Breast Reconstruction

Breast reconstruction surgery is a reconstructive surgery rather than a cosmetic surgery.

Removal of breast, which is an important element of feminine appearance and self-esteem, affects every woman's psychology to a great extent. This may cause problems in social life and sexual relationships.

Thanks to the innovations and technological developments in the medical world, it is now possible to perform operations that reconstruct natural looking new breast instead of the breast that has been removed. Breast reconstruction allows many women to open a new chapter in their lives and feel better mentally and physically.

Before undergoing breast reconstruction surgery to be performed due to cancer, the patient is evaluated by a team consisting of a general surgeon, a plastic surgeon, medical and radiation oncology specialists. Thus, the most appropriate treatment method is determined, and the operation process is managed.

What is Breast Reconstruction?

The goal of breast reconstruction is to restore the missing breast or asymmetric breasts to normal appearance. Depending on the situation, either a permanent breast implant is placed directly, or a tissue expander is placed for a while to allow the tissue to flex and expand, and then the implant is used.

Why is it done?

Breast reconstruction is performed to reconstruct missing breast tissue in people with a single breast or no breasts due to congenital deformities or various traumas, mostly due to mastectomy, lumpectomy (removal of breast tissue).

What is the right time to have breast reconstruction?

Many women whose breast has been removed due to cancer may undergo breast reconstruction. Breast reconstruction is performed either during breast removal (concurrent) or afterwards (late reconstruction), as deemed suitable by the doctor. The situation of each patient is different. Many factors such as age, body structure, whether the patient has had radiotherapy or chemotherapy, stage of the disease should be evaluated together by physicians.

Simultaneous Breast Reconstruction

It involves reconstruction with standard or inflatable breast implant performed immediately after removal of breast tissue due to cancer during the same operation.

Delayed – Simultaneous Breast Reconstruction

If breast tissue as well as skin are removed due to cancer, a tissue expander is placed in the breast during the operation.

After a few months, the tissue expander is replaced with a breast implant to complete the reconstruction.

Delayed Breast Reconstruction

It involves reconstruction during a second operation following radiotherapy or chemotherapy long after the initial breast removal operation.

How is breast reconstruction performed?

3 methods are adopted in breast reconstruction. The first involves use of tissue expander and implant. The second involves use of the patient's own tissue. Another option is transplant of tissue enriched with stem cells.

Depending on the condition of the patient and the breast, it is possible to utilize some of the options together if necessary.

Nipple and Areola Reconstruction

After completion of breast reconstruction to give the final form of the breast, a new nipple is made from the patient's own tissue.

Tattoo method is utilized to reconstruct the dark-colored area (areola) around the nipple.

Providing Symmetry between Breasts

If only one breast will be reconstructioned, it is reconstructed in size and type in accordance with the other breast. If the intact breast is too large or saggy, this breast can be reduced and lifted during the same operation so that both breasts have equal features.

How long does breast reconstruction take?

Although the duration of breast reconstruction varies according to the planned surgery and conditions, it takes approximately 1-3 hours.

Is breast reconstruction a painful procedure?

After surgery, you may have mild pain, which will gradually remit and finally resolve with simple painkillers.

Type of Anesthesia

Breast reconstruction is performed under general anesthesia.

Before Breast Reconstruction

Who can have Breast Reconstruction?

People whose breast shape has changed, whose breast has been reduced or completely removed for congenital reasons, as a result of an accident or following mastectomy can have breast reconstruction.

In people with a high risk of cancer and in some types of breast cancer, intact breast tissue is removed along with the cancerous breast.

Breast Reconstruction with Implants

What are types of breast implants?

By shape:

Tear Drop implant (Anatomic)

In tear drop implants, vertical diameter is slightly longer than horizontal diameter and the implant height is higher in lower pole than in upper pole. They are also called anatomic because they are more similar to natural breast shape.

Round implant

In round breast implants, horizontal and vertical base diameters are equal to each other. They have a diffuse appearance.

By content:

Silicone-filled

The inner and outer materials of silicone-filled implants are made of silicone. It is highly compatible with human tissues and is natural in the sense of touch.

Saline-filled

Saline-filled breast implants contain sterile saltwater solution.

By surface structure:

• Smooth surface
• Textured surface

Textured surface implants were found to cause lesser number of capsules compared to smooth surface implants.

