Breast reconstruction at Yanhee: implant and flap options after mastectomy
What breast reconstruction is
Reconstruction restores the shape of a breast after part or all of it has been removed, usually for cancer. It can be done with an implant, or by moving skin and fat from elsewhere on your body.
Two honest points before the detail. A reconstructed breast can look natural and feel normal to touch from the outside, but it does not restore sensation — the skin over it will largely be numb, permanently. And reconstruction is a choice, not an obligation. Some women want it immediately, some want a prosthesis, some decide years later, and some choose to stay flat and are content with that. All of those are reasonable. The purpose of this page is to set out the options accurately enough that the decision is yours.
Radiotherapy changes the answer
If you have had radiotherapy to the chest wall, or are going to, say so at the first consultation. It matters more than almost anything else you will discuss.
Radiation permanently changes the tissue it passes through: the skin becomes tighter, less elastic and less well supplied with blood. In a breast reconstructed with an implant, that raises the rate of capsular contracture, wound healing problems, infection and implant loss substantially, and it can distort a result that looked good at first. For that reason, radiotherapy generally pushes the decision toward reconstruction with your own tissue, which brings its own blood supply into the radiated field.
Timing is affected too. Where radiotherapy is planned after mastectomy, many teams prefer to delay definitive reconstruction until it is finished and the tissues have settled, which can be several months. Where it has already been given, the tissue is already changed and that informs which technique is realistic.
None of this is a rule that decides for you — it is the conversation to have with a surgeon who has your radiotherapy record in front of them, alongside your oncology team.
Timing: immediate or delayed
Immediate reconstruction is done in the same operation as the mastectomy. It avoids a second anaesthetic, preserves the breast skin envelope, which gives a better shape, and means waking without the loss. Delayed reconstruction is done later — months or years — and gives you time to finish cancer treatment, recover, and decide without pressure.
Neither is better in the abstract. The decision belongs with your cancer team as much as your surgeon, because it depends on the tumour, on whether radiotherapy or chemotherapy are planned and when, and on your own readiness.
The two routes
Implant reconstruction
An implant is placed on the chest wall, generally behind or partly behind the pectoralis muscle, sometimes after a period with a tissue expander to stretch the skin first. It is the shorter operation, has no second surgical site and needs less recovery. The trade-offs are that it does not change with your body, may need replacing over the years, and does less well in radiated tissue. Implants are the same FDA-approved devices used for breast augmentation.
On the filling: silicone gel gives a more natural feel and is what most reconstruction uses. Saline is filled with sterile salt water; a rupture is obvious because the implant deflates, whereas a silicone rupture is often silent and found on imaging. Neither is simply safer than the other.
Flap (autologous) reconstruction
A flap rebuilds the breast from your own skin and fat, sometimes with muscle. It gives a softer, more natural result that droops as a breast does, changes with your weight, ages with you, and tolerates radiation far better. The costs are a longer operation, a second scar where the tissue was taken, and a longer recovery.
A pedicled flap keeps its original blood supply and is rotated into place. A free flap is detached completely and its artery and vein reconnected to vessels in the chest under a microscope. Free flaps give the best tissue options but they are microsurgery, and they carry a risk a pedicled flap does not: if the reconnected vessels clot, the flap must be returned to theatre within hours to be saved.
Comparing the flap techniques
| Technique | Tissue source | What to know |
|---|---|---|
| DIEP flap (free flap) | Skin and fat from the lower abdomen | Spares the abdominal muscle, so abdominal strength is largely preserved. Soft, natural result that also flattens the abdomen. Requires microsurgery and close monitoring in the first days. |
| TRAM flap (pedicled or free) | Lower abdominal skin, fat and rectus muscle | Takes the muscle as well, so it carries a risk of abdominal bulge or hernia and a lasting limit on heavy lifting. Now generally less favoured than DIEP where DIEP is available. |
| Latissimus dorsi flap (pedicled) | Skin, fat and muscle from the back | Rotated round to the chest with its own blood supply, so no microsurgery and no flap-failure emergency. Usually needs an implant underneath for volume. A good option where there is little abdominal tissue, or where a free flap is not appropriate. |
DIEP flap in detail
The DIEP flap uses skin and fat from the lower abdomen. For the tissue to survive it needs an artery bringing blood and a vein draining it, and the DIEP takes the deep inferior epigastric perforator vessels, which run up through the abdominal muscles. The surgeon dissects those vessels out through the muscle rather than taking the muscle with them, which is why the abdominal wall stays largely intact and why it is called a perforator flap. The tissue is moved to the chest, shaped into a breast, and its vessels joined to vessels behind the ribs under a microscope. The abdomen is closed much like a tummy tuck.
