Breast Reconstruction After Mastectomy

To Create a New Breast After Mastectomy For Breast Cancer

Although medical treatments are advancing, breast cancer is still a serious health problem especially for women and treatments are disfiguring. On some occasions one or both of the breasts would be amputated.

Psychological, physiological and sexual effects of the breasts

There is no need to talk about the importance of the breasts for baby feeding. Mother milk is the most valuable material for maintaining the continuation of human population and mammalian animal species. In humans prominent breasts represent productivity and femininity of the woman. In different geographical areas and cultures men prefer to have sexual relation with women who have prominent breasts. Also in many cultures and races having prominent and erected breasts are a very pleasing and prideful situation for women. Breast are widely considered as secondary sex organs.

Nonexistence or loss of breasts

Genetically, breasts could be very small. Rarely one of the breasts might be totally absent from the birth. However, recently the most important reason for the absence of breast(s) is amputation for the treatment of breast cancer. Additionally “prophylactic mastectomy” operation caused absence of both breasts in a considerable number of women. This operation was very popular in the past and was done to prevent breast cancer in risky women. However its popularity is no longer valid nowadays.

Psychological effects of breast removal

Removal of breast(s) creates a deep devastation in women’s life. They think that their body integrity is broken and they are not the “old self”. Most of them try to hide their absent breast(s). Their sexual life may be no more satisfactory.

Making a new breast (breast reconstruction)

Beginning in the 1980’s plastic and reconstructive surgeons created new breasts from the own tissues of the patients. Following years, operation for breast cancer is changed and less skin and breast tissue are removed. From that moment breast reconstruction with silicone implants gained popularity. This method is easier and faster than the reconstruction with the autologous tissues. Although new breast reconstruction methods should be a remedy and hope for breast cancer victims, still numerous women are not willing to have it after breast removal.

Societies who are against breast reconstruction

I don’t need two

Melissa Jansen had breast cancer operation in 2017 and the left breast had been removed. She refuses the operation for a new breast and declares herself as “uniboober”. She claims that mastectomized women can live happy and self confident without wearing special bras or having breast reconstruction operations. She uses the slogan “I don’t need two” and created a web page. She also works as an activist with the same slogan in social media. You may see the shares from these links:
https://www.idontneedtwo.com/
https://www.instagram.com/idontneedtwo/

Flat closure now

“Flat closure now” is a non profit organization and its mission is quite different. Let’s tell it with their own words from the website https://www.flatclosurenow.org/

We are an education and advocacy group created by breast cancer survivors and advocates that is dedicated to ensuring the recognition of and understanding that “going flat” (aka – aesthetic flat closure) is a, beautiful, and healthy breast reconstruction option after a mastectomy or removal of breast implants.

Going flat (living flat)

While most women choose to have some type of reconstruction, some women don’t want to have additional surgery. Some also don’t want to deal with special bras, magnets, or adhesive patches that hold a prosthesis in place. They choose no reconstruction and don’t wear a breast form most of the time. Many women and doctors call this “going flat” or “living flat”. Some nonprofit organizations against breast reconstruction describe themselves as:

• We are strong women who don’t feel their breasts define their identity.
• We are confident women who know they can look great in clothes without showing lots of cleavage.
• We are active women who want to continue exercising without any restrictions.
• We are mature women who understand that love of spouses, friends, and family isn’t dependent on having breasts.

Reasons preferring “going flat”

• Not to have additional operation after breast removal.
• Not to bear the stress of making new breast operations.
• Probability of having unsatisfactory result after new breast making.
• Probability of having unexpected complications many years after new breast making.
• In reality sometimes the operation for making new breast is more complicated and difficult than breast removing procedure.

Some women are against the idea that breasts are necessary for full sexual activity. They defend that women can be beautiful and sexy without breasts and if they are happy with their appearance they can be seen without hiding their flat chests without any projection.

Evaluation of the subject from plastic and reconstructive surgery’s side

We plastic and reconstructive surgeons always plan our treatments according to the demands of our patients. We never try to persuade a patient who had had breast removal for new breast making. On the other hand if the patient desires this, our job is to the best for this request.

Breast reconstruction

Before for the patients who have had breast removal it was a destiny to live forever as it. In the 1970’s in the world and Turkey a variety of operations for creating a new breast were begun. Before the 1980’s really extensive operations were done for breast cancer treatment. All breast skin and gland including underlying chest muscles were removed. This leaves a defect both ugly and difficult to repair. At that time the only reconstructive option was bringing large amounts of skin and soft tissue to the oıperation side from the other parts of the body. This volume is only available in the abdomen and back. So early operations were bringing the lower abdominal skin and soft tissues to the chest or lower back skin and muscle to the chest. Both operations are timely and relatively big, even sometimes bigger than the original operation. But today operations for breast cancer are not as extensive as before. Usually some (or sometimes all) part of the skin is preserved. This enables enough volume for inserting a breast implant into it. If the volume is not large enough tissue expanders (inflatable silicone balloons) can be implanted and expand the skin gradually. However long term durability of silicone implants in cancer patients are not predictable and some of them may be removed due to complications. Today the most reliable material for filling the breast area is the patient’s own fat. This gives a safe and reliable long term result with very good appearance. However, for this treatment the patient should have enough fat to harvest. In very slim patients multiple fat harvesting and injections may be needed to have a satisfactory result. Prof. Ozgentas prefers autologous fat injections for breast reconstruction and breast enlargements. This gives reliable, satisfactory and long term results.

Conclusion

Every person has choices about their body appearance and this should be respected. Breast reconstruction after cancer operation is not a necessity but a choice if the patient desires it. The anti breast reconstruction movements are probably the result of deep frustration, suffering and despair and will not stay too long. Breast reconstruction techniques are getting better and more satisfactory and few women will choose living flat without breasts in the future.