The Role of Plastic Surgery in Breast Cancer
No organ is as important as the breast in defining a woman's femininity. Small breasts cause psychological pressure for a woman in modern society from an emotional, social, and sexual perspective. A person may not feel like a complete woman because she lacks the most important, most striking quality of her womanhood. Research conducted in Sweden on a group of women who underwent breast augmentation surgery for aesthetic purposes showed a relationship between breast size and degree of femininity in women. The most surprising finding in the study was that approximately half of these women did not undress in front of their partners before the surgery and even did not allow their breasts to be touched during intercourse.
In fact, this problem is not only encountered today but also centuries ago. Corsets, breast pads, massage methods, and creams were used to make small breasts appear larger or to increase their volume until implants were found. Of course, no method other than surgery truly provides any real benefit in this regard.
Basically, we can divide women with this problem into two groups. The first group consists of young women whose breasts remained small after their body development was complete, while the other group consists of those who previously had full breasts but whose breast volume decreased after pregnancy and breastfeeding or due to excessive weight loss.
What is the motivation of patients who desire breast augmentation surgery, or what should the correct motivation be?
The most appropriate motivation is for a woman with high feelings of femininity, who perceives herself in the mood created by the estrogen hormone and reflects this situation in her behavior, to want to adapt the masculine, hard rib cage appearance caused by the small breasts she sees in the mirror to her soul and inner world by having her breasts enlarged. Unfortunately, the rate of such patients is low, or they are somehow unable to express their motivations. The majority complain about clothing problems. They state that they no longer want to use reinforcements like push-ups, and they do not want to experience problems wearing bikinis. I listen to all this with a smile. I actually think about how to explain that the basis of my job is to make a naked female body look more attractive and feminine, and that I will enlarge the breasts not for bikinis and dresses, but for femininity and the female spirit.
For years, different techniques have been tried to fill the missing breast volume. Hormone therapy was attempted but abandoned due to its significant side effects. Filling with fat removed by liposuction was considered a logical solution, but it was found to cause fat cysts, abscesses of dead fat tissue, and micro and macro calcifications. Due to the danger of these calcifications often being confused with breast cancer, this method is no longer recommendable.
While on the subject of cancer, I find it useful to take a look at the relationship between silicone breast implants and breast cancer. Based on the questions asked by my patients, I realized that there is a perception that silicone increases the risk of breast cancer. Research conducted in 1995 at the World Congress of Plastic Surgery in Yokohama on 45,000 women in a total of 16 institutions from various regions of the world showed that there is no connection between the appearance of breast cancer and autoimmune connective tissue diseases and silicone breast implants. In fact, the conclusion drawn at the institutes in Calgary and San Diego is surprising: it has been observed that the incidence of breast cancer in women using silicone breast implants is reduced by half compared to the normal population.
These data lead one to ask the question, "Do silicone breast implants prevent breast cancer?" It is clear that silicone, as a material, does not protect against cancer. However, it is also clear that this organ, which has become more beautiful, more feminine, and provides happiness with an implant, will not get sick. The saying "what truly gives happiness never makes one sick" is very applicable here. Another known fact is that silicone breast implants provide the greatest help to women whose breasts have been removed due to breast cancer.
The first silicone breast prosthesis was introduced in America in 1963. Silicone is the material closest to breast tissue due to its consistency. In addition to silicone, there are many alternative breast prosthesis types such as soybean oil, NaCl solution, and hydrogel. Soybean oil has been abandoned in Europe due to severe complications. Hydrogel prostheses are also known to be banned in the UK.
The prosthesis surface, which used to be smooth, has been made rough to minimize the formation of capsular contracture, which is the biggest complication of silicone breast prostheses.
It is in our hands as surgeons to prevent or minimize the risk of the breast tissue contracting around the prosthesis, forming hard, and sometimes even tennis ball-like, deformations.
In addition to technically correct surgical application, patient psychology also plays a significant role in reducing this risk. I have stated in my previous articles that mental turbulences affect wound healing in the postoperative phase.
This tissue hardening, called capsular fibrosis, is actually an internal wound healing process. Just as surgical wounds show swelling, hardness, and even keloid formation, contracture (tension, shortening) occurs; capsular fibrosis is also the hardening and contraction of the wound membrane formed on the prosthesis inside. Just as a hypertrophic wound causes a burning, stinging, and stretching sensation in its active phase, the same is true for capsular fibrosis.
My patients always want to know when the prosthesis needs to be replaced. As long as you like the shape of your breast and there is no discomforting hardness, there is no need to replace it.
The size and shape of the prosthesis should be decided after trying it on a sample with the patient, considering the patient's wishes and body compatibility. For us as plastic surgeons, what is important is body size, the shape of the rib cage, the elasticity of the breast skin, and the content of the breast tissue.
Considering these qualities, the position of the prosthesis, i.e., whether it will be placed under the breast tissue or under the pectoral muscles, should be decided.
The inframammary fold, armpit, and the lower edge of the nipple are the most common approaches used when placing a breast prosthesis. Today, the most commonly used method is to make an incision of approximately 2-3 cm from the inframammary fold, then advance either under the breast tissue or under the pectoral muscles as needed to create a suitable pocket for the prosthesis and place the prosthesis. No impairment in breastfeeding function is expected after breast augmentation surgeries. Another frequently asked question is the possibility of a silicone prosthesis rupturing or leaking. In modern prostheses today, this possibility is almost nonexistent under normal circumstances. However, it is, of course, possible for a silicone prosthesis to be perforated after a traffic accident with a rib fracture or due to a penetrating instrument injury.