Breast Reconstruction
Definition of oncoplastic breast surgery means joint planning of a cosmetic procedure that will create a better aesthetic result in the breast along with a surgical procedure that will be performed due to breast cancer and covers the following subgroups:
- Reconstructive interventions in breast protective surgery
- With classic breast protective surgery
- Macromastia (large breast)
- Repair of chest wall defects
- Risk reduction surgery (prophylactic-preventive mastectomy and reconstruction)
- Reconstruction after mastectomy
It has been shown in many studies that breast reconstruction has a positive effect on the psychological state of women and that follow-up of patients can be easily performed without causing serious difficulties. It has no negative effect on the recurrence of the disease or the success of cancer treatment (in other words, the duration of survival).
The oncological and cosmetic needs of the person should be taken into considiration when talking to the patient regarding the treatment plan. A balanced decision should be made taking into account the age of the patient, medical and psychosocial status, the wishes and expectations.
Breast Reconstruction Methods
Different methods can be used for reconstruction purposes:
Only synthetic implants (silicone prostheses, those whose outer wall is filled with saline (saltwater) inside the silicone, etc.)
Procedures in which the Implant and the patient’s tissues are used together
Initiatives in which only the patient’s tissues are used
Failures of reconstruction procedures with only prosthetics and fear of silicone have made breast reconstruction with the patient’s tissues (autologous) more popular in recent years.
Often when considering the patient’s tissue to take advantage of the latissimus dorsi Nov-leather flap (LD flap – back muscles transversus abdominis and rectus flap (TRAM flap – Nov abdominal wall and adipose tissue) are used.
Latissimus dorsi muscle-skin flap (LD flap – back novelization)
But after 1976-1977, this method began to be used for breast reconstruction and became popular after that.
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Patients with small and medium-sized breasts, latissimus dorsi is a suitable choice for the novelization of the muscle-skin flap. If necessary, proper symmetry and appearance can be achieved by placing a prosthesis under the flap (without the need for any surgical procedure in the other breast). It is a solid muscle-skin flap, if their veins are taken care of and protected during preparation, no serious problems are encountered after the operation; functional deficits do not occur Nov. Reconstruction with LD flap is a technique that should be preferred primarily today due to its robustness, potential tissue volume (± prosthetic) and low complication rates in many patients.
It is preferred in patients where more tissue is needed to capture an appropriate symmetry with the opposite breast.
There are two types:
Pedicled (transfer of the phleb by protecting the vessels)
Free (cutting the vessels feeding the flap and mouthing with other vessels properly after tissue transfer)
The cosmetic results of free TRAM phleb are better, but it is a surgery that requires longer and more experience. Microsurgical techniques are needed during the operation.
What To Consider After Breast Reconstruction
After surgery, 3-4 days of rest should be required.
Painkillers and antibiotic drugs should be used to prevent pain and edema that will occur in the area after breast surgery.
• You should not shower for the first 3 days after breast surgery.
Rest during the period recommended by the doctor, heavy physical activities should be avoided.
In some cases, doctors may use drains. Some movements are avoided until these drains are pulled.
Dressing should be applied regularly. Weight should not be lifted for 5-6 weeks.
Again, attention should be paid to the sleeping position during the healing process.
It is not appropriate for the patient to lie on their breasts or face down for about 15 days.
