated one; the second operations are easier and if the tissue expander method is chosen for reconstruction, the tissue expander can be removed and a prosthesis can be placed or nipple and areola reconstruction can be performed. Often, it may be necessary to slightly reduce, lift, or augment the normal breast in order to adapt the newly formed breast to the normal breasts on the other side. However, it should be noted that operational scars leave after these surgeries.
After the operation
Post-operative pain can be largely relieved with medication. You will be discharged from the hospital within 2 to 5 days depending on the size of your operation. In the surgery, drains that prevent the fluid accumulation can be placed and these are removed in the first or second week after the operation. Stitches are removed within 7 to 10 days.
Returning to normal
It may take 6 weeks for you to return to normal after mastectomy and reconstruction or just flap reconstruction surgery. In prosthetic surgery, this period may be shorter. The normal sensation is not gained with reconstruction; however, some sensation may come over time. Most of the scars can fade over time. However, this period might be 1-5 years and scars never disappear completely. As long as the quality of the reconstruction is high, you will pay less attention to these scars.
Follow your surgeon’s advice on when to start exercise and sports. As a general rule, it may be good to avoid sexual intercourse and heavy exercise for 3-6 weeks.
Your new appearance
For most mastectomy patients, reconstruction dramatically improves the appearance and life quality. It increases the joy and commitment to life.