Cosmetic Services

Breast Reconstruction

If you’ve undergone a mastectomy due to a cancer-related condition, considering breast reconstruction surgery may be important to you. Our comprehensive guide will walk you through everything you need to know about the procedure, from initial consultation to post-operative care.

What is Breast Reconstruction?

The decision to undergo breast reconstruction is deeply personal. While many women cannot imagine forgoing reconstruction, others may choose to wear a prosthesis or delay reconstruction. Some women may decide on reconstruction after a period of time.

Breast reconstruction is a surgical procedure performed by a skilled plastic surgeon to restore the shape and appearance of the breasts after complete or partial removal (mastectomy) due to breast cancer.

This procedure has brought significant physical and emotional benefits to many women who have faced breast cancer. However, it’s important to understand the limitations of the surgery before deciding to proceed.

While breast reconstruction can create a new breast, it does not replicate natural sensation. While it may feel normal to the touch, it lacks significant sensitivity.

For many women, undergoing reconstruction is a positive choice, making it easier to wear certain clothing and helping them move past their cancer experience. However, not everyone is satisfied with reconstruction.

Ultimately, the decision to undergo surgery is individual. It’s important to thoroughly educate yourself about the available procedures and their implications. You will then need to decide what you want and when you want it done.

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When to have Breast Reconstruction Surgery?

One decision you’ll face is when to undergo reconstruction. It can be done immediately after mastectomy or at a later time.

Immediate reconstruction offers the advantage of avoiding additional surgery later. It also allows for a smoother transition and helps maintain the breast skin, which can be beneficial for certain types of reconstruction.

On the other hand, some women choose to delay reconstruction because they’re unsure about it or don’t feel emotionally prepared yet. This approach gives them more time to consider their options and to focus on their recovery from mastectomy. It’s important to discuss your preferences and concerns with your healthcare team to determine the best time for you.

Types of Breast Reconstruction

Everything You Need to Know

Breast reconstruction can generally be categorized into two main types: implant-based reconstruction, which uses synthetic materials, and autologous reconstruction, which uses your own tissues (flaps). Within these categories, there are several variations. The most suitable type of reconstruction for you depends on your preferences, desired outcomes, and the extent of your breast cancer surgery.

Implants

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There are two types of implants: saline and silicone. Saline implants are filled with sterile salt water that closely matches the salt content in our bodies. Silicone implants consist of a silicone sack filled with silicone gel.

The procedure for both silicone and saline implants is similar. The implant is typically positioned behind the pectoralis muscle, the main muscle in the chest wall, and then the skin is closed over it. If you have the implant inserted at the same time as your mastectomy, it will not add days to your hospital stay.

Flap Reconstruction

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Flap reconstruction involves using your own tissue to create a new breast. There are various techniques for flap reconstruction.

This technique requires harvesting skin, muscle, and fat from another part of your body and using it to form a new breast.

Flap reconstruction is often preferred over implants for several reasons. Since the surgeon uses your own tissue, it’s possible to create a larger breast if necessary. Additionally, the reconstructed breast typically has a more natural droop compared to one created using an implant. Because it’s made from real tissue, a breast reconstructed with a flap may feel more natural to the touch, although it will still have limited sensation.

If you choose flap reconstruction, you will have two scars: one where your breast was removed and another where the tissue was harvested 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 then reconnected to tiny blood vessels in another area. Surgeons use 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 utilizes skin and fat from your lower abdomen to reconstruct your breast. For this tissue, often called a “flap,” to effectively transfer ample amounts of fat and skin to create your new breasts, it must contain an artery that brings blood, oxygen, and nutrients to the flap, as well as a vein that transports deoxygenated blood away from it.

The DIEP flap uses the Deep Inferior Epigastric Perforator artery and vein. These vessels travel through the rectus muscles, which are the vertical muscles in your abdomen that create the “six-pack.”

Our surgeons use advanced techniques to carefully dissect the blood vessels free from the muscles. This allows them to harvest only the skin, fat, and blood vessels, leaving the rectus muscle in place in the abdomen. This advanced reconstruction is typically called a “perforator flap” because it only takes the blood vessels and leaves the muscle in place.