Latissimus dorsi flap in detail
The latissimus dorsi flap moves skin, fat and the broad muscle of the back round to the chest, keeping its own blood supply. Because nothing is disconnected there is no microsurgical risk. It usually does not provide enough volume alone, so an implant or expander goes underneath. Some women notice reduced shoulder or back strength afterwards, which matters more if you are an athlete, a climber or a wheelchair user.
The stages after the first operation
Reconstruction is rarely one operation. Expect to discuss:
- Revision and shaping. A second, smaller procedure to refine the shape, correct contour dips or add fat grafting is normal rather than a sign something went wrong.
- Nipple and areola reconstruction. Usually months later, once the breast has settled. The nipple can be rebuilt from local skin, and the areola created by medical tattooing — modern 3D areola tattooing produces a convincing result and some women choose it alone, without nipple reconstruction.
- Symmetry surgery on the other breast. Very common, and part of reconstruction rather than vanity: a lift, a reduction or an augmentation of the unaffected side so the two match.
If you are travelling for this
Most procedures in this hospital's cosmetic service travel well. Breast reconstruction is the one that needs thinking about carefully, and it would be dishonest to present it like the rest.
- A free flap can fail in the first 48 to 72 hours, and saving it means returning to theatre within hours. That is not a complication you want to develop on a plane or in a hotel, and it is the reason flap patients stay in hospital under monitoring rather than being discharged early.
- Reconstruction has to be sequenced with your cancer treatment. Chemotherapy, radiotherapy and endocrine therapy all have timing implications, and the team planning them is usually at home. Surgery abroad has to fit their schedule, not the other way round.
- Complications after you fly home are managed by someone else. Reconstruction has a real revision rate; whoever picks that up will not have done the original operation.
- You may not need to pay for this at all. In many countries reconstruction after mastectomy is covered by insurance or the public health system as part of cancer treatment rather than as cosmetic surgery. Check before you spend anything.
None of that means travelling is wrong — for some women, access, waiting lists or cost make it the right decision. It means the questions to ask are different from the ones you would ask about a cosmetic procedure. Ask specifically how many days you will be inpatient, what the flap monitoring arrangements are, who to contact after you fly, and how a complication at home would be handled.
What breast reconstruction costs at Yanhee
Reconstruction is quoted case by case rather than as a package, because the technique, the timing and whether it is done with the mastectomy all change the operation. A free virtual consultation gives a personalised plan and quote. Bring your pathology report, your treatment plan and your radiotherapy details, since those determine what is realistic before cost is even discussed.
Procedure | Hospital Stay | Price (THB) |
Breast reconstruction — implant or flap | Confirmed at consultation | Quoted per case |
Symmetry surgery, opposite breast — breast lift, round block / peri-areolar | 1 Night | 83,000 |
Symmetry surgery, opposite breast — breast lift, inverted T-scar | 1 Night | 111,000–136,000 |
Symmetry surgery, opposite breast — breast reduction | 2 nights | 136,000 |
Symmetry procedures on the unaffected breast are priced on the breast lift, breast reduction and breast augmentation pages; where they are done alongside reconstruction they are quoted as part of one plan. Prices are subject to change and confirmed after consultation — see plastic surgery prices.
