(Breast REPAIR)Breast RECONSTRUCTION / REPAIR OPERATION AND TREATMENT
Breast cancer is the most commonly diagnosed cancer in women. On average, one in every 6-7 women is known to develop breast cancer at some point in her life. It is known that genetic predisposition is valid in this cancer type and the risk of breast cancer increases in people with particular genes. Those with a history of breast cancer in a mother, sister or aunt are also included in the risk group. However, advanced age, early menarche, late menopause, no breastfeeding, late delivery or no delivery, history of radiation exposure, bowel and uterine cancer, high socio-economic level, hormonal drug use increase the risk of cancer. Another point to note is that the age of cancer is decreasing gradually. Reconstruction of the breast is possible with various techniques in patients, who underwent surgery for breast cancer. Breast reconstruction (breast repair) is performed because of the post-treatment sense of damaged feminine identity and this reassures the person and speeds up the integration of the person to the social life.
TECHNIQUES USED IN Breast FORMATION (Breast RECONSTRUCTION)
First of all, despite related opinion diversity among cancer centres, patients should wait at least one year before breast reconstruction, to ensure that cancer does not recur. The oncologist should be informed about the treatment and her opinion should be taken.
The simplest method is the placement of a prosthesis in cases, where there is sufficient epithelium and the effect of radiotherapy is limited. This technique can be initiated with the expander prosthesis, which is inflated through fluid injection, and then can proceed with permanent prosthesis placement. Although its quick results and short operation durations are advantageous, it is a disadvantage that prosthesis tears out of the skin or that it is sensible just below the skin in patients lacking adequate breast tissue as a result of radiotherapy. In such cases, flapping the muscle tissue at the back over the prosthesis or placing the prosthesis under the muscle (only if it is strong and tumour free), which lies below the breast tissue, is necessary for the success of the treatment. In some cases, it is required for permanent repair that an expander prosthesis is placed during muscle repair, in order to create an appropriate cavity.
Flapping the “transverse rectus abdominis muscle (TRAM Flap)”, located in the abdomen of the person, into the breast region is relatively safe. Here, the muscle is released from one end together with the skin and brought to the breast area and fixed in the appropriate position. In some cases, the vessels of the muscle tissue on the cut end are stitched to the appropriate recipient vessels and hence the blood circulation of the muscle is supported.
Breast reconstruction is also performed via free tissue transfer. The skin-subcutaneous tissue located in the abdomen region is transported freely to the breast area, protecting its feeder vessels, and anastomosis with appropriate vessels is performed by the micro-surgical method. This technique is called repair with “DIEP Flap” and has become quite popular recently. The long-lasting operation is its only disadvantage.
In breast repair, all alternatives should be shared with the patient and the patient should be expected to make the decision. The patient’s age, general health status, and expectations are critical in determining the type of operation.