Where are breast implants placed?

A breast implant can be placed by a surgical procedure from 4 sites in general.

• Breast crease (submammary, IMF incision)
• Around the nipple (periareolar)
• Armpit (transaxillary)
• Belly button (transumblical)

Where is breast implant placed?

Although variations such as dual plan, full or partial submuscular plan and subfascial plan have been developed recently, implants are conventionally placed in submusculular or subglandular planes. Each has different disadvantages or advantages.

Round Implant or Drop (Anatomical) Implant?

Breast implant selection should be based on body structure of the patient and the state of tissue where the procedure will be applied. A highly natural result can be obtained with both implants according the existing condition.

Breast Reconstruction with Patient's Own Tissues (Autogenous Tissues)

It is a reconstruction procedure performed with flap, which is a person's own tissue (consisting of skin, fat, muscle). Near or distant peripheral tissues in the abdomen, back or other part of the body are removed and transferred to the chest area to form new breast tissue.

Doctor Selection

You should definitely consult an aesthetic and plastic surgeon experienced in reconstruction for breast construction surgery.

What are the characteristics of an ideal breast reconstruction method?

• A safe application for the patient
• Minimal risk of complications
• No additional risks to the patient; even in the presence of additional risks, they are acceptable
• That it results in no promiment functional impairment
• That it causes no delay in the application of treatments such as chemotherapy or radiotherapy
• Creation of a natural breast and texture
• Providing symmetry between two breasts
• Achieving permanent results in the long term

Things to consider before surgery

If the surgery will be performed after breast cancer operation, the surgeon and the oncologist evaluate the patient's condition before reconstruction. Appropriate timing of the operation is important. As with all operations, it's recommended that blood thinner medications, smoking and drinking alcohol should be stopped before breast reconstruction.

After Breast Reconstruction

Things to consider after surgery

• You should lie on your back during the first week and avoid lying face down for 6 weeks. Avoid lifting your arms too much.
• Avoid showering for 2 days. For a problem-free recovery period, rest at the beginning and avoid strenuous activities afterwards.
• You should wear a sports bra for 3 weeks.
• You should strictly comply with routine follow-up schedule.

Recovery Process

Overnight hospital stay after the operation is necessary. On day 2 or 3 after the procedure, bandages are removed, and you can resume normal activities.

Price of Breast Reconstruction Operation

The prices of reconstruction operations vary by the technique employed, stages and patient condition.

What are the risks of breast reconstruction operation?

Except for the possible risks that may occur in all surgeries, there is no health risk particularly specific to breast reconstruction.

Frequently asked questions about breast reconstruction surgery

Who cannot have breast reconstruction surgery?

Breast reconstruction with implant is not a suitable option for people who had radiotherapy on chest wall or people highly likely to undergo radiotherapy after surgery.

However, if a person who underwent breast reconstruction with a breast implant requires radiotherapy later, there should be no metal parts in the implant. If the implant has metal parts, the surrounding tissue is exposed to radiation more and the implant leads to unnecessary tissue damage.

Will there be any scar left after surgery?

All surgical procedures may cause scarring, either large or small. Factors including skin structure, experience and diligence of the plastic surgeon performing the procedure and protection of the area from irritation and infection during recover play a role in the extent of the resulting scar.

How are silicone implants made?

The silicone implant is manufactured in the form of a bag with an outer sheath of silicon several millimeters in thickness. It also has a silicon filling. Implants are diversified as a result of the development of technology. Round implants are generally softer because they are filled with a more fluid gel. Tear drop implants are denser and better in maintaining their shape.

Does a silicone implant explode?

A silicone implant is extremely robust, retaining its shape even if cut in half. The sheath made of silicone and layers shows a high resistance to physical and chemical effects.

What is symmastia?

Symmastia is confluence of the breast tissue of both breasts across the midline. The skin between the breasts rises, the cleavage depth decreases or disappears completely. There may be only a small horizontal bridge between two breasts, or the breasts may appear fully merged in midline.

Special bras are used to treat symmastia, but they cannot provide a permanent solution. Actual treatment of symmastia is surgical intervention.

I do not have breast cancer. But congenitally, I only have a nipple. Can I have a reconstruction?

Congenitally deficient breast or breast tissue can be reconstructioned using either autogenous tissues or an implant depending on the condition of the patient.