Recovery, by technique
The two routes recover very differently, and one timeline for both would be misleading.
| Implant reconstruction | Flap reconstruction | |
|---|---|---|
| Operation length | Shorter | Long, particularly a free flap |
| Inpatient stay | Around 1–2 nights | Several days, with flap monitoring — confirm the number with the team |
| Surgical sites | Chest only | Chest plus the donor site |
| Return to normal activity | Sooner | Longer, and limited by the donor site as well as the chest |
| Effect of radiotherapy | Raises contracture and implant loss | Tolerates it considerably better |
Common to both: walking begins the day after surgery, swelling and bruising settle over the first weeks, a supportive bra is worn as instructed, direct pressure on the breast and strenuous activity are avoided for about four weeks, and the final shape develops over 6 to 12 months. Follow-up is at 7 to 10 days for an implant reconstruction; a flap needs review sooner and more often, so agree your schedule before you plan travel.
Risks to understand
Common to both routes: bleeding, infection, delayed wound healing, asymmetry, numbness across the breast and areola which is expected and largely permanent, unfavourable scarring, and the likelihood of at least one further procedure to refine the result.
Implant-specific: capsular contracture, which is more likely after radiotherapy; visible rippling, particularly in thin tissue; malposition; rupture; and eventual replacement, since implants are not lifetime devices.
Flap-specific: partial or complete flap loss, which for a free flap is an emergency requiring return to theatre within hours; fat necrosis producing firm lumps in the reconstructed breast; and donor-site problems — abdominal bulge or hernia after a TRAM, weakness or seroma at the back after a latissimus dorsi flap, and a long abdominal scar after either abdominal flap.
Frequently asked questions
Implant or flap — which is right for me?
An implant is the shorter operation with no second surgical site and a quicker recovery, but it does not change with your body, may need replacing over the years, and does less well in tissue that has been irradiated. A flap uses your own skin and fat, so the breast is softer, droops naturally, changes with your weight and tolerates radiotherapy far better, at the cost of a longer operation, a donor-site scar and a longer recovery. If you have had or will have radiotherapy, that usually points toward a flap.
How does radiotherapy affect breast reconstruction?
Substantially, which is why it should be raised at the first consultation. Radiation permanently changes the tissue it passes through, making skin tighter, less elastic and less well supplied with blood. In an implant reconstruction that raises the rate of capsular contracture, wound healing problems, infection and implant loss, and can distort a result that initially looked good. It generally pushes the decision toward reconstruction with your own tissue, which brings its own blood supply into the radiated area. Where radiotherapy is planned after mastectomy, many teams prefer to delay definitive reconstruction until it is complete and the tissues have settled.
What is a DIEP flap, and how is it different from a TRAM?
The DIEP flap takes skin and fat from the lower abdomen and dissects the feeding blood vessels out through the abdominal muscle, leaving the muscle in place, so abdominal strength is largely preserved. A TRAM flap takes the rectus muscle along with the tissue, which carries a risk of abdominal bulge or hernia and a lasting limit on heavy lifting. Both are moved to the chest and shaped into a breast, and the abdomen is closed much like a tummy tuck. DIEP is a free flap, meaning the vessels are reconnected under a microscope.
Will a reconstructed breast feel normal?
It can look natural and feel normal to the touch from the outside, but reconstruction does not restore sensation. The skin over the reconstructed breast will be largely numb and that is usually permanent. A flap made from your own tissue tends to feel softer and droop more naturally than an implant, but the loss of sensation applies either way.
Is reconstruction one operation?
Rarely. Expect a first operation to build the breast, then often a smaller revision to refine the shape or add fat grafting, then nipple and areola reconstruction months later if you want it — the nipple rebuilt from local skin and the areola created by medical tattooing, which on its own produces a convincing 3D result. Surgery on the opposite breast to match the two is also common and is part of reconstruction rather than an extra.
What should I know if I am travelling to Thailand for this?
Ask different questions than you would for a cosmetic procedure. A free flap can fail in the first 48 to 72 hours and saving it means returning to theatre within hours, so ask how many days you will be inpatient and what the flap monitoring arrangements are. Reconstruction also has to be sequenced with chemotherapy, radiotherapy and endocrine therapy planned by a team that is usually at home. Complications after you fly will be managed by someone who did not perform the operation, so ask who to contact. And check your cover first: in many countries reconstruction after mastectomy is paid for by insurance or the public health system as part of cancer treatment rather than as cosmetic surgery.
