What is it and how is it done?
Breast reconstruction is plastic surgery that restores the shape and volume of the breast after a mastectomy (removal of the breast) or breast-conserving surgery for breast cancer. It is also offered to women having a risk-reducing mastectomy because of a genetic predisposition such as a BRCA mutation. Whether and when to have reconstruction is a personal decision, and choosing not to have it deserves the same respect. Reconstruction can be done in the same operation as the mastectomy (immediate reconstruction) or after chemotherapy and radiotherapy are complete (delayed reconstruction). Timing is planned with the breast surgeon and oncologist so that cancer treatment is not disrupted.
Implant reconstruction often begins with a tissue expander. The expander is filled gradually at the practice over several weeks; once the skin has stretched enough, it is replaced with a permanent silicone breast implant in a second operation. In suitable cases the implant goes in directly at the first operation. Radiotherapy gradually hardens the skin and tissue and makes them less elastic, so capsular contracture and wound problems are more common around an implant in an irradiated breast; planning takes this into account.
Reconstruction with your own tissue most often uses the lower abdomen. In the DIEP flap (deep inferior epigastric perforator flap) technique, skin and fat from below the navel are taken together with the small blood vessels that supply them, while the abdominal muscle is largely preserved. The tissue is moved to the chest and its vessels are joined to chest-wall vessels under an operating microscope. The result is a soft breast that changes with the body, and the abdomen is closed much as in a tummy tuck. The technique requires microsurgical experience. Prof. Dr. İlker Yazıcı was a research fellow at the Microsurgery Laboratory of the Department of Plastic Surgery at Cleveland Clinic in the USA in 2004–2005 and has published peer-reviewed work in microsurgery. If abdominal tissue is not suitable, a latissimus dorsi flap made from back muscle and skin can be used, often together with an implant.
Reconstruction is usually completed in several stages. Fat injection (fat grafting) can smooth contour irregularities and support irradiated skin. The nipple is created from small flaps of skin on the new breast, and the areola is coloured with medical pigmentation. To balance the two breasts, the other breast may be lifted, reduced or enlarged.
At the practice in Nişantaşı, Prof. Dr. İlker Yazıcı reviews the pathology report, the treatment plan, previous operations and body shape, and explains the suitable options with their pros and cons. 3D imaging and 3D printed torso models can be used in planning. Reconstruction is generally accepted not to increase the risk of the cancer returning; cancer follow-up continues as the oncologist plans.
What are the aims?
- To restore the breast volume and shape lost after mastectomy.
- To achieve a more balanced look between the two breasts, both in clothes and in the mirror.
- To remove or reduce the need for an external prosthesis worn in the bra.
- To bring healthier, more elastic tissue to tight, hardened chest skin that has received radiotherapy.
- To complete the appearance by reconstructing the nipple and areola where needed.
- To keep every stage in step with the oncology plan, without disrupting cancer treatment.
Who is it suitable for?
- Women who are scheduled for, or have previously had, a mastectomy for breast cancer.
- Those left with marked deformity or asymmetry after breast-conserving surgery and radiotherapy.
- Those planning a risk-reducing mastectomy because of a genetic predisposition such as a BRCA mutation.
- Those whom the oncology team considers suitable and whose general health allows surgery.
- Non-smokers, or smokers who can stop several weeks before surgery.
- For reconstruction with their own tissue, those who have enough skin and fat in the lower abdomen.
- Those with realistic expectations who understand that reconstruction may take more than one stage.
When is it postponed or not recommended?
- During chemotherapy, or before blood counts have recovered; timing is decided together with the oncologist.
- Active smoking; wound-healing and circulation problems increase markedly, so reconstruction is postponed until smoking has stopped.
- Heart, lung or blood clotting conditions that make surgery and a long anaesthetic unsafe.
- Uncontrolled diabetes or severe obesity; risks rise, particularly with microsurgical reconstruction.
- Periods when the disease is widespread and drug treatment takes priority; reconstruction is then assessed separately with the oncologist.
Alternatives
- No reconstruction (flat closure)
- Some women do not want reconstruction; after mastectomy the chest wall can be closed to give a flat, smooth contour.
- External breast prosthesis
- A silicone prosthesis worn inside the bra needs no surgery and helps with symmetry in clothes.
- Fat grafting alone
- Small dents after breast-conserving surgery can be corrected with a few sessions of fat grafting; on its own it is often not enough to build a whole breast.
- Delaying reconstruction
- There is no deadline for reconstruction; it can be planned months or years after treatment ends.
