It is a surgery to rebuild the breast after removal of the breast (mastectomy) due to breast cancer. Which method needs to be applied depends on medical status of  the patient, her breast shape and size, her general health status, her lifestyle and her wishes.

The ones with small or medium-size breasts are the best candidates for breast reconstruction. Breast reconstruction is performed with the patient’s own tissue, breast implant (silicone implant) or their combination. The patient’s own tissue is in the form of skin, fat and/or muscle, which is called flap tissue. It is transferred from abdomen, back or another region of body to breast region in order to reform new breast tissue. Other surgical interventions may be required in order to correct the symmetry and appearance after breast reconstruction. For example, building a nipple and areola (dark coloured part around the nipple)after newly-formed breast tissue heals. This is a procedure which is generally performed under local anaesthesia and does not require hospital stay. It can be performed by using skin graft or tattooing method. During breast reconstruction, another operation such as reduction, augmentation or lifting can also be performed in order to catch a similar appearance.

It is a surgery to rebuild the breast after removal of the breast (mastectomy) due to breast cancer. Which method needs to be applied depends on medical status of  the patient, her breast shape and size, her general health status, her lifestyle and her wishes.

The ones with small or medium-size breasts are the best candidates for breast reconstruction. Breast reconstruction is performed with the patient’s own tissue, breast implant (silicone implant) or their combination. The patient’s own tissue is in the form of skin, fat and/or muscle, which is called flap tissue. It is transferred from abdomen, back or another region of body to breast region in order to reform new breast tissue. Other surgical interventions may be required in order to correct the symmetry and appearance after breast reconstruction. For example, building a nipple and areola (dark coloured part around the nipple)after newly-formed breast tissue heals. This is a procedure which is generally performed under local anaesthesia and does not require hospital stay. It can be performed by using skin graft or tattooing method. During breast reconstruction, another operation such as reduction, augmentation or lifting can also be performed in order to catch a similar appearance.

BREAST RECONSTRUCTION WITH IMPLANT

Implant and flap surgery may need to be combined for women with big breasts. It can be recommended to perform augmentation, reduction or lifting surgery for the other breast in order to enable maximum symmetry.

Timing

Breast reconstruction can be performed during mastectomy (immediate reconstruction) or weeks, months or years after mastectomy ( delayed reconstruction). During immediate reconstruction, a tissue expander is placed in the mastectomy area. When the tissue expands sufficiently, it is removed and breast implant is replaced. No matter which method will be applied, it is helpful to know breast reconstructions have a few steps. Immediate reconstruction has two pros such as fewer number of operations and being low-cost. However, the possibility of complication is higher. Pros of delayed reconstruction is that the patient does not have to make her decision about reconstruction and supplementary treatments such as radiotherapy and chemotherapy will have ended in the course of reconstruction. In delayed reconstruction, the patient has enough time to get over her medical, financial and emotional problems..

Immediate reconstruction

  • One Step Immediate reconstruction with Breast Implant.
  • Two Step Immediate Reconstruction with Implant Following Tissue Expander (2-3 months later) Delayed Reconstruction
  • Two Step Delayed Reconstruction with Implant Following Tissue Expander (2-3 months later )

Reconstruction methods with breast implant

One Step reconstruction

One step Immediate breast reconstruction is performed during mastectomy. After general operator removes the breast tissue, plastic surgeon places breast implant.

Two step (immediate or delayed) reconstruction – tissue expander is placed in the first step, a few months later the tissue expander is removed and breast implant is placed. Tissue expander may be placed during mastectomy or months or years after mastectomy. During mastectomy, as the general operator removes not only breast tissue but also skin, breast Wall flattens and tightens. Tissue expander is placed under this remaining tissue.

Tissue expander is a balloon-like device made from elastic silicone. It is inserted unfilled and inflated with physiological saline solution at certain intervals. As long as tissue expander inflates, the tissue surrounding it expands as in abdominal parts of pregnant women. Therefore, a breast-shaped pocket in which breast implant can be inserted is created in the breast wall.

Tissue expander is inserted under general anaesthesia in operating room. Duration of operation is one or two hours. It may require one-night hospital stay. The patient can go back to her daily activities within two or three weeks. Since there will be no sense on breast wall after mastectomy, there will be no post-operative pain. However, when tissue expander is inflated, the patient may feel uneasy or pressure. As the tissue expands, this feeling of discomfort will disappear. Expansion of tissue  takes two-six months. After removing the tissue expander, breast implant in inserted in the pocket. This procedure is conducted under general anaesthesia in the operating room. It may require short-term hospital stay.

Breast Reconstruction without Implant: Flap procedures

Breast reconstruction can be performed by transferring a tissue section consisting of skin, fat and muscle from one part of body to another. This tissue can be gained from abdominal or back region. Flap tissue is either transferred to the breast regions by passing through a tunnel without cutting a self-feeding vessel (pedicled flap) or anastomosed  with microsurgical methods to another vessel in breast region by cutting the feeding vessel ( free flap). In the latter method, duration of operation is longer. Flap surgical methods necessitate longer hospital stay than implant surgery. Also, a scar tissue remains in the region where flap is obtained and in the breast region. However, tissue cannot be expanded if the tissue in breast wall is damaged due to radiotherapy. Only flap surgery can be performed. In flap surgery, the other breast does not need to be balanced in order to enable symmetry. The most frequently used muscle flaps are TRAM flap removed from abdominal region and latissimus dorsi removed from upper part of the back TRAM flap  is a major operation. It is a bigger intervention compared to mastectomy. It needs good status of general health and strong emotional motivation. Patients who are overweight, smoking, have had a previous operation on the flap region,  and circulation problems are not suitable for flap procedures. Also, patients who are very thin, and do not have sufficient tissue in their abdomen and back are not suitable fort his method or combination with implant is necessitated.

TRAM Flap (pedicled or free)

A tissue section from abdominal region is transferred to breast region in order to rebuild the breast in TRAM flap operation. Meanwhile, abdominal region is kept flat as in abdominoplasty operation. Pedicled TRAM flap operation takes nearly 3-6 hours under general anaesthesia. Free TRAM flap procedure takes longer. Duration of hospital stay is 2-5days. Within 6-8 weeks’ time, you can go back to your daily routines. Muscle weakness may appear around abdominal region temporarily or permanently. There will be a long scar on the abdominal region and also a few scars on the breast.

Latissimus Dorsi Flap

During Latissimus dorsi flap  procedure, a tissue section on the back region is transferred to breast region. Latissimus dorsi flap is smaller and thinner than TRAM flap. It is more appropriate for the patients with small breasts. The operation is performed under general anaesthesia. It takes 2-4 hours. Duration of hospital stay is 2-3 days. Patients can go back to their normal daily life within 2-3 weeks. Weakness on the back or shoulder may appear temporarily or permanently. Scar on the back can be hidden in the bra. Some scars may appear on the reconstructed breast.

Post-operative care

As in all surgeries, there will occur some pain, oedema, bruising and sensitivity after the operation. These indications may last for a month or longer but will disappear in time. Complications are bleeding, infection, flap necrosis.