Do I have to have reconstruction?
No. A prosthesis, delaying the decision for years, or choosing to stay flat are all legitimate. Reconstruction is offered because some women want it, not because a mastectomy has to be corrected. Take the time you need, and if you decide later, delayed reconstruction remains available.
Available doctors
These plastic surgeons at Yanhee perform breast reconstruction. Your surgeon is confirmed at consultation. If a free flap is being discussed, ask directly how many the surgeon performs each year and how the flap is monitored afterwards.
- Doctor of Medicine, King Chulalongkorn Memorial Hospital (1984); plastic surgery, Siriraj Hospital (1993)
- Hand and microsurgery fellowships, Kleinert Hand Center, USA (1994) and Singapore General Hospital (1996) — microsurgery is the technique free-flap reconstruction depends on
- Member of the Society of Reconstructive Microsurgery
- Craniofacial and cosmetic surgery, UCLA Medical Center (1994); maxillofacial surgery, Kantonsspital Basel (1998)
- Speaks Thai and English
- Doctor of Medicine, Prince of Songkla University (2005)
- International training in head, neck and breast reconstruction, Royal Melbourne Hospital, Australia — reconstruction after cancer surgery is the discipline this page is about
- Society of Aesthetic Plastic Surgeons of Thailand (2008); Society of Plastic and Reconstructive Surgeons of Thailand (2006); Royal College of Surgeons of Thailand (2004)
- Speaks Thai and English
- Doctor of Medicine, Khon Kaen University (1993)
- Holds the Board of Plastic and Reconstructive Surgery, Mahidol University (2003) and the Board of General Surgery, Khon Kaen University (1999)
- Fellow of the Royal College of Surgeons of Thailand
- Reviewer of this page
- Speaks Thai and English
- Doctor of Medicine, Prince of Songkla University (2005)
- Plastic and reconstructive surgery, Siriraj Hospital, Mahidol University (2013)
- Reviews the Yanhee breast reduction, breast lift and male breast reduction pages — the symmetry procedures on the opposite breast are her area
- International plastic surgery fellowships in South Korea (2012, 2014) and Taiwan (2013)
- Medical Council of Thailand; Society of Plastic and Reconstructive Surgeons of Thailand; ThSAPS; OSAPS; Royal College of Surgeons of Thailand
- Speaks Thai and English
- Doctor of Medicine, Siriraj Hospital, Mahidol University (2011)
- Plastic surgery residency, Siriraj Hospital, Mahidol University (2014–2019)
- Cadaveric workshop in breast aesthetics and reconstruction, Chulalongkorn and Siriraj (2019)
- Medical Council of Thailand; Society of Plastic and Reconstructive Surgeons of Thailand; Royal College of Surgeons of Thailand
- Speaks Thai and English
- General Medicine, Songkhlanakarin University (1993)
- Holds the Board of Plastic Surgery of Thailand and the Board of General Surgery of Thailand
- Advanced training, Boston, Massachusetts (2005); Asian Congress of Plastic Surgery (2004)
- Speaks Thai and English
- Doctor of Medicine, Chulalongkorn University (1985)
- Plastic surgery, Siriraj Hospital (1996); general surgery, King Chulalongkorn Memorial Hospital (1991)
- Holds the Board of Plastic & Cosmetic Surgery of Thailand
- The longest-serving surgeon on this list
- Speaks Thai and English
- Doctor of Medicine, Chiang Mai University (1990); general surgery, Prapokklao (1994); plastic surgery, Siriraj Hospital (1996)
- International postgraduate training, Chang Gung Medical School, Taiwan (1996)
- Professor, College of Medicine, Chulalongkorn University, Prapokklao Hospital branch (1996–2010)
- ISAPS; American Society of Plastic Surgeons; Society of Plastic & Reconstructive Surgeons of Thailand; Association of General Surgeons of Thailand
- Speaks Thai and English