Breast Reconstruction

Breast reconstruction surgery is an important contribution in normalization of lives of the women who have a breast tissue loss. The breast tissue loss affects patients physically, socially and mentally.
This type of organ loss constantly reminds the patient of the trauma, disrupts the perception of the body, leads to thinking that she is not desired and liked. This causes the deterioration in relationships both within the family and society.
Especially in summer, there are problems with clothes, and many patients who cannot wear bathing suits do not want to go on a holiday. In cases where the other breast is larger, an asymmetry occurs and this causes the disruption of the balance of the body which leads to spinal problems. Externally used silicone prostheses cause problems on the shoulders and neck and adversely affect the skin due to perspiration and contact.

Breast reconstruction after breast cancer increases the quality of life of the patients and makes them feel better both mentally and physically.

when should breast reconstruction be performed?

In early-stage tumours, reconstruction is started during the breast removal. If the tumour stage is advanced and postoperative radiotherapy is planned, the reconstruction process is postponed. The termination of chemotherapy and radiotherapy is awaited and the reconstruction is usually started one year later. If it is unclear whether or not the patient will receive postoperative radiotherapy, an empty tissue expander is placed under the breast muscle during mastectomy and the filling is done after the end of treatments. In this way, the patient is saved from an extra operation.

how is breast reconstruction performed with the patient’s own tissues?

Reconstruction is carried out with the skin and subcutaneous tissues obtained from various parts of the body. The tissues are transplanted together with the underneath muscle and veins feeding them. The transplantation is carried out by transplanting the whole muscle to the breast or the tissue to be transplanted is removed from the body as a graft and its veins are connected to the veins in the breast under a microscope. These types of transplanted tissues are referred to as flaps. In breast reconstruction, flaps are most often taken from the abdomen and back:

TRAM flap: The abdominal tissue under the belly is transplanted with the underlying muscle in the anterior abdominal wall.
Latissimus dorsi flaps: These wing muscles located on the back are transplanted from the armpit to the chest wall with their skin. There are other types of flaps used but their areas of usage are limited.

in which patients is breast reconstruction with their own tissues preferred?

In patients with severe skin loss after mastectomy, in cases where the quality of the skin in the chest wall is not good and in patients who have received radiotherapy their own tissues are preferred instead of a silicone prosthesis. Patients who have given birth are suitable for TRAM flaps taken from the abdomen.
Abdominal region is not preferred for people who do not have enough tissue in the abdomen and who did not give birth. In these patients, tissues obtained from the back can be used instead. In addition, prostheses should be the first choice to be preferred for those requiring bilateral reconstruction.

is breast reconstruction carried out in a single session?

Breast reconstruction procedures are usually multi-session surgeries. The whole process spreads over a year. Among these, the major and painful procedure is often the first operation. Subsequent procedures are shorter and less painful.

In cases of reconstruction with prostheses, the tissue expander is placed in the first operation and the opposite breast is reduced. In the second session, the prosthesis is placed and symmetry is achieved. If the patient’s own tissue is going to be used, the tissue is transplanted in the first operation and the other breast is shaped pro re nata. The second operation requires minor revisions to provide symmetry.
In all methods, nipple reconstruction is performed in the third operation. This is a fairly simple procedure and is usually performed under local anaesthesia.

In the mastectomy procedure, the breast reconstruction is carried out either in single or two stages, in order for the incisions to heal properly and obtain the best results.

In the first stage right after mastectomy, your doctor carefully fixes a special teardrop shaped tissue expander under your pectoral muscle. This expander is filled with some serum to prevent the pressure of the protected skin of on the removed breast during the surgery. Then, a special kind of skin called Dermal Matrix, which is taken from the cadaver and underwent a special procedure with advanced technology, is used to cover, strengthen and stabilize the lower part of the tissue expander that cannot be totally covered by the muscle. The tissue expander is then painlessly and easily filled with serum until it reaches the size decided by you and your doctor during the controls.

