Breast Reconstruction

In its historical development, there have been two important developments in the surgical treatment of breast cancer. The first is the radical mastectomy performed by William Halsted at the end of the 19th century, and the definitive treatment for some patients, and the second is breast reconstruction surgeries that started in the second half of the 20th century. Firstly, knowing that breast cancer can be treated and preventing them from being late by reducing their fear of the disease, secondly, knowing that their breast can be repaired again enabled patients to apply earlier. In large randomized studies, it has been proven that the results of conservative breast surgery combined with radiotherapy are similar to total mastectomy. However, there are situations where protection surgeries are not appropriate. It can lead to a cosmetically unsightly breast. 6 weeks of radiotherapy can be difficult for the patient. The thought of cancer-forming breast tissue staying in place may disturb the patient psychologically. The choice of mastectomy type depends on the preference of the patient and the breast cancer treatment team. While doing this, the location and diameter of the tumor, the size of the breast, the presence of cancer in more than one location, the type of cancer, common calcification findings on mammography, and the patient's tendencies are the criteria taken into consideration. As a result, both conservative breast surgery and radiotherapy, total mastectomy, and breast reconstruction are accepted treatment approaches all over the world today.

Breast cancer is one of the biggest traumas a woman can experience in her lifetime. Since it is observed in one out of every 8-9 women, many women undergo mastectomy. Few women can survive this trauma with great calmness and live their lives fully at peace with life. Since the breast is the most visible organ of the female sex, its removal affects most women deeply. Some of them declared that they felt incomplete as a woman, some of them ugly, and some that they felt sick throughout their lives. Almost all of the women who have gained their identity in contemporary countries have applied to plastic surgeons for breast repair because they do not want to continue living like this anymore. Breast reconstruction has improved self-image in most patients. More precisely, they felt better and became more optimistic about the future. Even the removal of the need to use an external prosthesis has provided an advantage in itself. Breast reconstruction has been a new start in life for most patients. Family relationships and the sexual life of patients who underwent breast reconstruction were more harmonious. From this point of view, breast repair is not a cosmetic surgery, but a repair (reconstruction) surgery. In other words, it is the replacement of a limb loss due to disease. The breast repair procedure does not change the prognosis of the patient in any way. That is, it does not affect the outcome of cancer in a good or bad way. It does not hinder further follow-ups. Breast reconstruction can be done immediately, that is, simultaneously with mastectomy or later. The cosmetic results of the immediate repair are much better. It is generally applied in early-stage cancers, but it can also be used in advanced-stage cancers. In particular, breasts repaired with their tissues do not constitute an obstacle to radiotherapy and chemotherapy applications.

In general, breast repair can be evaluated in 2 groups:

• With foreign material (prosthesis use) a. Use of silicone prosthesis b. Prosthesis use with tissue expansion c. Use of back tissue (Latissimus dorsi flap) with or without prosthesis
• Using own textures a. Use of abdominal tissue (TRAM flap). It is the most used method today. The tissue normally discarded in aesthetic tummy tuck surgery is used in breast repair. Thus, the patient has abdominal aesthetics together with breast repair. b. Free tissue transfers: These are heavy surgeries due to microsurgical applications. All methods have their advantages and disadvantages. The choice of technique to be used depends on the physician and the patient. The amount of tissue defect is important in which method is preferred. For this, the distance between the collarbone and the inframammary fold is measured on the intact and mastectomy side. The difference shows the tissue defect.
• Use of silicone prosthesis: It can be applied if the tissue defect is less than 5 cm compared to the intact side. There should be enough tissue to cover the prosthesis. It is relatively easy to apply. It may cause an artificial appearance.
• Prosthesis use with tissue expansion: If the tissue defect is 7-8 cm it can be done. The prosthesis is periodically inflated. It is difficult to provide adequate projection with this method.
• The use of back tissue (Latissimus dorsi flap) with or without the prosthesis: If the tissue defect is more than 7-8 cm, it provides additional tissue support. If a small breast is to be made, a prosthesis may not be needed. However, prosthetic support is usually needed. The flap can be removed endoscopically with a small incision in the repairs of the large skin island when it is not needed.
• The use of abdominal tissue (TRAM flap): It is the most used and most popular technique in breast repair. The tissue normally discarded in tummy tuck surgery is used here in breast repair. The patient's gain is two-sided. On the one hand, while the breast is naturally repaired with its tissue, the belly is also stretched.
• Free tissue transfers: Free TRAM flap, free gluteal (hip) flaps, free Rubens flap.
• Instant Repair: First, general surgeons perform a mastectomy that preserves the skin of the breast. In the same session, plastic surgeons continue to repair the breast. Thus, patients do not experience the psychological trauma of mastectomy. The aesthetic results are much better. It can be applied in every case. They do not hinder the application of radiotherapy and chemotherapy afterward.
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