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Breast Reconstruction After Breast Cancer

Data on breast cancer lies back to thousands of years ago. It is a very wrong attitude to directly describe people who got breast cancer as “patient”, and consider them as individual who caught an incurable disease. A woman, who had no organic disorders and seemed to be in good health until the day before, may notice a mass in her breast when taking a bath, and next day a tumor may be detected in her breast as a result of tests, but such a situation does not mean that she became ill at that moment.

If we simply consider the formation of a tumor in the body, we can regard it as the proliferation of tissues in the human body that occurs by means of an aggressive development; in other words, as an aggressive behavior of the body.

Diagnosis and treatment of breast cancer is a case of crisis that affects women’s lives physically, psychologically, socially and spiritually. A woman whose breast has been removed feels like she has lost her sense of femininity; or in the best-case scenario, her senses get weaker. Her organ that used to make an important contribution to her ability to feel like a complete woman is no longer available. A woman, whose breast has not been reconstructed, i.e. has not been repaired, mostly tries to complete her deficiency, (more precisely her incomplete feelings caused by this condition), by using prosthesis bras or mastectomy bras with pads. If such products are not available for her, she fills the bras with cotton; but in any case, she feels the need for meeting that deficiency by doing something.

How is a plastic surgery done after breast cancer?

In brief, breast reconstruction after breast cancer is the procedure that involves the production of a breast for a woman, who has lost her breast. An ideal breast reconstruction procedure to be carried out after mastectomy should be able to produce a breast that has an appearance and tissue similar to that of a normal breast; form symmetry with the other breast; give long-lasting results in the long term; and if required, these risks should be at an acceptable level.

“No breast reconstruction procedure can produce a breast that looks exactly the same as a normal breast.”

After losing their breast tissue due to breast cancer, women first get in to a depression process. Since the breast is one of the most important organs that make women different from men, they get an unfavorable psychology.

What procedures are used in breast reconstruction surgeries after breast cancer and who are suitable candidates ?

Two main procedures are carried out in breast reconstruction. These are the repairs with implants (tissue expander balloons and/or silicone breast implants) and/or the patient’s own tissues (self-tissue, autogenous tissue) are repaired.

Many factors such as the person’s general state of health, age, body features, previous surgical scars, whether she has received radiation therapy, the status of the other breast, the patient’s expectations and preferences play a role in the selection of the surgery procedure.

What are the procedures intended for creation of the breast tissue? What substances are used ?

Unfortunately, there is not only one standard method suitable for each patient. Selection of a procedure suitable for the patient depends on a detailed examination, and sometimes various analyses may be required. Each patient is unique. In consequence of my experiences, I ascertained the fact that patients are mostly interested in results rather than technical details. Of course the important points that lead us to the result should be known.

In breast reconstructions with tissue expanders and silicone implants, first tissue expanders are used. The procedure involves the preparation of a pouch with a size adequate for the placement of the breast implant, and then the placement of that breast implant. This tissue expander is inflated with physiological saline solution (salt water) at certain intervals, by means of a valve. (Usually no pain is felt during the inflation.) This procedure can take a certain period of time ranging from several weeks to several months, depending on the size of the permanent implant. After carrying out an adequate inflation process, that issue expander is removed with another surgery. Than the desired implant is placed in its place.

Breast reconstructions with self-tissues (the patient’s own tissues) or autogenous tissues can also be carried out as a three-dimensional breast repair, by using tissues taken from the abdomen, back, buttocks and thigh area. The advantages of self-tissue are that it provides a live, soft, and three-dimensional repair ensuring the reconstructed breast to be very similar to the normal breast. The scar formation in the donor area, and the risks caused by tissue transplantation can be considered to be the disadvantages of this procedure. The physical behavior of a breast reconstructed with self-tissues is very similar to that of the normal breast, and a better sense of touch is obtained. In the postoperative period, the scars begin to fade, the tissues used get softer, and all these increase the feeling of satisfaction in the course of time. The reconstructed breast gives response to weight gain and loss, like a normal breast.

In nipple reconstruction, 6-8 months after the first surgery, the nipple of the reconstructed breast is marked, and then a nipple is made from the tissues suitable for the process. Tattoos can be applied to make the dark area around the nipple; but instead, a self-tissue taken from the other nipple or the groin can be used, as well. These processes can be carried out under local anesthesia, and do not require hospital stay. At this stage, certain operations such as breast reduction and breast lift are applied to the other breast, with intent to provide symmetry. These procedures require general anesthesia.

What are the advantages and disadvantages of breast reconstruction?

In terms of timing, breast reconstruction can be done in two sessions. The optimal time is variable and depends on many factors such as the stage of breast cancer, your medical history, your social and psychological status, and the possibility of postoperative radiotherapy. Each approach has certain advantages and disadvantages specific to it. Nevertheless, the both approaches are ended with a reconstruction process. One of these is performed simultaneously or involves immediate repair. In such a case, in patients diagnosed with breast cancer, breast reconstruction can be performed during the session of the mastectomy. Thus, the patient gets out of the operating room (that she has entered with breasts) with a new breast, instead getting out of there without breast. Patients diagnosed with breast cancer at an early stage are suitable candidates for simultaneous reconstruction. In patients diagnosed with breast cancer at an advanced stage, or in patients who will receive radiation therapy, applying reconstruction procedure after a couple of years lived without disease would be a more appropriate approach. This is called late-reconstruction.

What are the risks and harmful properties of breast reconstruction?

Alcohol and smoking appears as very big risk factors, as well. In all the breast surgeries that I have done until today, I have witnessed the facts that the wounds of smoker could heal late, they get wound infection, impaired blood circulation in the nipple, and even necrosis (disruption of blood supply to associated tissues). Therefore, I request my patients to stop smoking at least 6-8 weeks before the surgery.

What are the points to consider besides stopping alcohol consume and smoking, during breast reconstruction period after breast cancer?

I generally request our patient to be very careful about their nutrition and do exercise before surgeries. As guidance, they can follow the American Cancer Society’s recommendations:
To eat mostly plant based foods; eat at least 5 servings of vegetables and fruits a day; eat plant based foods such as breads, other cereals, pasta, rice legumes on a daily basis; to avoid especially fatty foods produced from animal sources; prefer less oily foods; to reduce the consumption meats, especially fatty meats; become physically active; to reach a healthy weight; become moderately active for a period of at least 30 minutes on most days of the week; to maintain the ideal weight; to reduce alcohol consumption (if used), etc.
Besides these, also the genetic factors pose a risk. If cancer cases have been observed in the mother and aunt of the patient, she should definitely share this information with her specialist physicians, who will then need to take certain preventive measures.