Breast reconstruction surgery  is a surgery performed to reconstruct the breast tissue as a result of a congenital breast anomaly or removal of the breast for any reason. Breast reconstruction surgery is a procedure commonly performed when mastectomy is preferred in the treatment of breast cancer.
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 After mastectomy, breast reconstruction surgery is performed to help people regain their self-confidence, make peace with themselves, and continue their lives to the fullest .
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You can find answers to frequently asked questions about breast reconstruction surgery, breast cancer, mastectomy in breast cancer treatment and breast reconstruction in our article.
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What is Breast?
Breast is basically the name given to the protrusions found in the upper ventral region of the bodies of all primates. The function of the breast is quite different in men and women. The breast, which develops from the same embryological tissue in both women and men, is functional in women.
Breasts in women produce the milk necessary for nutrition. Breasts develop only with the estrogen and growth hormone secreted during puberty in humans. Breast development is minimal in other primates other than humans.
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In other primates, breast development occurs with pregnancy. Although the main function of the female breast is to provide nutrition to babies, today this organ is also very important from a social perspective.
Breasts, which have been accepted as a part of the female silhouette for hundreds of years and perceived as a reason for sexual attractiveness, are definitely highlighted in studies on the female body. Nipples are erogenous zones in the breast structure and are considered a part of sexual stimulation.
Breast Anatomy in Women
The developing breast tissue in women contains fat, fiber and glandular tissue. Within the glandular tissue, there are structures called lobes and lobules and milk ducts. Fibrous tissue helps the breast attach to the rib cage and take its distinct shape. Fat tissue fills the spaces between glandular and fibrous tissues.
Fat tissue is effective in determining breast size in women. Except for the fatty tissues in the female breast, all the remaining tissues are called fibroglandular tissue. Apart from this, the structures located under both breasts, known as the pectoral muscles and providing support between the rib cage and the breast, are also a part of the breast anatomy.
What is Breast Repair?
The surgery, called breast repair or breast reconstruction, can be defined as restoring the shape of the breast as a result of completely removing the breast for a reason.
Breast reconstruction is an operation generally performed in cases where the breast needs to be removed in the treatment of breast cancer, so that people can have a normal appearance both individually and socially, after the completion of the treatment.
Why is Breast Repair Done?
The surgical removal of part or all of the breast tissue for any reason is referred to as mastectomy. Mastectomy is one of the procedures that can be preferred as a treatment method for breast cancer, which is very common in women.
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Mastectomy surgery can be preferred not only in the treatment of breast cancer but also as a preventive treatment for people at risk of breast cancer.
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The need for breast reconstruction may arise after mastectomy. Once the treatment is completed after complete removal of the breast, the operation referred to as breast reconstruction, breast reconstruction or mastectomy reconstruction comes to the fore. With this operation, the breast is reconstructed with different techniques according to the person’s expectations, treatment status and feasibility.
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Although breast reconstruction is not a physically necessary operation, losing the breast, which is the “symbol of femininity” for women, can lead to serious psychological problems. For this reason, breast reconstruction is an operation recommended for the person to have a healthier mood, to feel physically complete and to regain the “symbol of femininity”.
What is Breast Cancer?
Cancer can be defined as a class of diseases characterized by abnormal cells invading healthy cells in the body and causing serious problems as a result of uncontrolled abnormal cell growth.
Breast cancer is a type of cancer that occurs in the areas where the breast tissue is located and can metastasize, that is, spread, in different parts of the body in later stages. Breast cancer basically starts in breast cells, but its progression can be very different.
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Cancer begins in cells, which are the basic building blocks that make up tissues. Anomalies that occur in cell production and growth are defined as cancer. Failure to achieve what is expected in cell growth processes and new cell formation occurring in excess of need; As a result of old and damaged cells not dying, cell accumulation occurs in the body. As a result of this cell accumulation, tissues called tumors are formed.
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Breast cancer occurs with the formation of a malignant tumor in the breast. The cells that form the malignant tumor in the breast can spread through blood and lymph vessels. With this spread, cancerous cells can damage different tissues and organs. This is the metastasis we mentioned before.
