AESTHETICAL SURGERY IN BREAST CANCER
The main purpose of surgery in breast cancer is to remove cancerous tissue from the patient's body and save her life, as in other cancers.
People suffering from breast cancer. Women are faced with the devastating situation of having cancer, and they also have to deal with the fact that the appearance of their breasts, which is an important element of their female identity and appearance, will be changed, distorted, or even lose their breasts by surgery. This situation has significant negative effects on the psychosocial and even sexual life of the woman. Anxieties brought about by possible changes in physical appearance can also negatively affect a woman's fight against cancer. This situation has led to the emergence of the field of 'oncoplastic breast surgery' in order to preserve the existence of the breast.
'Oncoplastic breast surgery' is the surgical method in which the principles of plastic surgery breast surgery are applied during the treatment of the breast with oncological surgery. The aim is to preserve breast integrity, shape and existence as much as possible and to re-create breast tissue if necessary. Instead of the complete removal of breast tissue, which was previously practiced in breast cancer surgery, more limited, breast-conserving surgical techniques come to the fore today. For this reason, the use of oncoplastic surgery has become widespread not only for the reconstruction of surgically removed breast tissue, but also for planning before the actual breast cancer surgery and ensuring breast integrity during surgery. During breast cancer surgery, planning and drawing of the skin required for the surgery is made according to the amount and location of breast tissue to be removed. After the oncological surgery part of the surgery is completed, breast shaping and/or new breast creation is performed. At the same time, surgical intervention can be performed on the opposite breast to ensure that the breasts are symmetrical.
What can be done in oncoplastic breast surgery?
1- Skin and tissue incisions are made in breast cancer surgery. to make planning
2- To correct breast deformity after breast cancer surgery and to recreate breast tissue if necessary
3- M In women with breast cancer, when large breast tissue is removed, the open wound is closed with other tissues
4- Lifting and reduction surgery on the normal breast opposite the breast that underwent breast cancer surgery.
to ensure symmetry by applying
5- In women with high risk of breast cancer, when mastectomy (removal of breast tissue) surgery is performed for protective purposes even though breast cancer is not detected
new for creating breast tissue
6- For creating nipple and areola after breast cancer surgery
Who can undergo breast reconstruction?
Those who do not have single or double breast, general health Breast reconstruction can be performed on any woman who can tolerate surgery. In the majority of patients who have undergone mastectomy, there is no medical obstacle to breast reconstruction. Different methods may be more suitable for different patients and may provide more successful results. Does breast reconstruction have any effect on breast cancer treatment? Breast reconstruction has no known risk of breast cancer recurrence. In addition, radiotherapy (radiation therapy) or chemotherapy (drug therapy) will not be affected by breast reconstruction. The methods used to monitor breast cancer can also be applied after breast reconstruction. However, in patients who have undergone reconstruction with breast prosthesis (silicone), MRI examination is more appropriate for follow-up instead of mammography.
When should breast reconstruction be performed after mastectomy?
Early reconstruction: Breast reconstruction can be performed after mastectomy or at the same time as mastectomy. With the increase in early diagnosis of breast cancer, 'instant reconstruction' applications have begun to increase. The immediate reconstruction option performed in the same surgery as mastectomy is more successful in terms of the patient's psychosocial adaptation after surgery and eliminates the need for a separate surgery for reconstruction. Immediate reconstruction may be easier for the surgeon and aesthetic results are better. The disadvantage is that breast cancer surgery and reconstruction surgery take longer together and the recovery process is longer.
Late reconstruction. sion: Breast reconstruction can be postponed to a later time than mastectomy, with the recommendation of the general surgeon and oncologist, or due to reasons such as the patient not requesting it, being overweight, smoking, having high blood pressure, and not being able to tolerate a long surgery time. In this case, some patients may concentrate on treating the actual breast-related disease. It may be more appropriate to determine the exact stage of the disease and plan radiotherapy if necessary, along with surgery for breast cancer. In this case, reconstruction is postponed to avoid the side effects of radiation.
In our country, breast reconstruction is generally performed 'late' at a later date.
What are the breast reconstruction options?
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Breast reconstruction is performed by 2 main methods:
- With breast prostheses
- Autogenous reconstruction (with the patient's own tissue)
Silicone breast prostheses: It may be preferred because the surgery is easier and it is a relatively safe reconstruction option that does not require long surgery time. It is preferred in patients who cannot tolerate long surgery or who do not want another part of their body to be operated on. The disadvantages of this method can be listed as the risk of not giving good aesthetic results, risk of infection, risk of skin necrosis, risk of capsule formation, slippage and asymmetry. This risk is higher in patients who also underwent radiotherapy.
