Breast Reconstruction

Breast reconstruction is a series of surgical procedures performed to recreate a breast. Reconstructions are commonly done after one or both breasts are removed as a treatment for breast cancer. Also, a breast may need to be refashioned for other reasons, such as trauma or abnormalities that occur during breast development.

A breast that appears natural offers a sense of wholeness and normalcy, which can aid in the psychological recovery from breast cancer. It eliminates the need for an external prosthesis (false breast), which many women find physically uncomfortable as well as inconvenient.

Precautions

Not all women are good candidates for breast reconstruction. Overall poor physical health, or specific problems such as cigarette smoking, obesity, high blood pressure, or diabetes, will increase the chance of complications. Also, a difficult and/or prolonged recovery period or failure of the reconstruction may be a result. A woman's physical ability to cope with major surgery and recuperation also need to be considered.

Procedure

Breast reconstruction is done in, with the ultimate goal of creating a breast which looks and feels as natural as possible. It is important to remember that while a good result may mimic a normal breast closely, there will inevitably be scars and loss of sensation. The reconstructed breast cannot be exactly like the original.

At first a breast mound is created. This is accomplished by using tissues from other parts of the woman's body and or using artificial materials called breast implants,. In the next step involves creating a balance between the newly constructed breast and the breast on the opposite side by different procedures such as grafting, tattooing etc. to create the nipple-areolar complex. This is usually done several months after the mound is created. Other procedures may be necessary, such as lifting the opposite breast, or making it larger or smaller to match the reconstructed breast.

Timing, immediate or delayed reconstruction

Immediate: While immediate reconstruction is not recommended for women with breast cancer who need to under-go other, more important treatments, breast reconstruction can be done almost anytime. It even can be done during the same procedure as the mastectomy, or it can be delayed. The advantages of immediate reconstruction are the cost is generally lower, there is one fewer operation and hospital stay, Surgeon's fees may be lower for a combined procedure than for two separate surgeries. The disadvantages include longer duration of surgery, causing more time under anaesthesia, more post-operative pain, discomfort and longer recovery time.

Delayed reconstruction offers different physical and psychological advantages. The initial mastectomy procedure alone takes less time, and has a shorter recovery period and less pain. The patient has more time to adjust to her diagnosis and recover from additional therapy. She is better able to research her options, and to formulate realistic goals for reconstruction. The psychological stress of living without a breast, higher costs, and the extra procedure are some of the disadvantages of delayed reconstruction.

Breast reconstruction surgery may be performed by inserting an artificial substance, or implant, to replace breast tissue. Autologous reconstruction, in which a woman's own tissues are used, includes the latissimus dorsi flap, where skin and muscle taken from the back is rotated around to the breast area, and the TRAM flap, in which abdominal fat and muscle are tunneled under the skin to the breast area.

Preoperative workup:
Consultations:
It is important for you to understand the implications of such procedures and that the reconstruction will not resolve a psychological problem the woman had before mastectomy, nor makes an unstable relationship strong. An expectation of physical perfection is unrealistic. Complete understanding of the benefits and limitations of this surgery is necessary for a satisfactory result.

Preoperative Evaluation :
This includes your Blood tests and relevant Investigations

Preoperative instructions:
Anaesthesia: General Anaesthesia

Results
A normal result of breast reconstruction depends on the woman's goals and expectations. It will not be the same as the breast it replaces. In general, it should be similar in size and shape to the opposite breast, but will have less sensation and be less mobile than a natural breast. A reconstruction using implants will usually be firmer and rounder than the other breast. Scars are unavoidable, but should be as unobtrusive as possible.

Cost: The cost can be discussed on consultation.

Note:
Cost includes the surgical fee and day care hospital cost or one day hospital cost in a single room as applicable to a surgery. If for some reason you need/want to stay in hospital for additional time, you will have to pay that separately. Cost will also increase if you choose a superior room.
Cost mentioned or discussed is approximations only, for general guidance. They are subject to change. Prices apply to average healthy individuals. If you have additional problems like diabetes/ hypertension etc, which require the involvement of another specialist/ special medications/ anaesthesia, such cost will be added.

FAQ

What is breast reconstruction?
Breast reconstruction is a type of surgery for women who have had a breast removed where techniques are used to recreate the breast mound and then the nipple. The surgery rebuilds the breast to match the unaffected side or recreate both sides. The nipple and areola (the darker area around the nipple) can also be added, usually at a later shorter surgery. Most women who have had a mastectomy can have reconstruction. Patients with a lumpectomy can also be candidates if the lumpectomy was deforming.

Why have breast reconstruction?
Women choose breast reconstruction for many reasons:
To make their breasts look balanced when they are wearing a bra
To permanently regain their breast contour
To avoid using an external prosthesis (form that fits into the bra)

When should I consider Breast Reconstruction: Immediate or Later?
Immediate reconstruction is done at the same time as the mastectomy. An advantage to having immediate reconstruction, is that the chest tissues are undamaged by radiation therapy or scarring and one less surgery.
Delayed reconstruction means that the rebuilding is started later. For some women, this may be advised if they need radiation to the chest area after the mastectomy. Radiation therapy given after breast reconstruction surgery can cause complications.

What are different types of breast reconstruction?
Several types of operations can be done to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. A tissue flap is a section of your own skin, fat and muscle is moved from your tummy, back, or other area of your body to the chest area.
Complete understanding of the benefits and limitations of this surgery is necessary for a satisfactory result.

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