At the end of chemotherapy or radiotherapy which may be required, the second stage is planned in which the tissue expander that is placed in the first stage is replaced with a softer and permanent prosthesis.

Breast reconstruction can sometimes be performed as a single-stage procedure in suitable people. In suitable patients, it is possible to place the prosthesis directly in the first stage after the breast has been removed. Your doctor carefully places the permanent breast prosthesis under the chest muscle (pectoralis major).

A special kind of skin called Dermal Matrix, which is taken from a cadaver and underwent a special procedure with advanced technology, is used to cover, strengthen and stabilize the lower part of the tissue expander that cannot be totally covered by the muscle. If you are interested in the single-stage procedure, you should discuss this option with your doctor.

“Transverse Rectus Abdominis Flap”, which is known as TRAM, is the skin and fat tissue beneath the belly button in the abdomen, is an autologous tissue source for the breast reconstruction. Transverse Rectus Abdominis muscle is located in the lower abdomen between the ribs and the pelvis. Breast reconstruction procedure with the TRAM flap uses the skin, fat, and muscle of the lower abdomen. The TRAM flap method can be ideal for people with a proper body structure, so if you are interested in this method please discuss it with your doctor.

What is symmastia?

Symmastia means the abnormal position of the breasts, breast prostheses, the confluence of the breasts in the midline or positioning of one of the breasts towards the midline of the chest. In some cases, prostheses may appear as combined by displacing and joining in the chest.

This condition may develop due to the formation of a very large space for prosthesis during the surgery, and in particular by creating a large space in the middle of the chest cage.

Often, this may occur with prostheses placed under the muscles, but sometimes even with prostheses placed on the muscles.

Previously, the only and best way to correct this was to remove the prostheses and wait for months to heal. Then, in a single session, new prostheses were placed in their new spaces.

Years ago, scientific articles were written on how to correct this situation and the term “capsular contracture” repair was proposed. This term essentially means using the suture to close the cavity close to the middle area and to apply it to both sides and then to replace prostheses at the same time.

In solving this problem, this method was a more primitive procedure; there were times when it worked, but it was a difficult technique to apply surgically and was not popular. If prostheses were on the muscle, they could be replaced under the muscle to correct the problem. However, since the problem usually arises with sub-muscular prostheses, it is not applicable to most patients.

Recently, many surgeons have begun to apply a new surgical technique that is both easier and safer to overcome this problem. This procedure is called a neosubpectoral pocket or new sub-muscular pocket.

Essentially, this operation allowed us to create a new pocket for prostheses by closing the old pocket at the same time. However, in this case, with the repair of the capsule, instead of partially closing the old pocket, we close it completely.

With this surgery, it is possible to solve not only symmastia but also many prosthetic displacement problems and even in some cases, the capsular contracture. This method, which requires an advanced planning and application, is successfully applied by surgeons with a breast reconstruction experience. We also successfully perform these surgeries in our clinic with more than 15 years of breast reconstruction experience.

Even In recent years, we have been able to increase the chances of success by introducing materials such as Acellular Dermal Matrix (specially treated cadaveric skin) or artificial skin to support and reinforce these repairs. Just as the chimney skirt protects the chimney from the leakage of the metal dropper, the artificial skin gives us the opportunity of treatment by using a neosubpectoral pocket and then to strengthen and support with the artificial skin.

In many cases, we use tissue-based patches or artificial cadaveric skin. Recently, however, surgeons have started using biological fascia and synthetic Vicryl mesh instead of tissue-based patches.

In addition to the surgical treatment that can be performed almost always in a single step instead of waiting for a period of time after the removal of prostheses, we usually recommend that you choose a prosthesis that will probably fit better or fill the cavity, which means a smaller prosthesis than the original one. Not always, but in some cases, the problem is not caused by repeated entries to the tissue or the creation of new pockets, but also it may be due to the fact that initial prostheses were large for the female anatomy or the size of the chest cage.

Although the development and diagnosis of symmastia is a disappointing experience for a woman with breast prosthesis, the good news is that experienced surgeons have a chance to safely treat it by means of appropriate methods as described above.