Breast Reconstruction

Primary or immediate reconstruction of the Breast along with the removal of the breast for breast cancer is the best mode of breast reconstruction. Delayed breast reconstruction (done after 1 or 2 years or any number of years of breast removal) can also be done but the first choice should always be immediate reconstruction along with mastectomy and it should be offered to all women suffering from breast cancer. This should always be thought of and chosen by all if given an option .

Breast reconstruction is a surgical procedure required to restore one or both breasts to size, shape, appearance, and symmetry when breasts are –

• lost due to breast cancer and
• deformed or absent due to any congenital deformity.

Reconstruction of the breast can be done in the same sitting as removal of breast for breast cancer. Breast reconstruction helps to reduce the physical and emotional impact of mastectomy boosts the confidence of women undergoing breast removal to feel whole and improves their quality of life.

Delayed, or secondary, reconstruction should be an option for women who would like to wait and for women whose treatment protocol prevents immediate reconstruction.

• Reconstruction by autogenous tissues, FLAPS (A)
• Reconstruction with breast IMPLANTS (B)
• Flap + Implant (A+B)

As the name suggests, Flap Reconstruction uses the patient’s tissues taken from the selected body parts to recreate the new breast with microsurgical techniques and implant reconstruction uses artificial silicone implants to create the new breast.

• Your wish to opt for breast reconstruction along with mastectomy. Or Mastectomy has been done in the past.
• Details of previous surgeries and treatments.
• Current medications and supplements.
• Effect of post-surgery chemotherapy or radiotherapy.
• Any pre-existing medical conditions and drug allergies.
• Tobacco, alcohol, and drug use.
• You should discuss your surgical goals.
• Need for additional procedures .

• You should be motivated enough to undergo the procedure.
• You should be preferably a non-smoker.
• You should know well about what surgery you are planning to undergo.
• You should have a positive vibe about your body image.

Immediate reconstruction of the breast along with the removal of the breast for breast cancer is the best mode of reconstruction.

• Discuss any other option other than getting your breast reconstructed.
• Examine your overall health and risk factors.
• Discuss with you the different methods of breast reconstruction and their related outcomes.
• Plan out the best and safest method of breast reconstruction for you.
• Take photographs.
• Discuss the risks or complications involved with each of these procedures.
• Discuss your recovery period after breast reconstruction.
• Need for secondary breast procedure if the other breast is heavy or large.

• You should be physically healthy.
• You should stop smoking if you are a smoker at least two weeks before the surgery.
• Get the tests prescribed by Dr. Amit Agarwal .
• All pre-surgical work investigations should be shown to the operating surgeon and the anesthetist, and we will evaluate your fitness for the surgery. You will be given a date for the surgery only after you are declared fit for the procedure.
• Compression garment measurement should be given for post-surgical use (in selected procedures).
• Avoid taking anti-inflammatory drugs and herbal supplements as they aggravate bleeding.
• Admission will be done a day prior in the hospital chosen by you where Dr. Amit Agarwal is visiting.
• A written consent form will be signed explaining the procedure after the admission.
• Meeting with the anesthetist for Pre-Anaesthesia Check-up (PAC) before surgery.
• Nil by mouth at least 5-6 hours before the planned surgery.

The procedure would depend on the timing of the breast reconstruction whether it is immediate or delayed in cases of breast cancer and the technique to be used ( implant or autogenous tissues with microsurgery or both ).

• You need to be comfortable during the surgical procedure. So, in the first step, general anesthesia is given.
• Tissues on the chest wall are insufficient to recreate a breast after mastectomy (breast removal). So, the breast is reconstructed using a ‘flap technique’ or ‘Implant’. This will be decided by you and Dr. Amit Agarwal will come up with the best possible technique and suggestion for you.
• If it is immediate reconstruction, the raised skin flaps for removal of the breast will be used to support the flap or implant chosen. If it is delayed reconstruction, then a new pocket is created in the chest region for the transfer of the flap or implant.
• The outcomes of the surgery can be enhanced by revision procedures which include improvement of the symmetry of both the breasts and improving the appearance of the donor site.
• After reconstruction of the breast mound in the first sitting, the nipple and areola will be reconstructed later once everything heals. It is done under local anesthesia.

Different FLAP techniques can be used for Breast reconstruction. These Flaps can reconstruct the breast mound as per the requirement of the reconstruction technique which differs from person to person.

• TRAM Flap: In this technique, the donor site is usually the lower abdomen from where the muscle, fat, and skin are used for breast reconstruction. The Flap taken from the donor site is detached over a vascular pedicle and breast mound is formed from it and vessels are anastomosed in the axilla or chest with microsurgical techniques. The flap donor area is closed primarily and given an abdominoplasty type closure and a scar that is hidden under the panty line and an abdomen that is tighter, flat, and better cosmetically.

