Breast reconstruction surgery is the general definition of the surgical procedures that include reconstruction of breast after breast tissue is totally or partially resected because of breast cancer.
Nowadays breast cancer can be detected at very early ages due to the technological advances and widespread of preventive medicine. Loss of breast which is an important organ for female effects deeply every woman in any age
psychologically
Operations based on reconstruction of breasts do not interfere with the patient’s cancer treatment. Therefore information about reconstruction of breast must be shared with the patient after the diagnosis of cancer is confirmed. Factors such as size of the tumor, involvement of axillary lymph nodes, age, familial story of breast cancer, estrogen receptor existence should be evaluated in the process of planning surgical and oncological treatment of the patient. Breast reconstruction surgery can be performed synchronous to cancer surgery or after.Following the cancer surgery, breast reconstruction surgery can be made at the same session and the patient can recover from anesthesia with her new breast. In cases that synchronous operation is not possible or if the patient doesn't want the surgery to be synchronous, the reconstructive operation can be done at a time that patient determines after oncological treatment is complete. The reconstruction technique is determined according to the factors such as; the patient’s general health conditions, body structure and expectations, radiation therapy after surgery.
How is breast reconstruction surgery done?
Breast reconstruction surgery is performed at operating conditions in hospitals under general anesthesia. There are different techniques that serve the purpose.
In breast reconstructions that silicon breast prosthesis is used, after resection of breast tissue, a permanent prosthesis is placed under the muscle if skin and subcutaneous tissue is enough for the operation, if not a tissue expander is placed. After two weeks tissue expander is started to expand with normal saline solution infusions in sessions and desired volume of breast is achieved in 1-2 months. At least 6 months after the intended volume is reached tissue expander is removed and permanent breast prosthesis is implanted. If a prosthesis that is partially made of silicon and can be used as both tissue expander and permanent prosthesis is used at first surgery, the interconnection that provides the expander with normal saline is removed with local anesthesia at least 6 months after the intended tissue expansion is achieved and the prosthesis is left.
In reconstruction that autologous tissue is used, the autologous tissue is commonly collected from abdomen and back of the patient. The decision about which one is going to be used depends on the patient’s preferences and body shape. In the technique called TRAM; abdominal tissue is used with a part of abdominal muscle (rectus abdominus muscle). This technique is adequate for the patient who has excessive abdominal tissue and can be a suitable candidate for abdominoplasty. Scar is hidden under underwear site like abdominoplasty surgery. Back of the patient is preferred with the patient who doesn't have enough tissue on her abdomen. In this technique, dorsal tissue is used with a part of back muscle (the latissimus dorsi muscle). Breast prosthesis can be used in these patients because of the lack of excessive tissue especially if the patient is thin. Scars are planned to be hidden inside bra's. Hospitalisation time and return to active life is longer in operations that autologous tissues are used than breast prosthesis/ tissue expanders are used. Postoperative recovery process, revision possibilities and consequences must be discussed seperately for each technique.
How is the nipple reconstruction done?
In some cases of breast cancer when whole breast tissue should be resected, mostly nipples are added to surgical plan. In simultaneous or delayed breast reconstruction surgeries shaping of the breast is the main target. Reconstruction of nipples are planned to be done after the surgical process about shape and volume of breast is finalised. It is important to obtain the symmetry like appearance of the shape and volume of the reconstructed breast with the healthy breast.
If the healthy breast is sagging and large, breast reduction and lifting, if small breast augmentation surgery is preferred. This way nipple of the healthy breast and the nipple that has been reconstructed would be symmetrical and a more aesthetical appereance would be achieved.
Nipple is reconstructed by using local flaps planned from surrounding breast tissue. Areola(circular darker skin area around the nipple) is mostly made from skin that is harvested from pubic region or with tattoing.
Copyright/Main Edition 2012 Limited Revision 2022 Prof. Dr. Z. BURCAK TUMERDEM ULUG
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