BREAST RECONSTRUCTION
If you are one of the thousands of women who have one or both breasts removed from cancer related condition, you will want to consider breast reconstruction surgery.
What is breast reconstruction?
The decision of whether to undergo breast reconstruction is extremely personal. Most women cannot imagine not getting breast reconstruction. Some women prefer to put on a prosthesis while others may choose not to. And still, others may go for quite a while without breast reconstruction and then come to a decision to get the reconstruction.
Breast reconstruction is a surgical procedure, performed by an experienced and qualified plastic surgeon, to restore the shape and appearance of your breasts after having complete or partial breast removal surgery (Mastectomy) because of breast cancer problems.
Breast reconstruction has made a huge difference both physically and emotionally to a lot of women who had to suffer from breast cancer. But it is essential for you to understand the limits of the surgery prior to deciding to have one.
The reconstruction produces a brand new breast however, it is not natural – it is not going to have adequate sensation. When you (or another person) touch it, it will feel normal to your hand, but it gets not much sensation itself.
This surgery is an excellent option to think about. The majority of women feel that undergoing surgery is worth it, mainly because it becomes more convenient to wear certain types of clothing. For a lot of women, reconstruction equally provides another significant purpose – it helps them place their cancer experiences behind them. At the same time, not everybody is happy with reconstruction.
The decision to undergo surgery is highly individual. Before making a decision, be certain to become as knowledgeable as you can be about the different procedures and what they involve. You will next have to decide what you want to be done and when you want to have it done.
When to Have the breast reconstruction surgery?
One of the decisions you will have to make is when you want the reconstruction to be done. The reconstruction can be done just after the mastectomy or it can be done at a later time.
The benefit of having it done immediately is that you won’t need yet another surgery later. Women who decide to have the reconstruction done at a later point in time are those that haven’t yet decided if they want to have reconstruction or who do not yet feel emotionally ready to take that step.
Types of Breast Reconstruction
There are two main types of reconstructive surgery: those using synthetic materials (implants) and those using your own tissues (flaps). And also there are variations within these types. The type of reconstruction that suits you best depends on your preferences, the effect you desire, and the extent of your breast cancer surgery.
Implants
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There are two kinds of implants, saline, and silicone. Saline implants are filled with sterile salt water that closely matches the salt content in our bodies. A silicone implant is a silicone sack filled with silicone gel.
The procedure for silicone and saline implants is similar. And the implant is positioned behind the pectoralis muscle, the main muscle in the chest wall. Then the skin is closed over it. If you have the implant inserted at the same time you are getting a mastectomy, it will not add days to your hospital stay.
Flap Reconstruction
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There are a variety of techniques which use your own tissue to create a new breast. These are known as flap reconstructions.
This reconstruction technique needs the harvesting of skin, muscle, and fat from another part of your body and using it to create a new breast.
Flap reconstruction is a better alternative to an implant. Since the surgeon uses your own tissue, it is easier to create a larger breast, if that’s what is needed. And also, your breast will get an even more natural droop than one created using an implant. And since it’s created from real tissue, skin, and fat, a breast made from a flap reconstruction may feel more normal to you when you touch it. But it will still have little sensation.
If you decide to have a flap reconstruction you will have two scars, one where your breast was removed and one where the tissue was extracted to create the flap.
Pedicle Flap (Attached flap) VS Free Flaps
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Pedicle flaps remain attached to their original blood supply whereas free flaps are completely detached from one area of the body and reconnected to tiny blood vessels in another area. The surgeon uses a microscope to visualize vessels from the harvested flap and attach them to vessels in the breast area, a technique known as microsurgery.
DIEP Flap
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The DIEP (Deep Inferior Epigastric Perforator) flap makes use of the skin and fat from your lower abdomen to reconstruct your breast. To be able to effectively transfer ample amounts of fat and skin to create your new breasts, the tissues (often called a “flap”) ought to contain an artery that brings blood, oxygen, and nutrients to the flap including a vein that transports away from the deoxygenated blood.
The DIEP flap will use blood vessels named Deep Inferior Epigastric Perforator artery and vein. These vessels travel in the rectus muscles, which are the vertical muscles in your abdomen that create the “six-pack”.
