Plastic Surgery Approaches in Breast Cancer
Thanks to advances in tissue science and oncology in recent years, and frequent check-ups, it has become possible to diagnose breast cancer cases more often in their early stages. Of course, the earlier treatment for the disease begins, the better the results and the less breast tissue needs to be removed are the most important outcomes of early diagnosis.
It is possible to correct breast deformities that occur after surgical interventions to remove cancerous tissue and to give the breast a look similar to its original or even more beautiful than its original using modern plastic surgery methods.
In cases where a breast tumor is diagnosed early, the modern approach involves methods that preserve breast form or even further improve its aesthetic appearance.
In the vast majority of patients diagnosed with breast cancer, the breast is sagging or large. In cases where the tumor is located at the edges of the breast tissue, with the breast reduction, lift, and augmentation technique that I also apply (central pedicle breast reduction technique), it is possible to safely remove both the tumor and the surrounding tissue, and at the same time, lift, augment, and give the breast a better aesthetic appearance. It is very clear that the psychological support provided by the patient leaving an operation they entered with fear with a beautiful breast appearance will give them resistance against many difficulties they may encounter in the later stages of their treatment.
In tumor types that require complete removal of breast tissue, a skin-sparing technique can also be used. In this case, a small piece of skin or only the nipple and the skin around it are removed along with all of the breast tissue. The tissue deficiency resulting from this procedure can be completed as live tissue using microsurgical methods, using tissues taken from the back, lower abdomen, or buttocks.
While breast-conserving surgeries are performed in the same session as tumor removal, in cases requiring complete removal of breast tissue and skin (ablation), different strategies are applied according to the patient's psychological and physical structure:
Balloon-expander application (tissue expander method)
This method is envisioned for patients who have not received radiation therapy and have suitable skin quality. It involves placing an appropriately sized balloon under the skin and chest muscle, inflating it with sterile water at intervals to expand the skin, and making room for a silicone implant to be placed later. When the skin reaches sufficient size, this balloon is removed and a silicone implant is placed instead. In suitable patients, devascularized tissue can also be transplanted instead of an implant.
Tissue transfer
In this method, a new breast is created from the patient's own tissue, usually from the back or lower abdomen, and rarely from the buttocks, in place of the removed breast. Considering that such an operation will be performed for aesthetic purposes only, it is very important that it does not cause any deformity in the area from which the tissue is taken and that the result achieved is satisfactory. Here, there is a need for an experienced observer who can decide which reconstructive surgery method is more suitable for which patient, and when and at what stage it should be applied. In suitable patients, the method of recreating the completely removed breast with tissue transplantation, which we call "simultaneous reconstruction" or "primary reconstruction," can be chosen.
It has always been thought, but never proven, that the positive effect of a patient not feeling the absence of a breast after emerging from anesthesia could also positively impact the disease's prognosis. This issue is a constant topic of discussion at all senology congresses. While I previously advocated for primary reconstruction and chose this method in my practice for many years, in recent years, I have favored delayed reconstruction in cases of cancer where the breast is completely removed. The reason for this is linked to what I felt when I observed, from a distance, the experiences of a woman diagnosed with breast cancer.
When we evaluate the experiences of a woman diagnosed with breast cancer, or what patients tell us, we always see the same scenario repeating itself. The events usually unfold like a filmstrip: the woman noticing a lump while showering or getting dressed, pausing, thinking, and having a strange feeling mixed with fear inside, sometimes feeling a pain in the breast, consulting a doctor, being referred to a radiologist for a mammogram, the increase in fears and excitement, a report from the radiologist indicating suspected cancer, frantically starting to search for a surgeon specializing in this field, the surgeon outlining the possibilities and the decision for surgery... Until this point, the woman's main fear is usually not the removal of the breast, but the degree of the disease and whether she can recover. Then follow emotional fluctuations, discussions, and a period of intense uncertainty within the family.
For a woman undergoing surgery amidst all this confusion, it may be psychologically impossible to fully evaluate or understand the details of breast reconstruction, which is a secondary concern at that moment. However, after surgical and oncological treatments are completed, the patient can make the reconstruction decision, which will directly affect her quality of life, more objectively, calmly, and consciously.
Furthermore, I believe that the theory of "loss and grieving" advocated by psychologists should not be overlooked by us surgeons. Psychologists emphasize that it is important for a woman whose breast has been removed due to cancer to grieve this loss and to make an evaluation within her inner world during this process. It is thought that continuing to live with a newly constructed breast as if she never had cancer, without feeling the loss of the breast, may not positively affect the prognosis of the disease.
As I mentioned before, starting to seek the answer to the question "why me?" is one of the most important steps the patient will take in the healing process.
In my opinion, both the patient's psychological state and the stage where the cancerous tissue has been completely cleared and the treatment process is completed are the most appropriate times for breast reconstruction surgery.