The flap is then transferred to the chest, where your surgeon will shape it into your new breast. They will reconnect the blood vessels in the flap to vessels in the chest using a microscope.

Breast Reconstruction DIEP Flap

The area in your abdomen from which the flap was taken is then closed in a manner similar to a “Tummy tuck” (abdominoplasty).

The DIEP flap can provide you with a natural, soft, reconstructed breast with the additional benefit of flattening the abdomen. Because your new breasts are entirely composed of your own tissues, they will age with your body over time.

TRAM Flap

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TRAM (Transverse Rectus Abdominis Myocutaneous) flap reconstruction surgery is now less favored due to the risk of hernia or abdominal bulge and the limitation of lifting anything heavy (20 lbs.) after surgery.

In TRAM flap surgery, the flap remains attached to its original site, preserving its blood supply. The flap is then tunneled under the skin to the chest, creating a pocket for an implant or sometimes forming the breast mound itself.

Please refer to the table below for potential advantages and disadvantages of different reconstruction techniques.

Lat Flap

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The Latissimus Dorsi Myocutaneous (Lat) flap utilizes skin, fat, and the Latissimus muscle from your back to reconstruct your breast. The flap is rotated from your back to the breast area. Typically, this method is used in combination with a tissue expander or implant to achieve the necessary volume for reconstruction.

This reconstruction technique is a viable alternative if you lack lower abdominal tissue or if microsurgery is not your preferred option.

Lat Flap Breast Reconstruction Illustration

Take the first step and reach out to us for a complimentary virtual consultation. Our virtual consultants and surgeons will provide personalized recommendations based on your unique needs. Every client is different, and we tailor each procedure to match your individual requirements.

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Frequently Asked Questions

What are the advantages and disadvantages of silicone and saline implants?

Silicone implants offer a more natural feel and appearance. In the event of a rupture, saline is generally considered safer for the surrounding tissues compared to silicone.

What are some points to consider about placing implants over or under the muscle?

Implants placed below the muscle may show more movement when pectorals are flexed. Women with minimal natural breast tissue may have a less conspicuous “augmented look” with implants placed below the muscle. Mammograms are said to be slightly less accurate if implants are placed above the muscle.

Will I be asleep during the surgery?

Yes, you will be under general anesthesia during the procedure.

How long will I stay in the hospital for breast reduction?

Patients are typically admitted for 1-2 nights. Afterward, you may return to your hotel and engage in light activities such as shopping and sightseeing while awaiting your follow-up schedule. It is important to avoid lifting, swimming, and other strenuous activities. You should plan to return for a check-up 7-10 days after surgery, after which you can consider traveling or returning to work.

How soon after the operation can I leave Bangkok?

You should plan to return for a check-up 7-10 days after surgery. After this appointment, you may consider traveling or returning to work.

What is the typical recovery timeline after surgery?

Most patients can begin walking slowly the day after surgery and gradually improve over the next few days. Swelling and bruising are common and typically resolve within about 2 weeks. It’s important to limit physical activity and avoid direct contact with the breasts for about 4 weeks. Full wound healing and final results will gradually occur over 6-12 months.

How do I care for myself after the operation?

Your surgeon will provide instructions on caring for your breasts after surgery. This may include a special breast massage technique and wearing a supportive bra for several months to aid in the healing process.

What are the potential risks?

Some risks of surgery include bleeding, adverse reactions to anesthesia, infection, delayed healing, asymmetry, nerve injury, numbness in the areolae and nipples, scarring or keloids at the incision site, capsular contracture (scar tissue around the implant), rippling of the skin over the implant, implant leakage, and the potential need for revision surgery.

How do I prepare for surgery?

To reduce the risk of complications, it’s important to follow these guidelines:

  1. Stop smoking and drinking alcohol at least two weeks before surgery.
  2. Discontinue the use of hormonal pills, herbal supplements, and medications not approved by your doctor.
  3. Obtain surgical clearance from your medical specialist if you have any underlying health conditions.