tr-flagbreast reconstructionBreast cancer is one of the most common cancers of females. The main treatment of breast cancer is surgery including removing the breast totally or partially. Radiotherapy and/or chemotherapy can be added to surgery. Having a breast removed can cause great emotional strain. For patients whose breast removal was due to cancer, the absence of a breast can be a daily reminder of their struggle with a serious disease. The aesthetic quality of these reconstructions, fostered by technical advances, has emerged from that of amorphous blobs appearing as breast mounds to nearly normal appearing breasts. Breast reconstruction should be delayed until finalization of the radiotherapy and/or chemotherapy.

Using a number of different techniques, a breast that closely matches the shape, size and feel of the breast that was removed can be created successfully. First preferred and most commonly used technique includes surgically removing a section of muscle, fat and skin of the abdomen and transferring this composition upwards used to form the new breast (TRAM flap technique, see also figure on the right). The fat tissue of the abdomen is adequate to form breast mound. This technique has 2 advantages: A breast is created by patient’s own tissue without using a foreign body and also abdomen gains smoother and flatter appearance.

Breast Reconstruction Surgery

tram flebi

Surgical design of TRAM flap

Breast reconstruction surgery is done in a hospital, under general anesthesia and takes about 5-6 hours. You are allowed to go home 3 days after surgery if no problem is observed. Surgery covers both abdomen and breast region, so recovery takes longer than the other procedures. 10-15 days bed rest is recommended at home. During this period you can do personal activities at home with someone’s help. Pain may be felt due to the tightness of the skin on the abdomen. Pain is alleviated by avoiding the positions which cause more tightening the abdomen. While in bed, your legs should be bent at the hips in order to reduce the strain on the abdominal area. A shower can be had 5 days after breast reconstruction surgery. Nourishing with soft foods and avoiding the actions which may cause to increase intra-abdominal pressure such as coughing, sneezing and laughing are recommended for 2 weeks. You can return to routine life without heavy and tiring activities which especially affect breast and abdomen 2-3 weeks after surgery unless any problem observed. Heavy and tiring activities should be avoided at least 6 weeks.

TRAM flap technique is not feasible in some cases which had previous surgery on the abdomen. Temporary or permanent tissue expanders are feasible for such cases. Tissue expanders are silicone balloon in various shape and size which are placed underneath the skin where the expansion is required. Expander is inflated with saline solution as using a syringe 1-2 times each week, following surgical placement of the expander with appropriate size and shape. Inflation of the expander causes fullness under the skin. Inflation quantity depends on the size of the expander. Inflating period depends on the size of the expander and the volume of the saline solution added into the expander each time, but it usually takes 6-8 weeks. At the end of the inflating period, chest region gains breast shaped fullness. If a permanent expander is used, it is not removed anymore unless any problem is observed. If a temporary expander is used, it is removed surgically after adequate fullness is gained and silicone prosthesis that used for breast augmentation is replaced permanently at the second stage.

Surgery of the expander placement is done in a hospital, under general anesthesia. It takes 1-1,5 hours. You may go home at the same or the next day. A shower can be had 3 days after surgery. Slight pain may be felt and can easily be alleviated by medication, but severe pain is unusual. After the end of the period of 10-15 days for wound healing, expander is inflated with 3-5 days intervals and desired fullness would be gained within 6-8 weeks. Inflation can be done in the office and is not painful. In this period, you can continue to routine life but avoiding the activities which are heavy and tiring is recommended.

After the breast gained the desired size and shape as using TRAM flap technique or tissue expander, additional surgery is required to form the nipple. There are various surgical techniques for nipple formation. The technique which is going to be used is decided as discussing with you. The nipple can be formed during the permanent prostheses placement in the patients who had previously temporary expander.

You should also be aware that a reconstructed breast may not duplicate the other breast exactly; it may seem firmer and have a slightly different shape. For most patients, these factors do not detract from their overall satisfaction with the replacement of a lost breast. When the reconstructed breast conspicuously different in size and shape, similarity can be gained as reshaping the other breast surgically. Breast reconstruction can help restore women’s self-confidence, femininity and sense of wholeness, so that they can go on with their lives.

Op. Dr. Nazmi Bayçın

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