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Different treatment methods can be preferred in breast cancer treatment to eliminate the risk of metastasis and combat the disease. At this point, the type of breast cancer is very important in determining the treatment.
Types of Breast Cancer
Breast cancer is a disease that has many different types and requires different treatment methods for each type. Mastectomy is not the preferred treatment method for every type of breast cancer.
Ductal carcinoma in situ (DCIS):Â Â It is a type of non-invasive cancer in which abnormal cells are found in the milk ducts. It is very easy to treat with early diagnosis. It is a type that has an easy treatment, but if there is no early diagnosis and treatment, it can spread to the breast tissue.
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Invasive Ductal Carcinoma (IDC):Â Â Cancer occurring in the milk ducts
It is expressed as the spread of cells into the breast tissue. It is a fairly common type of breast cancer and can spread to other parts of the body. IDC accounts for approximately 70% of all breast cancer diagnoses and is the most common type of breast cancer in men.
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Lobular Carcinoma In Situ (LCIS):Â Â It is the presence of abnormal cells in the lobules that make up the breast. The treatability rate in this type of cancer is quite high. However, if LCIS is diagnosed in one breast, there is a high risk of developing LCIS in the other breast.
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Invasive Lobular Cancer (ILC):Â Â ILC is a type of cancer that starts in the milk-producing glands in the breast and then spreads to the surrounding tissues. It is known as the most common type of breast cancer after IDC. This type can also spread throughout the body through blood and lymph vessels.
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Triple Negative Breast Cancer:Â Â In this type, the three receptors that support breast cancer growth are not found in the cancerous area. This means that the results of tests for breast cancer cells come back negative. Chemotherapy, rather than targeted drugs and hormone therapy, is effective in this type of cancer. Although this type of cancer is aggressive and difficult to treat, ongoing research is being conducted for treatment.
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Inflammatory Breast Cancer (IBC):Â Â It is an aggressive type that progresses rapidly. This type of cancer progresses more significantly when it spreads to the breast tissue and lymph vessels. Its symptoms begin with the blockage of lymph vessels.
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Metastatic Breast Cancer:Â Â It is known as stage four breast cancer. Breast cancer has spread to the lungs, bones, brain, or liver.
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Medullary Carcinoma:Â Â is characterized by tumor formation in the breast tissue, but is diagnosed by mammography because the tumor has a spongy structure.
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Tubular Carcinoma:Â Â It is a type of cancer that is more common in women aged 50 and over and responds to hormone therapy. It can be diagnosed through a mammogram.
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Colloid:Â Â Also known as mucinous carcinoma, this breast cancer is a type that causes mucus production in the area. It is easy to treat.
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Paget:Â Paget’s disease is a very rare type of cancer that affects the areola located around the nipple.
Breast Cancer Symptoms
Since there are many different types of breast cancer, it is natural that there are differences in breast cancer symptoms. Breast cancer symptoms, which may vary from person to person, may not appear at all in some cases.
Commonly known breast cancer symptoms:
- Lump in the breast or armpit area,
- Form changes such as thickening or swelling in one area of ​​the breast,
- Irritation, redness and deterioration of the breast skin,
- Shedding or redness in the areola, also known as the nipple area,
- Nipple discharge other than breast milk,
- Nipple collapses inwards,
- Pain in the nipple,
- Change in breast shape and size,
- It can be expressed as pain in any part of the breast. It should not be forgotten that these symptoms do not only indicate breast cancer, but may also occur due to different reasons. However, in cases where early diagnosis is very important, such as breast cancer, it is important for women not to skip their monthly physical examinations and to have regular mammograms as recommended by their doctors.
Breast Cancer Treatment Methods
There are 5 commonly used treatment methods in the treatment of breast cancer. During the treatment planning process, 1 of these 5 treatments or combinations of these treatments are preferred. Some of these treatments directly target cancerous tissues and tumors, while others target cancer-fighting agents throughout the body. Each patient must be evaluated individually and the correct treatment plan must be made individually.
- Operation,
- Radiation,
- Hormone therapy,
- Chemotherapy,
- Smart drugs are the most basic methods used in breast cancer treatment.
What is Mastectomy?
