Aesthetic – Plastic Surgery Procedures following Mastectomy and Childbirth

An aesthetic look is important for most women. Certain processes that can cause deformities in women's body can make them feel unhappy and desperate.

The first one that comes into mind is mastectomy due to breast cancer and childbirth. Today, developing technology and up-to-date aesthetic plastic surgery techniques help repair of the deformities caused by those two conditions. Assoc. Prof. Gökhan Adanalı from Aesthetic, Plastic and Reconstructive Surgery Department of Güven Hospital informs about post-mastectomy breast reconstruction and postpartum body recontouring.

Aesthetic and plastic surgery plays an important role in post-treatment status of breast cancer

The role of plastic surgery in breast cancer is just as important as the role of general surgery – the discipline that primarily treats this cancer. Current technological advancements allow diagnosis of breast cancer at very early stages. Therefore, we can save the patients from breast cancer and –in a sense- this disease is now curable. Since breast cancer is a treatable condition, breast reconstruction comes to the fore as the most natural right of a woman. To this end, we can offer various treatment alternatives to our patients according to the preferred technique.

Breast reconstruction is performed almost as frequently as mastectomy

If the breast is reconstructed after mastectomy – surgical removal of breast -, there are two main reconstruction options. The first one is the autologous reconstruction that uses patient’s native tissue, while the second one is the reconstruction that uses prostheses, called implant, which are colloquially called silicone prostheses. Reconstruction with silicone prostheses accounts for approximately 76 of 100 breast reconstruction procedures performed in the U.S.A. There are two reasons why it is preferred this frequently. First, these diseases cannot be managed only with surgery and therefore, certain modalities, such as radiotherapy, chemotherapy and medication treatment, are used in combination. Therefore, the risk of deformities in breast region is significantly probable especially in case of radiotherapy. This handicap is faced in approximately 30 percent of the cases. Thus, when we prefer the treatment with implants for patients who may have this kind of problems, we prefer tissue expanders that are called temporary implants. If the tissue expander – the place-holder implant – deforms, a second surgery is performed to replace the temporary implant with the permanent one within approximately 6 months after radiotherapy and other treatment are completed. Here, another important issue is the condition of patient’s healthy breast. If the disease is unilateral or involves only one breast, we, of course, do not touch the healthy breast. However, if there is also a condition in the healthy breast, such as enlargement, smallness, sagging or deformation, we convert the healthy breast into the reconstructed breast with optimal size rather than mimicking this breast. To this end, we operate on the intact breast to look similar to the other one in the second session, where we place the permanent implant. The second title is the breasts reconstructed with patient’s native tissue. In this treatment, use of patient’s own tissue helps to ensure that the breast looks like the other breast in the long-term. However, we use this method as late reconstruction since the surgery lasts long, an additional scar is formed on patient’s body and patients do not want to undergo an extra surgery in another part of their body for psychological reasons. Considering the fact that the disease is diagnosed in one out of every 8 women on average, we perform reconstruction surgery almost as frequently as the primary treatment of the disease. If the disease is diagnosed at very early stages and patient does not need any additional treatment, we can simultaneously place a permanent implant after we perform mastectomy or in other words, we empty the breast. Therefore, patients can get rid of the problem in a single session. For the other breast, we either perform this surgery in the same session and make both breasts look similar to each other or we carry out an aesthetic procedure for the other breast 6 months after we place the implant.

Procedures for repairing the postpartum deformities are considered in line with the future pregnancy plans.

The most beautiful and traumatic thing that happens to a woman is pregnancy and childbirth. In this period, which is challenging both physically and psychologically, a serious deformation occurs in women’s body due to certain hormonal and mechanical effects. This process does not end when the woman gives birth to her child; breasts deform especially in the breastfeeding period which follows the childbirth. Therefore, many women visit plastic surgeons to have this condition resolved. Here, it is necessary to consider the future pregnancy plans rather than the timing of the surgery. If the woman plans future pregnancy or pregnancies, all surgical techniques will cause negative outcomes on the future pregnancy and the deformities will recur after the future pregnancy. First, you should clearly learn the future conception plans of the patient.

Postpartum aesthetic surgeries should be performed 6 months after the breastfeeding is stopped.

Breasts enlarge and their volumes increase in the period of 9 months throughout the pregnancy, as the body prepares itself to breastfeed. Fifteen to 20 connective tissue elements that connect the breast to the anterior chest wall rupture due to the volume increase. Therefore, breasts sag. Considering that the mammary ducts become active and are filled with milk and the woman breastfeeds her baby for a period up to approximately 2 years, continuous use of breasts causes persistence of this physiopathological condition in breasts. Thus, if you are considering a breast surgery for a patient after childbirth, your basic principle should be planning the surgery 6 months after cessation of breastfeeding, but you also need to examine the mammary ducts. As the fetus grows inside the womb, muscles of anterior abdominal wall enlarge frontward and sideways. As a result, muscles are detached. These muscles cannot restore their original anatomic condition and they stay integrated through a very thin connective tissue after the woman gives birth to her baby. Surgery is the only option to repair this condition. Most of the patients will lose the weight they gain during pregnancy within approximately 1 or 1.5 year after the childbirth. If there is excess weight for a longer time, weight loss becomes quite challenging beyond this interval of time.

In these cases, the earliest date considered for the surgery is 6 months after the breastfeeding ends. We most commonly use liposuction – a closed surgery technique – or abdominoplasty surgeries – an open surgery modality – or their combination depending on the deformities in maternal abdomen, low back and hips. However, outcomes of these surgeries are negatively influenced by a possible future pregnancy. The loose and separated muscles that we repair with sutures will get harmed in second or third pregnancies. Liposuction procedures can also be used for hips, lateral and medial parts of legs and knees depending on the existing pathology. Sagging in inner part of arms can be usually seen –although rare- in patients who gain excessive weight. If the person can lose weight at early stage, the sagging can be tolerated; however, sagging that requires surgical intervention and severe deformities may occur even if a woman who gains 30 to 40 kg during pregnancy loses weight. Recently, genital deformities are added to the abovementioned issues. This is actually a different issue and it is extremely important. Recently, it is paid attention not only by plastic surgeons, but also by gynecologists and obstetricians. The major challenge is the dilatation and the resultant deformities of vagina in vaginal deliveries. Loss of quality of sexual intercourse and inability to take pleasure and have orgasm are some of the problems faced by women. If a second or third pregnancy is expected, there is no sense to perform a surgical procedure in this body part, because the condition will recur. This problem is not faced in Cesarean Section due to mechanical reasons. Although rare, mothers commonly complain of dark discoloration (skin color gets brown) of areola and genital skin – a condition that starts when the conception occurs – after the childbirth. It is possible to state that these conditions can be treated with advanced technology products. We may consider lasers to correct such conditions, but since the discolorations occur secondary to hormones, it is, undisputedly, wise to postpone this treatment modality until the mother stops breastfeeding or in other words, maternal hormones restore to preconception levels.