The process step by step
- 1
First contact
You can send your pathology report, a treatment summary and, if you wish, photos by WhatsApp or e-mail, or call the practice. This information gives you a general idea of the options and helps plan the examination; the medical assessment and the decision take place at the examination in Nişantaşı.
- 2
Examination and discussion of options
At the practice in Nişantaşı, Prof. Dr. İlker Yazıcı assesses the tissue of the chest, abdomen and back; suitable methods, stages, scars and risks are discussed in detail.
- 3
Coordination with the oncology team
Timing is decided with the breast surgeon and oncologist; the chemotherapy and radiotherapy plan directly affects the reconstruction method and its stages.
- 4
Surgery and hospital stay
Surgery is performed under general anaesthesia. After microsurgery, blood flow to the transferred tissue is checked frequently in the first days; the hospital stay is shorter after implant reconstruction.
- 5
Later stages
Once the breast shape has settled, fat injection, nipple and areola reconstruction and a symmetry operation on the other breast are planned as needed.
- 6
Long-term follow-up
Plastic surgery check-ups continue alongside oncology follow-up; if implants were used, regular examination and imaging when needed are advised.
Recovery timeline
Days 1–5
You stay in hospital. After microsurgery, the colour and blood flow of the new tissue are checked at regular intervals; walking starts early.
Weeks 1–2
You go home, and drains are usually removed during this period. If abdominal tissue was used, the abdomen feels tight and you walk slightly bent forward for the first few days.
Weeks 2–3
Stitches and wounds are checked. Most patients who had implant reconstruction can return to desk work; heavy lifting with the arms is avoided.
Weeks 4–6
After microsurgery, most daily activities resume. If a tissue expander is in place, gradual filling sessions continue at the practice.
Weeks 6–12
With the surgeon's approval, exercise and heavy lifting are resumed gradually, and swelling decreases noticeably.
Months 3–6 and beyond
The breast shape settles. Later stages such as fat injection, nipple reconstruction and symmetry surgery can be planned during this period.
Risks and possible complications
Every surgical procedure carries risks. Your personal risk is assessed in detail at the consultation.
- In microsurgical reconstruction, a clot in the vessel connection; it is usually noticed in the first days and may need urgent re-operation, and rarely part or all of the transferred tissue is lost.
- Firm nodules in the transferred tissue caused by fat necrosis; most are harmless, but imaging may be needed to tell them apart during cancer follow-up.
- With implants and tissue expanders: infection, capsular contracture (especially after radiotherapy), displacement, rupture and the need to replace the implant over time.
- A very rare type of lymphoma associated with textured implants (BIA-ALCL); its symptoms and follow-up are explained at the consultation.
- At the abdomen, fluid collection, wound separation, a lax or bulging abdominal wall, or a hernia; if back tissue was used, fluid collection in the back.
- Bleeding, haematoma, infection and wound-healing problems; smoking, diabetes and radiotherapy increase these risks.
- Deep vein thrombosis and pulmonary embolism; the risk is reduced with early walking, compression stockings or devices and, where needed, medication.
- Reduced sensation in the new breast; sensation is usually not the same as before and may partly return over time.
- Differences in volume or shape between the two breasts, and a possible need for further corrective surgery.
What determines the cost?
The cost of breast reconstruction varies considerably with the method chosen. Reconstruction with an implant or tissue expander, microsurgical reconstruction with abdominal tissue and reconstruction with back tissue involve different operating times, hospital stays and materials. Whether one or both breasts are reconstructed, the number of stages, fat injection, nipple reconstruction and any symmetry operation on the other breast also affect the cost.
Once the examination is done and the treatment plan is clear, you receive a written, itemised quote that shows which stages are included. Patients with private health insurance are advised to check with their insurer whether their policy covers reconstruction after breast cancer; the necessary medical reports can be prepared after the examination.
If you are coming to Istanbul
Patients coming from abroad are advised to plan on staying in Istanbul for about 7–10 days after implant reconstruction, or about 10–14 days after microsurgical reconstruction with abdominal tissue, during which drain and wound checks take place. The practice is authorised by the Turkish Ministry of Health for international health tourism (certificate no. ST-2365); help with accommodation near the clinic and airport transfer can be arranged through authorised partners. Back home, you stay in touch with the practice by sending photos and messages; if something needs to be examined, a check-up in Istanbul or a visit to a local doctor is arranged. In-person checks are usually planned at 1, 3 and 6 months, and the later stages require a separate visit.
Frequently asked questions
Can breast reconstruction be done at the same time as a mastectomy?
