Breast reconstruction in Turkey

Implant based reconstruction is shorter, has no second wound elsewhere on the body, and is often staged with an expander first to stretch the skin before the permanent implant goes in. It ages differently from the other breast, hardening around the implant is the commonest long term problem, and implants are replaced at some point rather than being permanent.

Tissue based reconstruction uses skin and fat from your own body, most often the lower abdomen. The DIEP flap takes that skin and fat with its blood vessels and reconnects them under a microscope, leaving the abdominal muscle in place. It is a much longer operation with a scar across the lower abdomen, and the result feels and ages more like a breast.

• Implant based

  Shorter surgery, no second site, often staged with a tissue expander. Ask about hardening around the implant, about revision over time, and about what radiotherapy does to it.

• Your own tissue

  Most often a DIEP flap from the lower abdomen. Longer surgery, an abdominal scar, and a result that behaves more like breast tissue. Needs a surgeon who does microsurgery regularly.

• Immediate or delayed

  At the same time as the mastectomy, or later. Immediate spares a period without a breast; delayed gives time to finish cancer treatment first and is a completely valid choice.

• Not one operation

  Reconstruction is a series. Surgery on the other breast to match, revision of the shape, nipple reconstruction and tattooing come afterwards. Any quote that covers one step is quoting one step.

For implants outside a cancer context, see breast implants. Surgery on the other breast to match may mean a breast lift or a breast reduction. For cancer care itself, see oncology in Turkey.

1. 1

   Discussion with the whole team

   The breast surgeon, the plastic surgeon and your oncology team. What has been removed, what treatment is still planned, and what that means for timing.
2. 2

   Planning and marking

   Which technique, which donor site, and what will be done to the other breast to match. Ask for this drawn and photographed, and for the plan to name every stage.
3. 3

   General anaesthetic

   Implant reconstruction is a shorter operation. A free flap is a long one, often most of a day, with two surgical sites.
4. 4

   Building the breast

   Either an expander or implant behind or in front of the muscle, or the flap raised, transferred and its vessels joined under the microscope.
5. 5

   Monitoring afterwards

   A flap is checked repeatedly for colour, warmth and blood flow. Any change means a return to theatre without delay. Drains stay in for a period at both sites.
6. 6

   The later stages

   Revision for shape, surgery on the other breast, nipple reconstruction and tattooing, each a separate appointment months apart.

• Check what is funded at home first. Reconstruction after cancer surgery, including delayed reconstruction and symmetry surgery, is covered by most European health systems. Paying abroad for something you are entitled to is worth avoiding by one phone call.
• Insist on contact with your oncology team. Records, imaging and treatment history should move between them. A surgeon who does not ask for these has not assessed you.
• Ask who does the microsurgery. By name, with their annual volume, if a flap is proposed.
• Ask how long you must stay. And compare it against the period in which flaps are lost. This is the question that decides whether the plan is safe for a traveller.
• Get the whole staged plan priced. Not just the first operation. Revision, symmetry surgery and nipple reconstruction are separate procedures and separate trips.
• Arrange who manages complications at home. Wound problems, infection and implant problems can appear weeks later. Know who will see you and what they will be sent.

• Flap loss. Partial or complete, from a problem with the blood supply. Uncommon in experienced hands, but it is the reason for close monitoring and rapid return to theatre.
• Hardening around an implant. Capsular contracture, more likely after radiotherapy, and the commonest long term reason for further surgery in implant reconstruction.
• Wound healing problems and infection. At either site, and more likely if you smoke, which is why surgeons ask you to stop well beforehand.
• Fat necrosis. Firm lumps in the transferred tissue. They need imaging to distinguish them from anything else, which is another reason your own team must know what was done.
• Abdominal weakness or bulge. After abdominal flaps. The DIEP technique is designed to spare the muscle, but the abdominal wall is still healing.
• Asymmetry and further surgery. Expected rather than exceptional. Reconstruction is revised, and a plan that does not mention revision is not complete.

• NHS, information on breast reconstruction after mastectomy.
• National Institute for Health and Care Excellence, guidance on early and locally advanced breast cancer.
• Association of Breast Surgery and British Association of Plastic, Reconstructive and Aesthetic Surgeons, oncoplastic breast reconstruction guidance.
• Breast Cancer Now, patient information on reconstruction options.
• Turkish Ministry of Health, register of facilities authorised for health tourism.