Breast Reconstruction in Turkey: Understanding Implant and Tissue Options with Prof. Dr. Hüseyin Borman

Facing a mastectomy involves complex decisions about physical recovery and body image. Understanding the surgical pathways available helps patients align their reconstructive choices with their medical realities and personal needs.

The Timing Factor: Immediate vs. Delayed Surgery

A central decision in breast reconstruction is determining when the procedure should take place. Prof. Dr. Hüseyin Borman explains that reconstruction can generally be classified by its timing relative to the mastectomy itself.

Immediate reconstruction is performed during the same surgical session as the breast removal. Because the surgical site is already open, the reconstructive surgeon can begin rebuilding the breast mound immediately, which is often clinically more straightforward. However, not all patients are candidates for immediate surgery, depending on their overall health and the specifics of their cancer treatment plan.

The "Prosthetic" Pathway: When Implants are the Primary Choice

When discussing reconstructive techniques, the use of silicone implants is a common pathway. How these implants are placed depends heavily on the condition of the skin that remains after the mastectomy.

The "Direct" Route (Preserved Skin)

In cases where the skin envelope is largely preserved during the mastectomy, it may be possible to insert a silicone prosthesis directly into the remaining pocket. This allows for a one-stage reconstruction with immediate aesthetic results.

The "Expansion" Phase (Managing Tight Skin)

Frequently, the mastectomy process removes the nipple, areola, and a significant portion of breast skin, leaving the remaining tissue too tight to accommodate a full-sized implant immediately. Attempting to force an implant into a tight space can yield poor results. In these scenarios, a two-stage process is required to create a new pocket.

• Stage 1 - Tissue Expansion: A temporary device called a tissue expander is placed beneath the skin or muscle. Over several weeks or months, it is gradually filled with saline to stretch the overlying skin, similar to how abdominal skin stretches during pregnancy.
• Stage 2 - Implant Exchange: Once sufficient skin laxity is achieved, a second, shorter surgery replaces the expander with a permanent silicone implant.
• Alternative - Becker Prosthesis: Prof. Dr. Borman notes the option of a Becker prosthesis, which functions initially as an expander but can remain in place as the permanent implant, eliminating the need for the second exchange surgery in some patients.

The "Autologous" Alternative: Rebuilding with Natural Tissue

Implants are not suitable for every patient. Prof. Dr. Borman explains that when the skin is excessively thin, when local tissues are inadequate, or when a patient simply prefers a natural approach without foreign objects, autologous reconstruction becomes the primary alternative.

Autologous reconstruction uses the patient's own tissue—typically fat, skin, and sometimes muscle—transferred from another part of the body to rebuild the breast mound. The most common donor sites mentioned are the back (such as the latissimus dorsi flap) and the abdominal region.

The Impact of Adjuvant Therapies on Reconstruction

The overarching cancer treatment plan significantly influences reconstructive choices. When a patient undergoes a mastectomy followed by chemotherapy or radiotherapy, reconstruction is often delayed to prioritize oncological care.

Radiation therapy, in particular, fundamentally changes tissue quality. Irradiated skin can become shriveled, thickened, and adhered to the underlying chest wall. As Prof. Dr. Borman details, if a delayed reconstruction is planned after radiation, the surgeon must first address this tethered, damaged tissue. This may involve releasing the adhesions and either utilizing tissue expansion (if the skin remains viable enough to stretch) or, more commonly, bringing in fresh, healthy autologous tissue from another area of the body to replace the damaged skin and create a stable reconstructive base.