Breasts are one of the hallmarks of becoming a woman, an essential part of sexuality that makes a woman look beautiful in clothes & important for feeding little babies. Whatever is a woman’s age, orientation, sexual activity, or relationship status, losing a breast is a very mournful feeling for any woman. When a woman gets her breast removed due to dreadful medical procedures like mastectomy or lumpectomy, it may cause immense psychological & emotional harm to her. Such women can opt for breast reconstruction surgery. This is surgery which reconstructs the breast mound to meet the shape & size of another breast.
What is a Breast Reconstruction Surgery?
Breast reconstruction surgery is performed to restore one or both breasts to near natural appearance, natural shape, size and symmetry following lumpectomy, mastectomy, or any other trauma. This surgical intervention often comprises several surgical procedures executed in stages & can be performed either from start at the time of mastectomy or be deferred until a later date.
Breast reconstruction surgery usually falls into following two categories.
- Flap Reconstruction: Flap reconstruction involves patient’s own tissue from another portion of body utilized to build a new breast.
- Implant Reconstruction: Implant reconstruction uses breast implants to help build a breast mound.
The following factors should be taken into consideration while choosing an appropriate option.
- Patient’s body type
- Type of mastectomy
- Cancer treatments
If only one breast of the patient is affected, it alone can be reconstructed by surgery. In addition to this, a breast reduction, breast augmentation or breast lift surgery may also be recommended by surgeons for the opposite breast to enhance position & symmetry of both the breasts.
Breast reconstruction surgery is an extremely individualized procedure. One should undergo breast reconstruction if they personally feel & should never be done under the influence of anyone. Good candidates for breast reconstruction should fulfill the following terms.
- High Endurance – When a patient is able to cope well with their diagnosis & treatment.
- No Medical Conditions – When the patient does not have any medical condition or another type of illnesses which may impair recovery.
- Avoid Smoking – Smoking can highly affect speedy recovery. One should completely avoid smoking to get good results.
- Comfortable with Surgery – Surgical techniques may leave incision marks at the donor site, usually situated in less exposed portions of body such as the abdomen, back or buttocks.
- Realistic Goals – When a patient is mentally strong, has faith & realistic goals for restoring their breasts & body image. Breast reconstruction surgery can repair a breast but the results are highly variable in nature. New reconstructed breasts may not have a similar sensation like the breast it replaces.
Highly effective propositions available for both mono-lateral (single breast) and bilateral (both breasts) reconstruction include the following.
- Expander or Implant Reconstruction – This method relies on an expander to recreate a breast mound, followed by the placing of a permanently filled breast implant. Expanders are simply empty silicone envelopes implanted under the pectoralis muscle, embedded between chest wall & breast. To permit skin & soft tissues of the breast to increase, an expander is deliberately filled with saline solution over a time span of several weeks. Implants are envelopes packed with a liquid that is placed into breast tissue & are used for creating shape of breast. Implants may be filled with silicone or saline gel.
- Prosthesis or Implant – When an implant is placed at the time of mastectomy, it is referred to as immediate reconstruction & when it is done at a separate stage, it is called as delayed reconstruction. It is generally put underneath the pectoralis major muscle & skin. In several cases, this may be a permanent & final implant. Breast reconstruction surgery with prosthesis usually involves less operative time compared to other techniques of breast reconstruction. Also, one does not need surgery in another part of their body, so there are lesser incisions that lead to faster recovery time.
- Autologous Tissue Reconstruction – This technique uses patient’s own body tissues to rebuild a new breast mound. A very common method to achieve this is transverse rectus abdominous muscle (TRAM) flap. TRAM flap usually involves removing a portion of skin, fat & muscle from abdomen & stitching it in place to the mastectomy wound.
- Combination of Own Tissues Plus Implant – When a patient is not a good candidate for either of the above procedures, then, in that case, tissue can be moved from their back to cover an implant. A most common technique that is performed is a latissimusdorsi (LD) muscle flap plus implant. Main advantage of this technique is having more tissue to gracefully cover an implant, which makes the reconstruction appear & feel more natural.
Surgeons may ask patients to get a medical evaluation before deciding to undergo breast reconstruction surgery. Patients may also be asked to avoid taking anti-inflammatory drugs as they can adversely affect the body & may lead to severe bleeding during & after operation. In addition to this, plastic surgeons may also recommend the following.
- Protein Intake – Protein intake before surgery is helpful in building up strength of tissues.
- Avoid Stimulants – Stimulants such as coffee & sedatives like alcohol should be avoided before surgery.
- No Smoking – Patients should completely quit smoking. Not only will they be healthier in the long run, but their surgical outcomes also fairly improve.
These decisions will be purely based upon requirements of particular procedure & in consideration of the patient’s preferences & the surgeon’s best judgment.