Our surgeons use the latest techniques to carefully dissect the blood vessels free from the muscles. This allows your surgeon to harvest only the skin, fat and blood vessels leaving the rectus muscle in its place in the abdomen. This advanced reconstruction is usually called a “perforator flap” since it merely takes the blood vessels and leaves the muscle in place.
The flap is then transferred to the chest where your surgeon will form it into your new breast. Your surgeon will then reconnect the blood vessels in the flap to vessels in the chest using a microscope.
The spot in your abdomen in which the flap was taken is then closed in a way similar to a “Tummy tuck” (abdominoplasty).
The DIEP flap can provide you with a natural, soft, reconstructed breast with the extra benefit of flattening the abdomen. Because your new breasts are entirely made of your own tissues, they will age with your body through time.
TRAM Flap
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TRAM (Transverse Rectus Abdominis Myocutaneous) flap reconstruction surgery is no longer a preferred technique because of the risk of hernia or abdominal bulge and the restriction of lifting anything heavy (20 lbs.) after surgery.
In TRAM flap surgery, the flap stays attached to its original site, preserving its blood supply. The flap is tunneled under the skin to the chest, making a pocket for an implant or sometimes creating the breast mound itself.
Please refer to the table below shows the potential advantages and disadvantages of the different reconstruction techniques.
Lat Flap
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The Latissimus Dorsi Myocutaneous (Lat) flap makes use of skin, fat and the Latissimus muscle from your back to reconstruct your breast. The flap is rotated from your back to the breast area. Generally, this is used in combination with a tissue expander or implant in order to develop sufficient volume for the reconstruction.
This reconstruction technique is a good alternative if you do not have lower abdominal tissue available or if microsurgery is not your preference.
Frequently Asked Questions
Q1: What are the advantages and disadvantages of silicone and saline implants?
Answer : Silicone has a more natural feel and look. In the occurrence of leakage, saline is much less injurious to the surrounding tissues.
Q2: What are some points to consider about placing implants over or under the muscle?
Answer : Implant movement when pectorals are flexed is more obvious with implants below the muscle. Women with scant natural breast tissue will have less obvious “augmented look” if implants are placed below the muscle. Mammograms are reportedly slightly less accurate if implants are above the muscle.
Q3: Will I be asleep during surgery?
Answer : You will be asleep under general anesthesia.
Q4: How long will I stay in the hospital?
The patient is typically admitted for 1-2 nights. After which you may go back to your hotel. You may do some shopping and sightseeing while waiting for your follow up schedule. It is important not to do any lifting, swimming, and other strenuous activities. You need to return for check-up 7-10 days after surgery, after which you can travel or return to work.
Q5: How many days after operation can I leave Bangkok?
Answer : You need to return for check-up 7-10 days after surgery, after which you can travel or return to work.
Q6: How long will it take me to recover?
Answer: Most patients can walk around slowly the day after surgery, and steadily improve over the next few days. There will be swelling and bruising, most of which will resolve in about 2 weeks. Limitation of physical activity and contact with breasts must be observed for about 4 weeks. . Full wound maturation and final results will gradually occur over 6-12 months.
Q7: How do I care for myself after the operation?
Answer: Your surgeon will teach you a special breast massage technique and prescribe a support bra for a few months.
Q8: What could go wrong?
Answer: Some risks of surgery include bleeding, adverse response to anesthesia, infection, delayed healing, asymmetry, nerve injury, numb areolae and nipples, contractures or keloid at incision site, contracture around the implant, rippling of skin over some parts of the implant, leakage, and need for revision surgery.
Q9: How do I prepare for surgery?
Answer: To avoid complications and reduce risk factors you need to stop smoking, drinking alcoholic beverages, taking hormonal pills, herbal supplements, and medicines (other than those that your doctor allows you continue), at least two weeks before your schedule. People with diseases need surgical clearance from their medical specialist.
Available Doctors
Dr. Somsak Chuleewattanapong
Dr. Vitawat Angkatavanich
Dr. Pitch Paiboonkasemsutthi
Dr. Kittichai Sipiyarak
Dr. Krairit Tiyakul
Dr. Duangkamon Chiranakorn
Dr. Suthat Koonnawarote
Dr. Sanit Pongkapanakai
Dr. Pramote Manurangsee