• DIEP Flap: This flap is similar in constituents and technique to the TRAM flap, but muscle is not included in the flap taken from the lower abdomen. So only lower abdominal skin along with fat is taken and transferred to the chest with native vessels to recreate the breast using microsurgical techniques.

• Flaps from other sites such as buttocks thighs or back may be chosen for reconstruction in appropriately selected women.

Latissimus Dorsi Flap (LD Flap): This technique uses the skin of the back region along with the fat and Latissimus Dorsi muscle of the back. The benefit factor of using this flap for breast reconstruction is that it is adjacent to the chest region, it remains attached to the donor site with the vascular pedicle which leaves the blood supply intact and can be swung to the chest to reconstruct the breast.

Breast Implant Reconstruction is an alternative form of reconstruction for women who prefer to avoid the transfer of tissues from any other part of the body for the reconstruction of the breast.

In Immediate reconstruction, the breast implant of the correct size is chosen to match the opposite breast and inserted in the created pocket during breast removal.

In delayed reconstruction, a tissue expander is placed in the chest in the first stage to expand the pocket gradually over 2 months and then the implant is exchanged with the expander in the second stage to reconstruct the breast.

Breast Implant can also be an addition to the Flap Technique where more volume is required for breast reconstruction. Usually, it’s the Latissimus Dorsi Flap (from the back region) that provides the necessary tissues and muscle to support and cover the breast implant.

After the surgery, bandages and dressings are applied to the surgical area.

You will be discharged after a week or 10 days of surgery if flaps are used for reconstructing the breast as it requires careful monitoring in the postoperative period.

You are made to wear a compression garment to reduce swelling and support your breasts in implant-based reconstruction. You will be discharged on the second day of the surgery after the drains are removed.

• There can be substantial swelling and bruising of the breast region and /or flap donor area which usually subsides in 3 to 4 weeks.
• The sutures will be mostly along the incision around the breast region which will be removed after 10 days to 14 days.
• In the days following surgery, there will be pain that can be subsided by painkillers given by Dr. Amit Agarwal.
• Soreness might last for a few weeks.
• You will be on bed rest for about a week or two after surgery
• You can return to work depending on your willpower and the type of work required between 3- 4 weeks.
• You can return to your normal lifestyle after 6 weeks of surgery.

• How to take care of the surgical site
• About the medications and how to maintain general health.
• About your follow-ups.
• About suture removal .

The healing process will be continued for several weeks.

During this time swelling and bruising will decrease, after which the breast will be more shaped and in position.

The complications and aftermaths of the surgery vary from person to person and her physical well-being. The factors which affect are poor circulation, a history of blood clots, diabetes, or heart, lung, or liver infection. Like every surgery, Breast Reconstruction also involves some risks and complications which include:

• Rare risks related to General Anaesthesia -General Anaesthesia is very safe in present times and with the best machines and a qualified anesthetist, chances of encountering any complication are less than 0.1 percent in a healthy individual. But no one can predict who will land up in complication. We at Kayakriti Plastic Surgery and Dental Centre are qualified with world-class anesthesia workstations, other equipment, and, two very qualified intensivists for the surgical procedures to be very safe and smooth.
• Risks related to Microsurgical reconstruction of flap technique like thrombosis or blood clot in the vessels of the flap, re-exploration / re-surgery to remove these clots, and flap failure is seen in less than 10 percent of cases.
• Risks related to higher BMI like a medical condition or higher the BMI, the higher the risks.
• Seroma formation or fluid accumulation can be there which usually decreases with time.
• Rare chances of infection which response to prolonged antibiotic therapy.
• Bleeding or hematoma formation can occur which might require drainage.
• Poor wound healing because of poor blood supply of flaps. Seen more commonly in smokers, diabetes, and hypothyroidism, and women with multiple comorbidities. Poor wound healing can lead to skin discoloration which can cause marginal or total skin necrosis.
• Numbness or altered skin sensation over the created breast.
• Scars will be there along the incision line which will fade with time. Scars can get hypertrophied if you are prone.
• Rare events of Deep vein thrombosis and pulmonary or cardiac complications can occur or precipitate in patients with multiple pre-existing diseases diagnosed or undiagnosed by routinely available standard tests
• Possibility of revision surgery.

These are the risks and possible complications that should be discussed by you with Dr. Amit Agarwal before the procedure.

The total benefits of Breast Reconstruction will be seen after the swelling subsides.

• You should always discuss any previous surgery, history of radiation, chemotherapy, or medical conditions without hesitation.
• You should always wear a pressure garment when advised as it reduces swelling and gives proper shape.
• You should immediately consult your doctor if you have any problems after surgery.
• You should always maintain a healthy lifestyle for the best and most prolonged results .