Breast reconstruction surgery patients can use the following outline of questions as a guide during their initial consultation appointment.
- Are you a certified plastic surgeon for breast reconstruction surgery?
- How many years of practice do you have in performing breast reconstruction surgery?
- Am I a good candidate for undergoing breast reconstruction surgery?
- Where will you perform my surgery?
- What will be expected of me to get desirable results?
- How will you perform my breast reconstruction surgery?
- Which surgical method is recommended for my breast reconstruction surgery?
- Can you describe the risks & complications associated with my surgery?
- How long healing time can I expect?
- What can I do if I am dissatisfied with the result?
- Can I have a look at before-&-after photos of patients who have undergone this procedure with you earlier?
- What outcomes are rational for me?
Patients should not hesitate to ask these significant queries to surgeons. Patients have a right to completely understand the procedure prior to undergoing surgery.
Investing time on necessary things for recovery before undergoing breast reconstruction surgery will save the patient from pain & frustration during the postoperative phase. It will also allow quick healing.
- One should prepare & freeze meals ahead of time & stock up on healthy juices, dinners & other nutritional foods which can be put through microwave later.
- Anticipate household items which may be required during recovery & move them from high closets into easy reach. Patients undergoing breast reconstruction surgery will find this step very helpful.
- Make a habit of sleeping in an elevated position for few days as after the operation it would be a compulsion in order to avoid swelling & other complications.
- Consider arranging for a friend to take proper care of any pet or small children at home.
- At last, it is mandatory to have someone stay with the patient during first night after surgery. While loved ones can take proper care to this important task, patients may also arrange for a nurse to stay with them if desired.
Breast reconstruction surgery mostly involves the following steps.
- General Anesthesia – Medications are administered for patient’s comfort during breast reconstruction surgery. Intravenous sedation or general anesthesia can be given to patients. Surgeon will choose the best option depending upon the condition of the patient.
- Flap Technique – Mastectomy or radiation therapy may leave very less amount of tissue on the chest wall to support & cover a breast implant. Use of a breast implant for reconstruction surgery most of the times requires either a tissue expansion or flap technique. TRAM flap relies on donor muscle, skin & fat from a woman’s abdomen to rebuild a new breast.
- Tissue Expansion – This stretches the healthy skin to give coverage for a breast implant. Breast reconstruction with tissue expansion promotes an easier recovery than flap techniques, but it is a time-consuming process. It necessitates several office visits over a duration of 3 – 6 months after placing of the expander to fill the device through an internally located valve for expanding skin.Another surgical procedure will be needed to replace expander if it is not properly designed to satisfy a permanent implant.
- Surgical Placement of Breast Implant – It creates a breast mound. Saline, as well as silicone implants, may be used for reconstruction. Surgeons will guide the patients properly to decide as to which is the best alternative for them.
- Grafting & Other Specialized Techniques – These are used for recreating nipples & areolas.
Planning for a successful outcome is the most important step of reconstructive breast surgery. During initial days after breast reconstruction surgery, patients should stay away from foods high in MSG & sodium, as these can cause an upset stomach or water retention. Patients should have a lot of water intake & take proper rest so that the body can recover at high speed. One should religiously follow instructions of surgeons & take prescribed medications in time to heal completely. Positive outlook, determination & will-power of patients will help in speedy recovery.
Breast reconstruction surgery patients may experience the following signs & symptoms following surgical intervention. In such cases, they should seek medical attention.
- Shortness of Breath
- Chest Pains
- Unusual Heart Beats
- Extreme Pain
When these complications occur, patients may need hospitalization & some additional treatments.
Undergoing breast reconstruction surgery is entirely a personal decision. Patients will have to decide if it is beneficial & will it actually help in achieving specific goals. Apart from that, a patient should agree to accept risks & potential complications of breast reconstruction surgery. The most probable risks of breast reconstruction surgery include, but are not limited to, infection, bleeding, poor healing of incisions & several anesthesia risks. Patients should therefore also know about the following risks related to breast reconstruction surgery.
- Use of implant carries a potential risk of capsular contracture & rupturing of implant.
- Flap surgery involves risk of either partial or complete loss of flap & loss of sensation at both reconstruction & donor sites.
The final outcome of breast reconstruction surgery following mastectomy treatment can aid lessen physical & emotional impact of mastectomy. After some time, breast sensation may return back & wounds as well as scar lines will voluntarily improve, although they will never disappear extensively. There are trade-offs, but usually, women feel these are very small compared to large progression in their quality of life & potentiality to feel complete. Careful observation of breast health through self-exam, mammography & other diagnostic methods is necessary to the long-term health of the patient.
Medical Tourism in India for Hi-Quality Breast Reconstruction Surgery
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