Breast Aesthetics

Breast Health / Breast Aesthetics
Prof. Dr. Orhan Çizmeci

Istanbul University, Istanbul Faculty of Medicine
Department of Reconstructive and Aesthetic Surgery
Faculty Member

The breast is the name given to the upper anterior part of the torso in mammals, including humans. Within breast tissue, the mammary glands are a type of specialized sweat gland, and their primary function is to produce milk for the nourishment of newborns. However, the function of the human breast is not limited to this alone; it also carries sexual and cultural meanings. Since ancient times, the female breast has symbolized fertility, productivity, and sexuality. Its permanent fullness outside the lactation period is a feature unique to humans.

In many respects, breast tissue represents an important component of self-identity for women. The loss of this tissue for any reason (such as cancer, trauma, infection, or surgery) causes significant emotional stress for both the patient and her surroundings. Although advances in early diagnosis and treatment of cancer have significantly reduced cancer-related mortality in recent years, breast cancer remains one of the leading causes of death among women aged 35–59 due to its high prevalence.

Therefore, a woman who is newly diagnosed with breast cancer often experiences profound disappointment. Regardless of her intellectual background, her mind quickly fills with numerous concerns. The first question is usually “Will I die?” This is followed by questions such as “Who will take care of my family?”, “Will I need chemotherapy?”, “Will I lose my hair?”, and “How will this affect my social environment?” These questions reflect both the societal perception of the word “cancer” and the woman’s role within society.

Most of these questions are initially answered by the surgeon examining the patient. At the same time, the surgeon presents the treatment plan, which often involves the partial or complete surgical removal of breast tissue. For many years, patients were sent home carrying these unanswered questions along with the decision for surgery.

After the initial relief, anxiety often increases as the patient faces a treatment process that may result in the loss of a body part. Each woman responds differently depending on her personal characteristics. While the patient’s surroundings are generally concerned with survival and physical well-being, the patient herself often experiences deeper concerns related to body image and self-perception.

At the current stage of breast cancer treatment, replacing the lost breast has become a crucial step. This falls within the field of plastic surgery, and the techniques involved are relatively recent developments. Because most advancements have occurred within the last 15 years, public awareness remains limited. A positive development, however, is the increased knowledge of general surgeons and the growing adoption of multidisciplinary teamwork.

Restoring the lost breast as early as possible contributes significantly to the patient’s treatment process, social life, and overall well-being. Naturally, this new situation also brings new questions and choices. Therefore, communication between the plastic surgeon, the patient, and the general surgery team is essential. Although many reconstructive options may be available, not every technique is suitable for every patient. For this reason, the treatment plan must be determined together with the patient following a detailed preoperative consultation and examination.

Here, we aim to provide general information and preliminary guidance regarding possible options prior to consultation with a specialist plastic surgeon.

Breast reconstruction is the surgical creation of a breast-like structure after the loss of breast tissue for any reason, using the patient’s own tissues and/or implants. Breast reconstruction is not a cosmetic surgery. While the ideal outcome is a breast that resembles the original shape and size and is symmetrical with the opposite breast, this is not always achievable. Additional procedures, including surgery on the opposite breast, may be required.

Breast reconstruction is a major surgical procedure and is usually performed under general anesthesia; therefore, it carries the risks associated with major surgery. After reconstruction, scars will remain both on the breast area and, if the patient’s own tissue is used, at the donor site. These scars are typically most visible during the first 2–3 weeks and gradually fade over time.

Breast implants are biocompatible materials covered with a silicone shell and filled with saline or silicone gel. Expandable implants are often used after breast surgery to generate sufficient skin for reconstruction. Once adequate skin expansion is achieved, the expander may be replaced with a permanent anatomical implant or filled using the patient’s own tissue. Advantages include avoiding additional donor-site scars and relative ease of application. Disadvantages include frequent postoperative visits for expansion, the presence of a foreign material in the body despite proven safety, implant-related complications, and the inability to fully replicate the natural softness and movement of breast tissue.

Autologous reconstruction uses the patient’s own tissue reshaped to form a new breast. Common donor sites include the lower abdomen, back, and hip region. Microsurgical techniques may or may not be used. Hospitalization is generally longer, ranging from 3 to 15 days.

Reconstruction using the lower abdomen involves transferring skin and fatty tissue, with or without abdominal muscle. Although this technique may reduce excess abdominal fat, it is not suitable for very obese patients or for those who have had previous surgeries affecting blood supply in this area. A long scar remains on the lower abdomen, usually hidden under underwear.

Back tissue reconstruction uses skin, fat, and muscle from the back and is often combined with an implant to achieve a more natural and symmetrical result. Its main disadvantage is a linear scar on the back and possible contour deformity. This option may not be suitable for smokers or patients with damaged blood supply to the area.

Hip tissue reconstruction can provide sufficient volume even in athletic women, but its use is limited due to potential asymmetry, longer surgery time, and postoperative care requirements. Regardless of the method chosen, the surgeon’s experience and the patient’s realistic understanding of options are the most important factors determining success.

Another key question is the timing of reconstruction. Breast reconstruction can be performed at any time after breast removal, including during the same operation. Immediate reconstruction often provides the best surgical results because tissues have not yet been affected by scarring or radiotherapy. However, the best surgical outcome does not always mean the highest patient satisfaction. Some women benefit psychologically from never experiencing breast loss, while others feel more satisfied with delayed reconstruction after processing the loss.

Breast reconstruction is a multi-stage surgical process. Nipple reconstruction, achieving symmetry with the opposite breast, and final refinements often require additional procedures.

Even if optimal surgical results are achieved during immediate reconstruction, patients may experience disappointment because the reconstructed breast may differ in shape and texture from the original. Ultimately, breast reconstruction, like many areas of plastic surgery, is an art. The subject of this art is the human being and the values represented. Therefore, informed patients and experienced plastic surgeons must work together to determine the most appropriate path for the patient and her environment.