Breast Reconstruction

Breast Reconstruction Surgery

Breast reconstruction is an oncoplastic surgical method that enables the reconstruction of the breast in patients who have undergone a mastectomy (breast removal) or have experienced shape deformities due to breast cancer. Reconstruction is not only an aesthetic procedure but also a functional and psychosocial treatment process aimed at restoring the patient’s body integrity, self-confidence, and quality of life. Breast reconstruction is planned entirely individually, taking into account the patient’s oncological condition, history of radiotherapy, tissue structure, and personal expectations.

When is Breast Reconstruction Performed?

Immediate Reconstruction

Performed during the same session as mastectomy.

• Achieving a new breast with a single surgery
• Easier psychological adaptation
• Reconstruction without damaging chest wall tissues

Delayed Reconstruction

Performed months or years after mastectomy. It is generally preferred in the following cases:

• Waiting for tissue healing after radiotherapy
• Completion of oncological treatments

Both approaches have their advantages, and planning is done in a multidisciplinary manner.

Methods of Breast Reconstruction

Reconstruction can be performed with implant-based, autologous tissue-based, or hybrid (combined) methods.

Implant-Based Reconstruction

One of the most common reconstruction methods that uses implants to create volume.

Expander-Implant Method (Two-Stage Reconstruction)

• In the first stage, a tissue expander is placed
• Gradual filling is done over time
• In the second stage, a permanent breast implant is placed

Careful patient selection is required for patients who have undergone radiotherapy.

Direct Implant Placement (Direct-to-Implant)

In suitable patients, the implant can be placed during the same session as the mastectomy. Submuscular or ADM-supported techniques may be used.

• Faster recovery
• Achieving a new breast with a single operation

However, this method is not suitable for all patients, and the tissue quality must be good.

Autologous Tissue Reconstruction (Creating a Breast with Natural Tissue)

This method uses tissues taken from the patient’s own body (abdomen, back, or hips) to create the breast.

DIEP Flap

• Micro-surgical tissue transfer from the abdomen
• The most natural and long-lasting results
• Muscle tissue is preserved
• An ideal option for patients after radiotherapy

Latissimus Dorsi (LD) Flap

Performed with tissue taken from the back muscle. If necessary, it is combined with a small implant.

TRAM Flap

This method uses tissue taken from the abdominal muscles. It is an alternative to the DIEP flap.

• Natural tissue sensation
• Reduced need for implants
• More durable results after radiotherapy

Hybrid Reconstruction

A method that uses both implants and fat transfer. It improves contour matching in patients with thin tissue or those who have undergone radiotherapy.

Nipple-Areola Reconstruction

After creating a new breast, the nipple can be reconstructed using the following methods:

• Local tissue flaps
• Medical tattooing
• Graft techniques

This process is usually the final stage of the reconstruction.

Pre-Surgery Preparation

• Oncology and plastic surgery team assessment
• Breast MRI / Ultrasound
• Examination of abdominal and back tissues
• Body symmetry analysis
• Evaluation of radiotherapy and medical history
• Smoking cessation
• Adjustment of blood-thinning medications

Surgical Process

• Performed under general anesthesia
• Average duration: 2–6 hours
• Tissue transfer or implant placement is done according to the selected method
• Symmetry is achieved
• Drains are placed if necessary
• The surgery is completed with a special bandage and bra

Post-Surgery Recovery

• Rest is recommended for the first 1–2 weeks
• Avoid heavy exercise for 4–6 weeks
• Recovery time is longer for autologous methods
• Swelling decreases within 2–3 months
• Final shape settles within 6–12 months

Potential Risks and Complications

Implant-Based Reconstruction

• Infection
• Capsular contracture
• Implant position issues
• Contour irregularities

Autologous Reconstruction

• Flap circulation problems
• Hematoma
• Healing issues at the donor site
• Fat necrosis

General Complications

• Asymmetry
• Visible scarring
• Sensory changes
• Need for revision

Longevity of Reconstruction Results

Autologous methods provide the longest-lasting and most natural results. In implant-based methods, implant replacement may be needed over the years. Fat transfer contributes to long-term stability. Weight changes can affect the breast form.