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    Breast Reconstruction

    What is breast reconstruction?

    Breast reconstruction is to restore a breast to near normal shape, size and appearance following mastectomy (breast removal in cancer surgery) by various plastic surgery procedures.

    Why do you need Breast reconstruction?

    Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.

    A new breast creation can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.

     Who is the ideal candidate for Breast reconstruction?

    Breast reconstruction is a good option for you if:

    • You are psychologically and physically ready to cope well with your diagnosis and treatment
    • You do not have other medical illnesses that may impair healing
    • You have a realistic expectation  for restoring your breast and body image

    As breast reconstruction single or multi stage procedure:

    • It can be done at the same time as mastectomy,
    • It can be delayed until you heal from mastectomy and recover from any additional cancer treatments

    What are the risks involved and safety required in this surgery?

    The general risks of breast reconstruction include, like normal surgical risk as bleeding, infection, poor healing of incisions, and anaesthesia risks but there is no life threatening risk. There are procedure specific risks like:

    • Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
    • The use of silicone implants carries the risk of breast firmness (capsular contracture) and implant rupture.
    • Breast implants do not impair breast health.

    How to procede for breast reconstruction surgery?

    • Routine blood test,  medical evaluation/ Pre anaesthesia checkup
    • Stop smoking well in advance of surgery
    • Avoid medicines those can cause increase bleeding like  aspirin, anti-inflammatory drugs and herbal supplements .

    Which anaesthesia given in Breast reconstruction?

    It is done under general anaesthesia and follow up cases like nipple areola reconstruction and fat grafting can be done under LA or sedation.

    What are the various types of procedure for breast reconstruction?

    There are various Flap techniques to reposition a woman’s own muscle, fat and skin to create or cover the breast mound.

    • SGAP/IGAP flap techniques which do not use muscle but transport tissue to the chest from buttock as free flap.
    • TRAM flap uses muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and tunnelled up through the chest wall, or be completely detached, and reconnected to chest blood vessels as free flap to form  into a breast mound.
    • DIEAP flap uses fat and skin from woman’s lower abdomen based on perforator of deep inferior epigastric artery. And elipse of tissue taken from lower tummy and reshaped to build new breast.
    • TUG (transverse upper gracilis )flap uses thigh skin, fat and muscle and transferred to chest as free tissue transfer, resulting same time nipple and areola reconstruction.
    • Alatissimus dorsi flapuses muscle, fat and skin from the back transferred to the mastectomy site and leaving blood supply intact.  It can be combined with silicone implant.

    Tissue expansion is two stage procedure which stretches healthy skin to provide coverage for a breast implant.

    Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a lengthier process. It requires multiple OPD visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

    A second surgical procedure will be needed to replace the expander with a permanent silicone implant.

    Nipple areola reconstruction is the last stage of breast reconstruction, can be completed through a variety of specialized techniques.

    What are the post operative instructions?

    Post operatively following surgeons instructions is key to the success of surgery. It is advisable to avoid excessive exertion, weight lifting and strenuous exercise during the time of healing.

    What is the outcome of breast reconstruction surgery?

    The final outcome of breast reconstruction following mastectomy can help lessen the physical and emotional trauma of mastectomy.

    Over a period of time, some breast sensation may return, and scar lines will improve, although they’ll never disappear completely.

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