When a breast or part of it is removed due to breast cancer, breast reconstruction surgery is one of the methods performed by aesthetic and plastic surgeons. Living without breasts after breast cancer is not a necessity. If the patient requests it, breast reconstruction surgery can be performed simultaneously with or after breast cancer surgery, using the patient’s own tissue or implants.

Following nipple-sparing breast surgery, where the nipple and mammary covering are preserved but the entire breast tissue is removed, or skin-sparing breast surgery, where the nipple is removed along with the entire breast tissue but the mammary covering is preserved, reconstructive surgery with implants is usually performed in the same session. In these surgeries, the use of submuscularly anatomically shaped implants is generally preferred. For safety reasons, it is desirable to completely cover the implant with muscle; however, for aesthetic reasons, leaving the lower part of the implant outside the muscle, just like in aesthetic breast augmentation surgeries, is superior. Therefore, we place a biological membrane obtained through tissue engineering in this missing area, thus creating extra tissue to cover the lower end of the implant while not compromising the shape of the breast.

The key factor in implant selection is the measurement of the patient’s breast width. An implant of a type and size that is compatible with the other breast should be chosen; however, expecting a perfect match is very difficult. Especially in breasts with moderate to severe sagging or large breasts, the breast pelvis that remains after nipple-sparing mastectomy is quite extensive, and using an implant large enough to fill it completely may not be suitable for the submuscular plane. Using implants smaller than this pelvis can accommodate will, over time, cause the breast pelvis to shrink irregularly and asymmetrically over the implant, distorting the shape of the nipple and creating an orange peel-like surface, resulting in an aesthetically unsatisfactory appearance.

Therefore, it is more logical to reduce the breast cap in a way that leaves an inverted “T” shaped scar, as in breast reduction surgeries, to choose a medium-sized submuscular implant suitable for the patient’s rib cage and the reduced breast cap; and to perform reduction or lift surgery on the other breast in the same session or later. In small to medium-sized breasts with no or very mild sagging, and in breast reconstruction surgeries with implants after cancer surgery, it is not necessary to change the breast cap; these types of breasts give the most beautiful, natural, and symmetrical results, and in most cases, there is no need to perform symmetry surgery on the other breast.

In patients whose entire breast tissue or a portion thereof is removed, whether or not the nipple and breast covering are preserved, and if they do not want reconstruction with implants or if reconstruction with implants is not medically feasible, reconstruction with the patient’s own tissue may be preferred. The most commonly used tissues are the Latissimus Dorsi muscle in the back and the Rectus muscle in the abdomen. Today, it is possible to reconstruct a breast using only the skin and subcutaneous fat tissue above these muscles, preserving their functions. In breast reconstruction from the lower abdomen, the tissue obtained is often sufficient to create a breast, whether or not the muscle is preserved, while tissue obtained from the back is often insufficient to create a breast on its own, whether or not muscle is included. In this case, a silicone gel implant is placed under this muscle. A small to medium-sized breast can be created in this way, along with a skin island to cover the lower pole of the breast.

If a larger breast size is desired, it is more logical to first use a tissue expander and then apply breast implants. Microsurgical techniques are generally preferred for breast reconstruction using tissue from the abdominal area, whereas this is not necessary for the back area. The scar created in this area after tissue removal from the abdomen is similar to that in abdominoplasty and, as a secondary effect, corrects sagging in the abdomen. These two methods take longer and are more demanding than surgeries using only implants, but they are safer and can be performed in the same session, or even years after a mastectomy due to cancer.

In cases where a portion of the breast tissue is removed but the breast covering is preserved, and closing the incision could lead to deformity, one of the techniques we use, and which is becoming increasingly common, is to implant the Latissimus Dorsi muscle, harvested from the back using an open or endoscopic method, into this space. Alternatively, in situations where we want to preserve the muscle in the back, we use a living tissue called “omentum” harvested from the abdomen using a closed method. We can also use this tissue when we want to cover the breast implant with a second layer of tissue.

In cases where both breast tissue and breast covering are removed, submuscular permanent implant placement is not suitable because there is not enough tissue to cover the implant. In this situation, if breast reconstruction surgery using the patient’s own tissue is not planned, a submuscular tissue expander is applied. The tissue expander is inflated weekly to a certain extent until sufficient breast covering is obtained, after which it is replaced with a permanent implant.

We discharge patients on the second day after breast reconstruction surgery with implants. We describe arm exercises to be performed at home. We usually remove the drainage catheter placed in the implant area after an average of 7-10 days. During this time, we provide antibiotics and painkillers for them to use. After the pain and tension, which are excessive in the first 2 days, we expect a quick return to normal. In the early stages, we can observe fluid accumulation around the implant, changes in breast skin color, hardness, partial or complete circulatory disorders in the nipple and udder, color changes, and superficial peeling. In cases where the cancerous breast tissue is close to the skin or nipple and therefore the skin has to be left thin, and in patients who have received radiotherapy, we may encounter a risk of losing part or all of the nipple or breast skin due to circulatory disorders.

In these cases, we initially prefer conservative approaches, but if the extent of breast loss is significant, implant removal and evaluation of other breast reconstruction alternatives may be considered.

Regardless of the technique used, radiotherapy applied to the breast area negatively affects the reconstructive surgery performed. In surgeries using the patient’s own tissue, tissue contractions, shrinkage, and contractions may occur. There is a high probability of contraction (stretching) and subsequent deformation of the implant capsule; therefore, the capsule around the implant may need to be re-evaluated, and if necessary, the implant may need to be replaced.