Mastectomy is one of the preferred methods in breast cancer treatment. In this method, it is essential to completely remove the breast and clean the area. However, different types of mastectomies can be performed depending on the planned treatment and the type and stage of the cancer. Breast cancer treatment can be performed with operations involving different approaches such as simple, modified radical, radical, subcutaneous and partial mastectomy.
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Simple Mastectomy:Â Â It means complete removal of breast tissue. In this operation, the lymph nodes in the armpit area and the perental muscles under the breast are not removed.
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Modified Radical Mastectomy:Â Â The pectoral muscles under the breast are not removed, some of the lymph nodes are removed and lymph node dissection is performed.
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Radical Mastectomy:Â Â The entire breast and some armpit lymph nodes are removed. In this method, the pectoral muscles under the breast are also removed.
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Partial Mastectomy:Â Â It is performed by removing the cancerous cells and formations in the breast tissue along with some of the surrounding normal tissues.
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Subcutaneous Mastectomy:Â Â Although the breast tissue is completely removed, the nipple and areola are left untouched.
Is the Entire Breast Removed During Breast Cancer Surgery?
If surgical intervention is considered in the treatment of breast cancer, it is possible to completely remove the breast with mastectomy. However, it should not be expected to remove the entire breast in every operation.
Life After Mastectomy
Returning to normal life after mastectomy can be challenging for women. The processes that occur after a surgical operation are the same for mastectomy. The duration of hospital stay after the operation varies between 1-3 days. However, in some cases, breast reconstruction surgery can be performed in combination with mastectomy. In planning such a combined surgery, the duration of hospitalization after the operation may increase.
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After mastectomy, it is important to strictly follow the recommendations of the surgeon who performed the operation. Protecting the area and performing regular dressings are also very important for the healing process. Self-dissolving stitches are generally used in such operations. However, if the opposite is the case, it is necessary to visit the doctor who performed the operation to have the stitches removed in a timely manner.
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The drains used in the operation are removed after approximately 10 days. Some exercises should not be neglected to prevent stiffness in the arm and shoulder area after the operation. Exercise planning should be done taking the drains into consideration.
Breast Repair After Mastectomy
The surgery, called breast reconstruction or breast reconstruction, allows the reconstruction of the breast removed by mastectomy. Collaboration between oncologist and plastic surgeon is of great importance for breast reconstruction after mastectomy. The oncologist planning the treatment after mastectomy may want to continue different treatments.
In this case, the right time must be waited for breast reconstruction. In some cases, breast reconstruction surgery can be performed simultaneously with mastectomy surgery. In order to make this planning, it is recommended that the person does not undergo tiring cancer treatment after mastectomy.
Who Gets Breast Reconstruction Surgery?
Breast reconstruction surgery is a procedure performed to reconstruct the breast as a result of removing breast tissue, usually after breast cancer treatment. Mastectomy refers to the removal of breast tissue and is often the preferred type of treatment for breast cancer. Anyone who has had a mastectomy operation and has an oncologist’s approval for breast reconstruction surgery can have breast reconstruction surgery if they wish.
When is Breast Reconstruction Surgery Performed?
The timing of breast reconstruction surgery should be decided by the Oncologist and the Plastic, Reconstructive and Aesthetic Surgeon who will perform the operation. There are 3 times that can be determined for breast reconstruction surgery. It is possible to talk about breast reconstruction surgery times as simultaneous repair, delayed repair and delayed – simultaneous repair.
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Simultaneous repairs are operations in which breast reconstruction is performed in the same operation as mastectomy. Simultaneous breast reconstruction is suitable for people who will not receive additional treatments such as chemotherapy after mastectomy. Simultaneous repair can be performed in people who are diagnosed at an early stage and have undergone mastectomy.
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Late reconstruction is breast reconstruction performed after the person’s ongoing treatments are completed after mastectomy. At this point, if chemotherapy, hormone therapy or radiotherapy will continue after mastectomy, late repair is recommended. Because these treatments cause the body to become tired and worn out. During this process, it is preferred that the body does not get tired in order to heal the breast repair.
