For many women, body image is an important part of feeling good. When a woman is diagnosed with breast cancer and is facing mastectomy, she may feel that image is going to be shattered. The possibility of losing one or both breasts can be devastating. For that woman, losing a breast is as important as losing an important part of her body.

Recent advances in reconstructive surgery now permit reconstruction of a satisfactory breast either at the time of the mastectomy or secondarily i.e months or years later. Breast reconstruction is a physically and emotionally rewarding procedure and can improve a woman’s self image, self confidence and quality of life. There are many decisions and many choices involved in the process of breast reconstruction, but perhaps the most important question to ask is the following: Is reconstruction right for you? For tens and thousands of breast cancer survivors, the answer has been yes. Not every woman facing a mastectomy may feel the need for breast reconstruction, but for many women, it is an important part of their recovery. There are many options available for women who decide that reconstruction is right for them. The more you know about the procedure and the options involved, the better equipped you will be to make the decision that is best for you.

The first thing to do is to have a detailed consultation with a specialist Breast Reconstructive surgeon. Remember, breast reconstruction can be done at the same time of the mastectomy( immediate or primary) or much later ( delayed or secondary). This decision will be taken jointly by you, your Breast Oncosurgeon and Plastic surgeon. There are many options, each one having its pros and cons. Hence, it is best if you can come to us for discussing and understanding all the options possible for reconstruction of your breast. All the pros and cons of the various procedures will be discussed and the procedure most suitable for you will be explained.

The reconstruction method that is right for you will depend on the kind of mastectomy you have had, the size and ptosis of the contralateral breast that has to be matched and the availability of donor tissues. Most of the reconstructive methods are best done as staged procedures, where the first stage consists of creation of the breast mound and the second stage consist of nipple and areola reconstruction and equalisation procedure to match the contra-lateral breast.

This is only possible at the time of skin sparing mastectomy and only if the contralateral breast is small and does not have any ptosis. A silicone implant is placed under the chest wall muscle where the breast has been removed.

Advantages: Simple, quick, uses the patients own skin to cover.

Disadvantages: A permanent prosthesis such as silicone is used. Risk of infection and extrusion of implant. Only small to medium sized reconstruction is possible, cannot give ptosis and hence cannot match a ptotic opposite breast. Not suitable after radiotherapy..

This can be done at the time of skin sparing mastectomies where the patients own tissues are used and a large ptotic(sagging) contra-lateral breast is to be matched. Initially a tissue expander is placed and inflated to the required size and then it is replaced with a permanent silicone implant to match. Contra-lateral reduction may or may not be necessary.

Advantages: No flaps are needed. patients own tissues are used.

Disadvantages: Two stage procedure, two prosthesis are needed. Risk of infection and capsular contracture. not suitable after radiotherapy.

This procedure is advocated both primarily or secondarily after mastectomy when there is skin deficit. This happens when a lot of skin has to be removed at the time of mastectomy and skin has to be imported from somewhere. Procedure: The skin of the back is swung around using the Latissimus muscle as a carrier of blood supply for the skin. The volume of tissue is usually not enough and hence an implant/expander has to be used as well, unless an autologous LD muscle flap technique is used. Your surgeon at Aesthetics should be able to discuss the pros and cons of this.

Advantage: Moderate sized breasts of better shape can be reconstructed. Moderate ptosis can be achieved if expanders are used. 3 -4 hour operation.

Disadvantage: Additional operative site on the back, where the LD muscle has to be partly sacrificed. Some weakness on forceful extension of the arm, such as climbing etc. may be experienced. Higher incidence of capsular contracture if radiotherapy is also given.

Here the skin and the fat of the abdomen below the umbilicus is used. The Rectus abdominis muscle(one of the vertical muscles of the tummy) is used as a carrier of the blood supply of the skin. The abdomen is closed like an abdominoplasty operation. 4 hour operation.

Advantages: No implant is necessary. Rarely surgery on the contralateral breast will be needed, and that too if there is gross ptosis. Patient gets an abdominoplasty simultaneously. Natural looking and feeling breast can e reconstructed. Can be used in radiotherapy cases. Tummy scar barely visible.

Disadvantages: After the muscle from the tummy is used, there is an area of potential weakness, which has to be closed with a mesh. This can sometimes give rise to a hernia. A slight fullness in the upper part of the tummy may persist where the flap has been turned around. Small risk of partial flap loss exists. Potential weakness while sitting up.

This is based on the inferior pedicle of the same muscle and the same amount of skin and fat is used, but the blood vessels have to be detached from the abdomen and re-attached to blood vessels around the breast. This involves microsurgery. It is a 5 - 7 hour procedure. A mesh may have to be used to close the abdomen fascia.



Advantages: Patients own tissues are used. More reliable blood supply to the flap. More natural look and feel. Better positioning. No bulge in the upper abdomen. Can withstand radiotherapy well Tummy scar barely visible.

Disadvantages: Risk of hernia, risk of flap failure 5 - 10%. Longer operation. More recovery time. Potential weakness while sitting up.

Here only the blood vessel which supplies the skin and fat of the lower abdomen is dissected out and thus the Rectus abdominis muscle is spared. microvascular surgery is used to join the vessels on the chest. 6- 8 hrs procedure.

Advantages: No mesh is needed and hence less risk of hernia or weakness. simultaneous tummy tuck procedure. Can withstand radiotherapy well. Good shape, position and appearance. Tummy scar barely visible.

Disadvantage: Longer more complex operation. Risk of flap failure. Longer recovery time. Risks of a longer operation.

These are other microvascular flaps which can also be used in select cases and with special indications. The SGAP flap uses a vessel on your buttock and the ALT uses a vessel on your thigh.
Secondary procedures.

These are required 4 - 6 months after your first procedure to achieve symmetry in breasts and to reconstruct the nipple and areola. To achieve symmetry, you might be advised a reduction, augmentation of mastopexy(Lift) of the other breast. The nipple can be reconstructed even under local anaesthetic if other procedures are not required. The areola is best matched by medical grade tattoing. This service is provided at Aesthetics..

Prior to surgery , you will be given
Test for anesthetic and surgical fitness.
Day of surgery instructions and medications
Specific instructions relating to anaesthesia.
Following Surgery

After the surgery, you may find small tubes placed to drain out accumulated blood. Once all the tubes are removed ( 2-7 days), discharge can be arranged. Some swelling and bruising at the operation site is quite natural. This usually takes about 3 - 6 weeks to clear.

It is important to understand that breast reconstruction can produce remarkable results, however it cannot exactly match a breast lost to mastectomy. Even with revision procedures on the opposite breast, sometimes symmetry between breasts may not be perfect. However, your appearance under most clothing and swimsuits can be natural and balanced. Sensation in breasts reconstructed with flaps may be reduced..

The final results of breast reconstruction following mastectomy can help you feel physically and emotionally fulfilled. Over time, some breast sensation may return and scar lines will improve, although never disappear completely. There are trade-offs, but most women feel these are small compared to large improvement in their quality of life and the ability to look and feel whole again. Careful monitoring of breast health through self- exam, mammography and other diagnostic techniques is essential to your long-term health..