BREAST CANCER TREATMENT
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What is Breast Repair?
Breast reconstruction is performed to restore the breast lost due to breast cancer to its natural state. Breast repair is a reconstruction, not a cosmetic surgery. In other words, it is an operation to replace a limb lost due to disease. Thanks to new advances in medicine, surgeons can now create a breast structure that is very similar to the natural breast. The breast cancer treatment team in developed countries with this understanding can include plastic and reconstructive surgery specialists as well as general surgeons who specialize in this field as “breast surgery specialists”.
Breast Repair Provides Women with Self-Confidence, Quality of Life and Psychological Strength.
For most women with cancer, the result of breast reconstruction surgery is a new start in life, a firmer grip on life and happiness. Family and environmental relations and sexual lives of these patients become more harmonious. It also provides high morale and psychological strength, which is very important during cancer treatment. This helps to fight the disease better.
Breast Repair Surgeries
Breast reconstruction can be performed in the same session as the surgery for breast cancer (simultaneous reconstruction) or in a separate session (late reconstruction) after adjuvant (postoperative radiotherapy, chemotherapy) treatments are completed.
Today, the more preferred technique is simultaneous breast reconstruction due to better psychological outcomes. There is no need for a second surgical procedure for this purpose. This may not always be the best choice. For example, if there is a high probability of radiotherapy after the operation, it would be appropriate to postpone reconstructions, especially with synthetic implants, to a later date.
Breast reconstruction should be a safe procedure for the patient. There should be no significant functional impairment, complication rates should be minimal and any delay in the initiation of adjuvant therapies after simultaneous reconstruction should be avoided. Regardless of the method used for reconstruction, the main goal is to provide a good symmetry with the other breast.
Different Methods Used for Reconstruction:
- Only synthetic implants (silicone prostheses, those with silicone outer wall filled with saline)
- Procedures in which the implant and the patient’s own tissues are used together
- Interventions using only the patient’s own tissues
Reconstruction with Synthetic Prostheses Only
Two types of prosthesis are used for this purpose:
- Tissue expanders placed overnight
- Permanent fixed volume breast implants
Tissue expanders are used to give elasticity to the breast skin before the placement of a permanent prosthesis. They are temporarily inflated by injecting increasing amounts of salt water into the reservoir inside. When the time comes, it is removed and a permanent implant is placed in the formed pouch or it is possible to leave some special types of tissue expanders in place like a permanent implant.
Fixed volume permanent implants are usually silicone-based products. Recent studies have shown that the use of silicone for this purpose is safe.
The use of only synthetic implants for reconstruction is preferred by patients who do not want surgery on their back or abdomen.
Reconstruction with synthetic implants is not a good option in patients who have received radiotherapy to the chest wall or who are likely to undergo postoperative radiotherapy.
In reconstruction procedures with either a tissue expander or a permanent implant, the prosthesis is placed under the muscles of the anterior chest wall.
Useful Information About Breast Repair Surgeries
Repair of the Nipple and Areola
Several surgeries may be required to achieve a natural breast appearance. In the first surgery, the process of creating breast tissue is more complex. The second surgery is easier if the nipple and areola (the dark area around the nipple) are created. These procedures can even be performed under local anesthesia. The nipple is made from tissues in the area. The surrounding dark area can be tattooed, or skin from the opposite nipple or groin can be used.
Ensuring Symmetry Between Breasts
In cases where unilateral breast repair is performed, the repaired breast is not expected to be symmetrical with the opposite breast at the end of surgery. In order to ensure symmetry between the breasts, some operations can be expected to be performed on the opposite breast. These are the reduction, lifting or enlargement of the opposite breast.
After Breast Surgery
Postoperative pain can be relieved with medication. You may need to stay in hospital for 1 to 2 days if reconstruction was not performed during surgery, or 2 to 5 days if reconstruction was performed. Patients can be discharged within 1 day if breast-conserving surgery has been performed, and within 1-2 days if mastectomy has been performed. If drains are placed to prevent the accumulation of fluids (seroma), these drains are removed between a few days and 1-2 weeks after surgery, depending on the surgery performed.
Return to Daily Activities
The time to return to daily activities depends on the extent of the surgery performed, but usually ranges from a few days to 4 weeks. Patients undergoing autologous (from their own tissue) reconstruction have a longer hospital stay than patients undergoing prosthetic breast repair surgery.
Even if they have drains, patients can take their baths after 2 days to prevent water from getting into them and as in normal life. Drain edge dressings should be renewed after bathing. There is no harm in wetting the surgical wounds with water after two days. However, harsh irritation on the wound should be avoided.
From a few hours after the end of the operation, no special diet is applied.
Reconstruction does not restore normal sensation, but some sensation may improve over time. The surgical scars may decrease over a period of one to two years. But it does not disappear completely.
Procedures in which the implant and the patient’s own tissues are used together
The most commonly used muscle-skin flap for this purpose is the latissimus dorsi muscle of the back. The permanent implant is placed over the muscles of the anterior chest wall and under the latissimus dorsi muscle-skin flap shifted from the back.
Especially in cases where there is a significant defect in the breast skin flap after mastectomy, reconstruction with a muscle-skin flap will be required because the procedure using only implants will not be sufficient and will not leave a good cosmetic result.
A good cosmetic result can be achieved in medium and large diameter breasts. Care is taken to ensure that the incision mark on the back remains below the bra line. However, the incision may be slightly larger depending on the amount of muscle-skin flap needed.
Interventions using only the patient’s own tissues
In patients who do not want to use synthetic prostheses for reconstruction, breast reconstruction (reconstruction with autologous tissue) is performed using the patient’s own tissues.
Autologous tissue flaps commonly used for this purpose are the latissimus dorsi muscle-skin flap (LD flap – back muscle and skin) and the transversus rectus abdominis muscle-fat-skin flap (TRAM – anterior abdominal wall muscle, fat and skin).
If the breast size is small, LD-flap alone may be sufficient, but in patients with medium or large breast tissue, TRAM flap may provide a better cosmetic result.
In the LD-flap technique, the incision scar is on the back, while in TRAM-flap, it is in the lower abdomen. After TRAM-flap, precautions may need to be taken to avoid a defect in the anterior abdominal wall and subsequent hernia development.