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Delayed simultaneous repair essentially means performing breast reconstruction with two surgeries. During a mastectomy, a balloon is placed behind the breast muscle to create space in the area. The purpose of this balloon is to expand the skin in the area and make room for body tissues or implants to be used for breast reconstruction. If there is radiotherapy and chemotherapy to continue, this procedure is performed during mastectomy and space is created in the area. After the treatments are completed, you can move on to other processes of breast reconstruction.
What are the Types of Breast Repair?
There are multiple techniques for breast repair or breast reconstruction. The technique to be used for breast reconstruction is determined according to the person’s physical condition and the extent of the mastectomy. Two techniques are generally preferred in breast reconstruction surgeries. These are called implant reconstruction and flap reconstruction.
Implant reconstruction: It is a breast reconstruction surgery technique using breast implants. In mastectomy operations in which the pectoral muscles are not removed, the operation is performed with breast implants placed in front or behind these muscles. This operation can be used in breast reconstruction surgery performed during mastectomy, also known as early breast reconstruction. However, in order for this to be achieved, there must be no cancer treatment planned after mastectomy and there must be no need to expand the breast tissue with tissue expander application.
Flap / Autogenous reconstruction: These are operations in which tissue taken from another part of the body is used for breast reconstruction. Skin, fat and muscle tissues can be removed from the belly, back, buttocks and inner thighs. In this operation, the tissue to be removed can be transferred to the breast area after being completely separated from the blood vessels.
Which Breast Repair Technique is Right for You?
Implant and flap / autogenous reconstruction are the best options for those who want to regain their old appearance after mastectomy. These operations have their own advantages and disadvantages.
Implant reconstruction can be performed in combination with mastectomy surgery. Since breast reconstruction with implants is preferred, the results appear in a short time. If there is no need for breast tissue expansion, it can be completed in a single operation.
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Flap reconstruction is based on breast reconstruction with tissues taken from the person’s body. After this operation, scars may remain in the area of the body where the tissue was obtained. However, performing breast reconstruction with one’s own body tissue ensures that the results are more natural.
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In addition, since it is possible to remove tissue from the hips and inner thighs, if there is excess tissue in these areas, a more radical body change can be achieved by removing the excess tissue.
Nipple Repair
If the nipple is removed along with mastectomy, that is, if a procedure other than subcutaneous mastectomy is preferred, nipple repair is required. In nipple reconstruction, a star-shaped incision is made in the area and the nipple is redesigned. If the aerola is not preserved with mastectomy, a new aerola is made by tattooing the area.
When is Breast Reconstruction Done After Cancer?
It is a matter of great curiosity when breast reconstruction will be performed after breast cancer treatment. Removing the breast, which is one of the most important parts of the body for women, is a traumatic process. For this reason, the time for breast reconstruction after cancer is very important for many women. At this point, planning in cooperation with the oncologist and plastic surgeon will help to obtain the most accurate result.
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Breast reconstruction can be performed in combination with mastectomy, or breast reconstruction can be performed after completion of treatments such as radiotherapy or chemotherapy that must continue after mastectomy. Determining the right time for breast reconstruction is important for the person to go through the process more comfortably and for the results to be satisfactory.
Frequently Asked Questions About Breast Reconstruction Surgery
When breast reconstruction is performed from the person's own body tissue, the area where the tissue will be obtained is determined. In this area, tissue, fat and, if necessary, muscle are removed and breast reconstruction is performed.
In breast reconstruction with implants, a silicone suitable for the person's body structure is selected and placed in front or behind the pectoral muscle under the breast. In some cases, for implant placement, it is necessary to perform an operation to expand the skin in the area and then place the implant.
Nipple repair can also be performed within the scope of breast reconstruction surgery. Nipple repair can also be performed after breast reconstruction is completed.
If breast reconstruction surgery will be performed after cancer treatment, it is important to include the oncologist who plans the person's cancer treatment in the operation planning. In this way, it is possible to minimize the risks that may occur during breast reconstruction surgery by involving the doctor who has the most comprehensive knowledge of the person's general health status.
However, comments on the extent to which the loss of sensation will decrease can only be made on a patient-specific basis. It is expected that sensation will return more effectively after breast reconstruction surgery performed with the person's own tissue.
