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Breast Health
Mammal Tissue
Breast Disorders
Mammography
Breast Esthetics
 

Breast Esthetics:

Prof. Dr. Orhan ÇİZMECİ
University of Istanbul  Faculty of Medicine
Lecturer in Department of Reconstructive and Esthetical Surgery

Mamma (breast) is the name given to the upper front part of the bodies of mammals including human. The milk glands within the breasts are in the form of specialized sweat glands and their primary function is to produce milk in order to feed the newborn. The functions of human breast are not limited to feeding, but also have cultural and sexual meanings. The breast of a women has meant symbol of fertility, reproductivity and sexuality since ancient ages. Human is the only mammal with a permanent bulgy-structured breast, even in non-breast feeding periods.

Breast tissue is an important component of ego for women in one respect. Loss of this tissue for some reason (cancer, trauma, infection, surgical...) causes an important degree of emotional stress for the patient and her neighborhood.  Although the recent advances in early diagnosis  and treatment of cancer has reduced the mortality rate significantly, breast cancer  resumes to be one of the prominent reasons of death in women between 35 and 59 when the frequency of the disease is considered. Therefore a newly diagnosed women as breast cancer is highly disappointed, and  is fulled of questions no matter how her fictive background has used to be. The first of these questions would be “Will I going to die?”, then “Who will going to take care of my family?”, “Will I recieve chemotherapy?”, “Will I loose my hair?” and “How will this affect my surroundings?” will go on.  These questions reflect the role of the women in her society with the general social judgement that the word “cancer” keep inside. The most of these questions are replied by the surgeon of the patient. The surgeon finally explains his opinion for the treatment, this opinion is generally surgical dissection of the mammal tissue totally or partially, and the patient leaves the clinic with many question marks in her brain. 

Following the first relaxation, the woman lives significant fears concerning the treatment marathon including the loss of her breast. Each woman will give personal responds to the issue according to her own character. However, the people around the patient may also give different responds to the subject. The first fear is generally about the survival and well-being of the patient, but the patient lives many different fears.

These affairs form around the loss of the organ which will change the sense of the ego. Replacement of the breast with a prosthesis is an important stage of the treatment in breast cancer currently. This is a subject of plastic surgery and the techniques introduced together with the subject are rather new. The opinion and knowledge of the society is limited since the developments belong to last 15 years. The pleasing point is that the general surgeons who are the primary physicians of the patients have wider knowledge and information, and that the team-work is starting to settle in our country too.  To replace the loss of the patient will contribute to a better social life, easier treatment period and the continuity of her well-being. Naturally this new situation brings new questions and new options together. This is why the communication of the surgeon with the patient and his work-team. Even though it may appear like the surgeon has many options about replacing the breast with a prosthesis, any technique may not be suitable for any patient.  Thus, the decision should be taken together with the patient. A detailed examination and conversation is necessary before the surgery.

Here we will give you some general information. We will make a pre-information concerning which options may be offered to the patient before she meets the plastic surgeon.

Breast reconstruction is the re-forming of the breast surgically by using autografts and/or implants. Breast reconstruction is not a plastic surgical operation. The size and symmetry of the reconstructed breast should be the same with the opposite breast, but this may not always be achieved. In order to succeed, additional operations and even surgical operations to the opposite breast may ne needed. Breast reconstruction is an important surgical operation and is generally performed under general anesthesia. That means it carries the risks of any surgical operation. There will be scars following the operation on breast and on other regions in case of autografting. These scars will be significant in the first 2 or 3 weeks post-operatively. It will fade away in months.

Implants : These materials which are called as breast prosthesis, are covered with a silicon membrane, can be filled with serum and are compatible with human body.  These inflatable implants which are used in many fields of plastic surgery in order to proliferate the insufficient skin tissue, are used to produce the skin that will be necessary to form a new breast following the surgery. When a proper size of skin is obtained, it may be replaced  with an anatomic-sized, serum or silicon containing implant that may give a more natural appearance, or may an autograft may be placed into this newly formed pocket. It has advantages such as not causing new scars other than the mammal region, and being rather easily applicable. Its disadvantages are the necessity of frequent hospital visits such as twive a week, in order to gradually inflate the breast until the desired volume is obtained, having the risks of inserting a foreign material into the body even the compatibility and reliability of the implants are proven, and not showing the self stifness and fluidity of a natural breast.

Autogenous  Tissues: Reconstruction with autogenous tissues are reconstructions performed by using a patient's own tissue. Available tissues include inferior abdominal region, dorsal region and thigh. Micro-surgical techniques may or may not be used. The hospitalization of the patient will be longer in autogenous reconstruction. This period may vary between 3 and 15 days.
Here, although the decision of the plastic surgeon who considers the specific characteristics of the patient is important, the patient should be given multi-options. Thus, we will introduce these methods shortly. 

Inferior Abdominal Region: Forming a breast tissue by dissecting the skin and sub-cutaneous fatty tissues of inferior abdominal region, either by involving the abdominal muscles or not. Although the method offers getting rid of the excess fats in the abdomen, it is not a proper option for over-fat women. A pre-operation history of the region which may cause insufficient vascularization, also limits the use of this area.

A long scar will be formed following this operation. But it may be hided via the underpants.

Dorsal Region: The skin, fatty tissue and muscles of the back are other options of an autogenous breast reconstruction. It is an important option if the abdominal region can not be used because of any reason, or  if the patient prefers a scar on the back rather than over the abdomen. This technique is generally combined with implant technique, and more symmetric and natural results are obtained. The most important disadvantage is a scar stretching towards the back which is expected to be hided by brassiere and a collapse.  This option may not be proper for smokers. Besides, the vascularization of this area may be injured during the breast surgery, in such a situation, this region can not be used.

Thigh:
The fatty tissue in thigh may provide sufficient voluma even in athletic women. However, the usage of theis region is limited concerning the asymmetry of the thigh, long duration of the operation and post-operative care. Whatever the preferred method is, the most important factors of a successful result are the experience and suggestion of the surgeon and a sensible approach of the patient to the suggested options.

Another question is the timing of reconstruction. Breast reconstruction may be performed at any time following the removal of the breast tissue. It is possible to be performed in the operation of dissection, and the best surgical result is obtained at that time. This is the time when the tissues the plastic surgeon will use are not scar-formed and has not been affected by the negative effects of radiotherapy. Better surgical results give better patient satisfaction. The patient will never live the absence of her breast. For many women, this means a very important psychological support. The patient will adapt to the therapy better if her self ego and sense of ego are not affected. On the other hand, a late onward breast reconstruction may work as an award mechanism following a psychological experience period without her breast for some women.  Then she may be satisfied more. Breast reconstruction causes a multi-stage surgical process. Construction of papilla and surroundings, providing the symettry to the opposite side, and the probabilites of additional surgical operations should be considered when evaluating this process.  


Even though an optimum result may be obtained by reconstruction the breast before the patient is awaked, it is possible for the patient to live an estrangement and a disappointment since the constructed form is different than the natural breast by means of its shape and stiffness.
As a conclusion, breast reconstruction is an art as are other fields of plastic surgery. The subject of this art is human and the merits they hold. Thus, deliberative patients and specialized plastic surgeons should decide the best route of treatment together with the people around the patient.

 

 
 

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