Yes, in suitable cases breast reconstruction can be done in the same operation as the mastectomy; this is called immediate reconstruction. The breast skin can often be preserved, and the patient wakes up with a breast shape already in place. If radiotherapy is likely to be needed after surgery, or if the patient wants time to decide, reconstruction can be left until treatment is complete. The decision is made jointly by the breast surgeon, the oncologist and the plastic surgeon.
Can I have breast reconstruction if I have had radiotherapy?
Breast reconstruction is possible after radiotherapy, but planning is different. Radiotherapy hardens the skin and tissue and makes them less elastic, so capsular contracture around an implant and wound problems are more common. In irradiated areas, methods that use your own tissue, such as microsurgical reconstruction with abdominal tissue or a latissimus dorsi flap, are often preferred. Reconstruction usually waits until the tissue has recovered after radiotherapy, which most often takes 6–12 months.
Implant or own tissue: which is used for breast reconstruction?
Implant and own-tissue breast reconstruction each have their pros and cons. Implant reconstruction is a shorter operation but often needs two stages, and the implant may need replacing over the years. In own-tissue reconstruction, such as the DIEP flap, skin and fat from below the navel are moved to the chest with microsurgery; the operation is longer and leaves an abdominal scar similar to a tummy tuck, but the new breast changes along with the body. The choice depends on radiotherapy history, body shape, general health and personal preference.
Is breast reconstruction painful, and when can I go back to work?
Pain after breast reconstruction is usually most noticeable in the first days and is controlled with regular pain relief. When abdominal tissue is used, tightness in the abdomen is the main discomfort. Most patients who have implant reconstruction can return to desk work within 2–3 weeks; after microsurgical reconstruction this is usually 4–6 weeks. Waiting 6–8 weeks and getting your surgeon's approval before heavy lifting and strenuous exercise is advised.
Where are the scars after breast reconstruction?
The position of the scars after breast reconstruction depends on the method. Immediate reconstruction often uses the mastectomy incision. When abdominal tissue is used, there is a low horizontal scar running between the hip bones and a fine scar around the navel; a scar may also be visible on the breast at the edge of the transferred skin. With a latissimus dorsi flap, the scar lies on the back, usually along the bra line. Scars fade and flatten over 12–18 months but do not disappear completely.
Is breast reconstruction permanent, and when is the final result visible?
A breast rebuilt from your own tissue becomes a living part of the body and stays in place for many years, changing with weight and age like the rest of the body. Implants are not designed to last a lifetime; they may need replacing over the years, and regular check-ups are advised. The breast shape usually settles in 3–6 months; once the nipple and symmetry stages are complete, the final appearance usually emerges within 6–12 months.
Can breast reconstruction be done years after a mastectomy, and is there an age limit?
Breast reconstruction can be done years after a mastectomy; there is no deadline for delayed reconstruction and no fixed age limit. What matters is general health, the course of cancer treatment and follow-up, any previous radiotherapy and how much tissue is available. For older women or those with other medical conditions, shorter procedures may be preferred. The decision is made at the examination, taking the oncologist's opinion into account.
Do smoking and my medications affect breast reconstruction?
Smoking impairs blood flow to the transferred tissue and skin, raising the risk of wound breakdown, infection and tissue loss; not smoking for at least 4–6 weeks before and after breast reconstruction is advised. Blood thinners, some herbal supplements and hormone treatments that can affect clotting risk are reviewed one by one at the consultation. No medication that is part of cancer treatment should be stopped on your own; if needed, a temporary adjustment is agreed with the oncologist.
What does the cost of breast reconstruction depend on?
The cost of breast reconstruction depends on the method chosen (implant, tissue expander, abdominal or back tissue), whether one or both breasts are reconstructed, the length of surgery, the number of nights in hospital and the materials used. Stages such as a symmetry operation on the other breast in the same session, fat injection and nipple reconstruction also play a part. After the examination you receive a written, itemised quote that states what is included; private insurance cover depends on the policy.
I am coming from abroad. How long should I stay in Istanbul?
Patients who come to Istanbul from abroad for breast reconstruction are advised to plan on staying about 7–10 days after implant reconstruction, or about 10–14 days after microsurgical reconstruction with abdominal tissue. Drain and wound checks take place during this time. Follow-up checks are usually at 1, 3 and 6 months; in between, you stay in touch with the practice by sending photos and messages. Later stages such as nipple reconstruction or symmetry surgery require a separate visit.
Last updated: · Responsible for content: Prof. Dr. İlker Yazıcı · info@ilkeryazici.com