Di Dr. Dinko Bagatin
Prevention is often talked about, but what to do when the disease has already occurred or when the breast has already been removed is rarely mentioned. Tumor or breast cancer in women is one of the most common cancers today, and the extremely worrying fact is that the tumor occurs at a very young age, sometimes even in girls under 20 years old, especially in cases where another female person in the family suffered from breast cancer.

We interviewed our doctor, dr. Dinko Bagatin, specifically on the subject of breast reconstruction and mastectomy, where asked to answer all the most common questions collected by patients.

Why still a large number of women does not decide on surgical reconstruction? What are their fears?

What we do know is that 1 in 8 women in the US will develop breast cancer in their lifetime, of which only 23% of women know about the wide range of reconstructive options available to them.

What must be our primary goal is to increase the knowledge of patients about breast cancer and the possibilities of reconstruction after surgery. We need to help women understand what their options are.

Here are important stories about hope, courage and the possibilities of reconstruction from the perspective of patients and doctors, I mean the experiences of patients, but also of doctors who deal with breast reconstruction. Ignorance is still the main reason why few women opt for reconstruction after breast cancer. I am sure that there are prejudices related to the reconstruction procedure itself.

Most often, a woman, after such a serious illness, does not want to go through any other additional procedures. Reconstruction, too, sometimes seems like something too complicated and something that might not give women the result they would like. I know that a woman just wants the disease to pass and thinks that after the cure she is too tired of everything.

Are there any reconstruction myths you'd like to dispel?

Yes, of course, there are several! The first myth is that breast reconstruction can only be done after a mastectomy (removal of the entire breast), which is not true. It can be done at the same time as the mastectomy, which is recommended in situations where it is possible. Of course, this is not possible in all cases and may partly depend on the therapy that is planned after the procedure. But patients should have this information.

Another myth I would mention is that breast implants are the only option for breast reconstruction. The truth is they aren't. It should be known that they are one of the options, but also that in addition to this option, there is also a combination of implants and own tissue, as well as the reconstruction with own tissue from the back, abdomen, buttocks or upper legs.

Furthermore, it is a myth that breast reconstruction is not an option when radiation is part of breast cancer treatment. Often in this case, later breast reconstruction is recommended to reduce the risk of complications. I would also mention the myth that the reconstructed breast must look unnatural.

This can be the case with some reconstructions, as well as with patients who want to have an artificial 'augmented' look. Reconstruction with own tissue can in some cases give a more natural appearance.

How far have we progressed in that area? Is this procedure performed the same way today as it was 10 years ago?

Progress is always present here, as well as in the world, in terms of the use of all advanced techniques used by others, which have proven to be good in breast reconstruction.

The goal of reconstruction is to restore an appearance similar to the normal shape, appearance and size after breast removal. The same techniques have improved, as have the materials used. I believe that in Croatia we are at the same level as, for example, the USA.

In what ways is breast reconstruction performed? Can you briefly describe the process?

Breast reconstruction usually involves multiple procedures performed in stadiums; it can start at the time of the mastectomy or it can be delayed until a later time.

It is divided into two types - breast reconstruction based on implants and reconstruction based on one's living tissue (flaps). In the first case, with implants, the first step is a mastectomy, that is, the removal of the entire breast tissue, and then breast reconstruction is immediately performed with an implant that replaces the lost breast tissue.

In the next act, the breast is further refined, more precisely, a new nipple is created, and more volume is added in terms of fat grafting and the like.

Another option is to take your living tissue from one region of the body and use that tissue for breast reconstruction.

We are talking about the option of reconstruction with our tissue, which can also be combined with an implant.

Is there an expiration date for implants?

It is recommended that the implants be replaced after 10 to 15 years. But if everything is fine and the patients do not have any problems with them, which we determine at regular check-ups, they can be left on for a longer time.

If the patient has one breast removed, do you have to perform surgical procedures on the other, healthy breast to make the breasts look the same?

Of course, it is always recommended that an adequate type of correction be made on the other breast. It can be lifting, lifting and reducing, as well as lifting and enlarging the other breast. It all depends on how much breast asymmetry there is after the reconstruction of the diseased breast.

Are there any patients you would reject for breast reconstruction surgery? Who represents a good candidate for reconstruction?

Most patients are good candidates for reconstruction, the only question is what is the best technique for their reconstruction.

Who is not a good candidate? I would like to mention here that smoking reduces circulation in the rest of the breast tissue and significantly increases the possibility of complications by 2 to 3 times or more.

When to undergo the procedure? How long should it take after a mastectomy?

It would be best to undergo the procedure immediately when the mastectomy is also performed, but of course, this is not always possible. The reason why the procedure is sometimes done after some time is the additional therapy that needs to be taken after the operation, for example, breast radiation or advanced breast disease.

What are the risks associated with breast reconstruction surgery?

As with any other procedure, whether standard or more complicated, there are certain risks.

After the reconstruction, infection or capsular contraction can occur (in the case of reconstruction with an implant), which means that strong scar forms around the implant, which deforms the breast, making it very hard and painful. Then a capsule should be made and the implant replaced. Also, after the reconstruction of your tissue, it may deteriorate due to poor circulation. Scars can sometimes be more pronounced.

What changes do you see in women after reconstruction? To what extent does it affect their mental health?

After the reconstruction, the women are really satisfied with themselves. They have a breast even though they have overcome cancer and that breast, most often, looks similar to the natural one.

Women mustn't have a sense of loss, nor a painful reminder that they had cancer. Reconstruction achieves a result similar to the appearance they had before the disease. The goal of the reconstruction is to get the most natural and beautiful look, that is, the look that women want.