For this reason, although doctors make great efforts to avoid scars after the operation, it may not be possible for all scars to disappear. When planning the operation, the location of the stitches is determined as points that will not attract attention and be seen at first glance. In this way, traces are prevented from appearing without detailed examination.
When breast reconstruction is performed with implants, the appearance will be more natural if silicones in drop form are preferred. In breast reconstruction surgery, the technique must be planned according to the person's general health condition and body.
However, it should be noted that the use of implants or breast reconstructions made from a person's body tissue does not have a direct relationship with the recurrence of breast cancer. Although people approach the use of implants with the perception that it may cause breast cancer, no studies have been conducted on this. Therefore, it is best for an expert to decide the most suitable technique for the person.
After mastectomy, many women begin to withdraw from their social life, experience problems with their partners, and unfortunately, begin to feel incomplete. Breast reconstruction surgery is an operation that should be performed on every patient who needs it because it helps eliminate all these feelings and thoughts.
Planning the surgery process, the doctor who will perform the surgery, and the general health condition of the patient determine the success rate of the surgery. Breast surgery is one of the types of surgery with the highest success rate among all surgeries.
Breast cancer recurs in three ways. It may recur in the area where it was originally seen, but recurrence may occur in the lymph nodes on the armpit or collarbone side of the original area, or in other parts of the body such as the lung, bone, brain, and in rare cases, the other chest. Even if the entire breast is removed after breast reconstruction surgery, there is a very low risk of recurrence.
The high number of people with the same type of cancer on the mother's and father's side may cause increased concerns. In this case, regular checks should definitely not be neglected. [11th]
Having a first-degree relative with breast cancer doubles the risk of breast cancer. In addition, having second-degree relatives means the risk is 3 times higher. It should also be noted that breast cancer can also be seen in men, although rarely.
The risk of breast cancer is higher in women whose father or brother has breast cancer. [12] Due to these possibilities, women with a family history of breast cancer may need to have regular check-ups and undergo mastectomy as a preventive treatment with the recommendation of their doctor.
A comfortable recovery process after breast reconstruction is also of great importance in terms of scarring rate. It should not be forgotten that the purpose of this operation is to reconstruct the completely removed breast tissue and to ensure that the person does not feel physically incomplete.
If the stitches used in the operation are self-dissolving, the stitches will disappear during the return to normal life. If staples and normal stitches were used, the stitches and staples must be removed at the specified time after the operation. It is important to follow the doctor's recommendations to ensure a more efficient recovery process after breast reconstruction surgery.
Smoking and alcohol consumption should not be done after the operation. It is also important for the healing process to avoid movements that will tire the arm area too much. Having a comfortable post-mastectomy recovery process also contributes greatly to the recovery process after breast reconstruction surgery. For this reason, the exercises recommended by physicians after both operations must be performed carefully.
Breast reconstruction surgery is an important operation that allows women to feel complete and self-confident. For this reason, patients who feel incomplete or unable to feel like a woman after the operation are helped to make peace with their bodies. With this reconciliation, sexual life is positively affected.
Factors such as protecting the area after the operation, staying away from humid areas where public use such as saunas and pools are used, not tiring the operated area, and performing regular dressings reduce the risk of complications that may occur after the operation.
If breast reconstruction is to be performed independently of mastectomy, the factor that determines the duration is the number of operations in which the repair will be performed. If an operation is to be performed for breast tissue expansion in breast reconstruction, this operation takes approximately 1 hour.
The operation planned to reconstruct the breast afterwards takes about 2 hours. If breast reconstruction is to be performed in a single operation and a breast design is planned from the person's own tissue, the operation may take 4-5 hours. The main reason why the operation is longer here is that the tissues to be used for breast reconstruction are removed from the person's body and the breast reconstruction is performed with these tissues.
Patients should avoid physical activity and sports for the first week. However, after a week, returning to normal life is no longer a problem.
One week after the surgery, it is possible to lie on your back again. During post-operative checks, it is necessary to lie on your back until the doctor recommends that you can lie face down.
In addition, the patient's oncologist must approve this surgery. Finally, for breast reconstruction surgery, the patient's general health condition is checked. As a result of various tests, it is decided whether the patient can undergo surgery or not.
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