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Breast repair surgeries

Breast repair operations performed after removal of breast tissue due to a tumor or other disease are one of the most successful operations of plastic surgery. Thanks to new technologies in medicine, surgeons can now create a breast that closely resembles a natural breast. Nowadays, these operations can be performed simultaneously with breast removal surgery (mastectomy). Thus, when the patient comes out of the operation, he has a new breast and gets rid of the psychological distress that a period without breasts can cause.
However, it should not be forgotten that; Breast reconstruction after mastectomy is not a simple operation. There are many options available to be decided by you and your doctor. Below you are given basic information about the surgery; such as when the surgery was performed, how it was performed, and what kind of results would be obtained. However, it is not possible to answer all questions. Therefore, speaking one-on-one with your surgeon will provide you with better information.
Who is the best candidate for breast repair surgery?
There is no medical obstacle for breast repair surgery in patients with almost all breast tissue removed, and most patients are suitable for simultaneous reconstruction with mastectomy. However, the best candidates for breast reconstruction are patients in whom the tumor has completely disappeared through mastectomy. There are many reasons to wait; for example, some patients do not want another surgery, some have difficulty accepting the diagnosis of cancer, and cannot consider breast repair options. Some patients may have been advised by their surgeon to wait, especially when the breast is reconstructed with the patient’s own tissue (flap transfer). In cases such as obesity, high blood pressure and smoking, patients may be advised to wait.
All surgeries involve some degree of uncertainty and risk.
Breast reconstruction can be performed in almost any woman who has lost her breast due to cancer. However, as with any surgery, some problems may arise after this surgery.
Bleeding, fluid collection or anesthesia problems, which are the general problems of surgery, can also be seen after this surgery, but are rare. In smokers, wound healing may be delayed, impaired, or more scars may appear. Sometimes these problems may require a secondary surgery. If a prosthesis is to be used, there is rarely a risk of developing an infection within two weeks. In some such cases, it may be necessary to remove the prosthesis and put it back in months later.
The most common problem, capsular contracture, occurs when the scar tissue around the prosthesis compresses the prosthesis. Thus, the feeling of breast hardness occurs. There are some treatment methods for capsule contracture; sometimes it may require removal and relief of scar tissue or replacement of the prosthesis.
Reconstruction has no effect on cancer recurrence and does not interfere with radiotherapy/chemotherapy. Your surgeon may recommend that you continue with periodic mammograms of your normal breast and your reconstructed breast.
Planning the surgery
From the time you are diagnosed with cancer, you can start discussing reconstruction. Ideally, your general surgeon and plastic surgeon will plan and operate together. After your health assessment, your surgeon will give you the best options, taking into account your age, anatomical structure, tissues and wishes. Your surgeon should be very honest with you about this. Breast reconstruction after mastectomy can improve your appearance and increase your self-confidence; However, remember, this surgery can only improve the result, not perfect it. Your surgeon should also provide information about anesthesia, the place where the surgery will be performed, and the costs.
Preparation for surgery
Your oncologist and plastic surgeon will give some warnings before surgery; for example, what to eat or not, take medicine etc. Do not forget to arrange a relative to drive you home after the surgery.
Where your surgery will be done
Breast reconstruction usually requires several surgeries. The first step, whether done concurrently or secondary to mastectomy, is usually done in the hospital. Other surgeries can be performed in the hospital, or your surgeon may prefer to perform them in one of the day surgery centers.
The first operation, namely the creation of breast tissue, is performed under general anesthesia. So, you sleep during the surgery. Secondary surgeries can be performed with local anesthesia (with sedation) – you will be awake during the surgery but relaxed and relaxed. Sometimes it can be a bit of a hassle.
Prosthesis types
There is a silicone layer on the outer sheath of breast prostheses, inside of which there is either a silicone gel or a salt water mixture called saline. In 2006, the Food and Drug Administration (FDA) accepted the use of gel-filled prostheses. In this case, women who are currently carrying tissue expanders, patients who choose simultaneous reconstruction with mastectomy, and a gel-filled prosthesis can be used. Prostheses filled with saline and gel are open to everyone.
There are many options and you should discuss them with your surgeon.
Expansion of the skin
The most commonly used technique is widening the skin and then placing a prosthesis. After a mastectomy, a tissue expander is placed under your skin and chest wall muscle. A valve-operated port is placed under your skin, and from there, your surgeon injects saline to inflate your tissue expander for weeks or months after surgery. After it is understood that your skin has expanded enough, a secondary surgery removes the tissue expander and a more permanent prosthesis is placed. Some tissue expanders are designed to be left on permanently. The areola (brown round skin around the nipple) and the nipple are done later. In some patients, there is no need for skin augmentation and a prosthesis can be placed with mastectomy.
Repair with flap
As an alternative to the prosthesis method, a breast can be made by taking a tissue from the back, abdomen or hip. This is called flap reconstruction. In one type of flap surgery, the skin, subcutaneous fat layer and muscle tissue remain connected to the original attachment area by a vessel stem 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 region to which it is attached, and its vessels are sutured to the vessels in the recipient area and are kept alive (reconstruction with a free flap). In order to perform this operation, the plastic surgeon must also be experienced in microvascular surgery. Because it is possible to stitch thin veins together under the microscope.
Both surgical methods mentioned above are more complex operations than the prosthesis method. There will be scars both in the places where the tissue is taken and the breast is made, and the healing process is longer than the prosthesis method. On the other hand, in breast reconstruction made with your own tissue, the result is more natural and there is no concern with silicone. Sometimes, improving the shape of your abdomen and getting rid of excess skin and fat can be a separate benefit for you.
Secondary surgeries
Breast reconstruction requires several surgeries over time. The first operation is the most complex; Secondary surgeries are easier and if the tissue expander reconstruction method is chosen, the tissue expander can be removed and a prosthesis can be placed, or the nipple and areola can be reconstructed. In most cases, the normal breast may need to be slightly reduced, lifted or enlarged in order for the newly made breast to adapt to the normal breast on the opposite side. However, it should be kept in mind that scars occur in these surgeries as well.
Your post-operative pain can be largely relieved with medication. Depending on the size of your surgery, you will be discharged from the hospital in 2 to 5 days. Drains that prevent the accumulation of fluids can be placed during the surgery and they are removed in the first or second week after the surgery. Stitches are removed in 7 to 10 days.
return to normal
It may take up to 6 weeks for you to return to normal after mastectomy and reconstruction or flap-only reconstruction surgery. In prosthetic surgery, this period may be shorter. Normal sense is not gained with reconstruction; however, some sense may come over time. Most of the scars can fade over time. However, this period may be 1-5 years and the traces never completely disappear. As long as the reconstruction is of high quality, you will care less about these scars.
Listen to your surgeon’s advice about when to start exercise and movements. As a general rule, it may be best to avoid sexual intercourse and heavy exercise for 3-6 weeks.
Your new image
Your new breast may look firmer, rounder and flatter than your other normal breast. It may not have the contour before the mastectomy or it may not be fully symmetrical to your other breast. These differences may seem obvious to you. For many mastectomy patients, reconstruction dramatically improves appearance and quality of life.