If the patient's own body tissue suitable for breast reconstruction is not possible,
If the breast tissue area is not badly scarred or infected,
If prophylactic (preventive) mastectomy has been performed,
If bilateral breast reconstruction is performed,
If the patient has consented to other breast surgery to ensure symmetry,
He has not received radiotherapy to the breast or chest wall. whereas; It is an ideal candidate for breast reconstruction with a silicone breast prosthesis.
Tissue expanders: In some patients, if there is not enough subcutaneous socket for the breast prosthesis, tissue expanders can be applied. This is a stepwise method. The subcutaneous tissue expander placed in the breast area is inflated with physiological saline 10-15 days after the surgery and at intervals of 3-5 days, and when the appropriate pocket is provided, this silicone-based expander is removed and the silicone breast size of the planned size is removed. brace is placed. The disadvantages of this reconstruction method are that it is a 2-stage surgery, it can sometimes cause mild pain during the inflation process, which is performed at various time intervals that can last 2-3 months in total, capsule formation, risk of infection, skin loss, and asymmetry. Both surgical stages of the method take about 1 hour.
Double lumen adjustable implants: If there is not enough socket when prosthesis application is planned for breast reconstruction and double surgery is avoided, Becker prosthesis can be used. This prosthesis is a permanent tissue expander. This double lumen prosthesis, which has a cavity that can be inflated with physiological saline on the inside and silicone gel on the outer lumen, is placed permanently. After the surgery, the inner part is inflated with physiological saline according to the desired size and left in place. Adjustments can be made as desired, and asymmetry can be prevented more easily.
What is autogenous breast reconstruction?
With skin, fat and muscle tissue taken from another part of the patient's own body. The breast creation process is autogenous reconstruction. The most important difference that distinguishes autogenous breast reconstruction from breast reconstruction with prosthesis is that it is a natural appearance due to its own tissue and there are no risks such as rejection due to the prosthesis, infection, capsule formation, skin loss, or the need for replacement.
Different options for autogenous reconstruction. available. The most important of these are the TRAM flap and DİEP flap made from the abdominal region, the latissimus dorsi flap made from the back area, the TUG flap made from the thigh, the gluteal flaps made from the hip, and the Ruben's fat pad flap made from the lateral region of the waist. Among these methods, the use of tissues obtained from the abdominal area is the most commonly used autogenous breast reconstruction option.
What other tissues are used for breast reconstruction?
Latissimus dorsi located in the back area. Muscle can be used alone or with some skin tissue to create breasts. Although this method creates sufficient cover tissue in most women, it cannot provide the fullness and curve that will create a breast appearance. In some patients, it can be used to close the opening in the breast area during mastectomy, and sometimes it is used with a silicone breast prosthesis. It can also be used to create adequate breast size and curve. The disadvantage of the method is that it leaves a scar on the back that is difficult to camouflage and may cause wound healing problems. When the abdominal and back area tissues cannot be used, 'gluteal flaps' from the hip area, 'Ruben's fat tissue' from the lateral waist area, and 'transverse superior gracilis flap' from the inner side of the thigh can be used as free flaps for breast reconstruction with microsurgical techniques. In addition, in some patients, tissues near the breast tissue can also be used for partial breast reconstruction.
What is the recovery process after breast reconstruction?
Breast reconstructions performed under general anesthesia, When a prosthesis is used, it can take 1-2 hours, and when the patient's own tissue is used, it can take 4-10 hours, depending on the technique. When breast prosthesis is used, the hospital stay is 1-3 days, and in autogenous reconstruction with flap tissues, the hospital stay is 4-7 days. Inside the created breast tissue and in the area where the patient's autogenous tissue is removed, there are silicone-based devices called 'drains' in the form of a hose grenade, which prevent the accumulation of fluid and blood in the surgical area. They are removed within 1-4 days as fluid and blood accumulation decreases. Removal is a simple, painless, outpatient dressing-like procedure. After the drains are removed, the patient can take a bath. Dressings continue for a while. Although returning to daily life with silicone prostheses takes a few days, it may take up to 1 week for the sensitivity and tension in the abdominal area (if abdominal tissue is used) to recover after autogenous breast reconstruction. Although the patient can do most of his own work after 1 week, he should avoid activities such as heavy lifting, exercise, sexual intercourse, and driving for 4-8 weeks. It should be protected from situations that increase intra-abdominal pressure, such as coughing, straining, constipation, and sexual intercourse.
In the long run, all the pain and troubles caused by surgeries are forgotten. Every day the wounds get better and the scars fade. The presence of breast tissue gives the patient going through this process the happiness and confidence to get out of the cancer disease along with a feeling of integrity.
Are other surgeries needed after reconstruction?
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