Breast Reconstruction in Ludhiana & Chandigarh, Punjab

You are a good candidate for the procedure if:

• You are an adult woman who has lost her breasts because of breast cancer
• You have been born with a breast deformity
• You are healthy enough to cope up with the treatment and the surgery
• You don't have any medical condition or you aren’t on any medications that may impair the healing process
• You have realistic expectations from the surgery and your body image after the surgery

In the end, it's the oncologist and your cosmetic surgeon who will make the decision of your suitability for the breast reconstruction surgery and the timing for the same.

The breast reconstruction surgery can be performed at the same time as the mastectomy or lumpectomy (immediate) or later once you have recovered from the surgery (delayed). The decision is influenced by your cancer treatment and your preference.

Immediate Reconstruction

This surgery is done at the same time as the mastectomy/lumpectomy. The advantages of this procedure are that the skin from the breasts can be preserved and the patient has to undergo fewer surgeries. An emotional benefit is to not feel any different even after mastectomy and walk home with the new breasts. In cases where chemotherapy or radiation is advised after surgery then immediate reconstruction cannot be performed.

Delayed Reconstruction

This surgery is performed months or even years after the breast surgery. You have ample amount of time to weigh in the pros and cons of the surgery before making the decision. In this case, the patient can recover from their radiotherapy without any problems. The disadvantage is the emotions that the patient needs to go through without the breasts. The patient will have to go through another surgery and the scar of the surgery will be larger.

The aim of breast reconstruction is to have a breast shape that looks natural and matches the other breast in its size and shape. Breast reconstruction can generally fall into two categories: implant-based reconstruction and flap reconstruction (using own body tissue) or both can be performed in combination.

Breast reconstruction using implants

Implant-based reconstruction may only be possible if after a mastectomy there is enough tissue left on the chest to support an implant. Breast implants have an outer cover made of silicone elastomer and are filled inside with saline water or silicone gel.

In this technique, a silicone or gel implant is inserted into the breast and the skin is stretched over it to form the breasts. It works well for patients with small or medium size breasts and the scarring is minimal. The breasts are firmer but don't feel natural and don’t behave like usual breasts. Silicone or gel breasts carry a shelf life and need to be replaced after approximately 15 years.

-While immediate breast reconstruction

The breast reconstruction, in this case, is performed during the breast cancer surgery. The implants can be placed under or above the chest muscle. The breast implants are wrapped in an acellular dermal matrix (ADM) or a mesh and are placed under the chest wall after the breast surgeon has completed the mastectomy. This helps the implant to stay in the correct position. ADM’s are made from animal skin and are like leather, whereas meshes are synthetic supports made by man. This procedure results in immediate round shaped breasts. This is the simplest reconstruction surgery and has a quicker recovery time than others.

-While delayed breast reconstruction

The breast surgeon first performs the mastectomy, then a tissue expander is placed under the chest wall before closure. After a few weeks, the surgeon or nurse slowly fills the implant with saline solution through a small port, that can be along the rib cage (connected by a tube) or in the expander itself. The solution is filled in multiple visits and the amount injected depends on the capacity and tolerance of the patient. Once the expander tissue reaches its final expansion or stretching, the muscle is left to relax and stretch. Once this is completed, a second surgery needs to be done to remove the tissue expander and place the permanent implants. Expanders with saline have been used for years but recently there is expander that is filled with air, which gives more control to the patients. This expander decreases the visits to the doctor and the total expansion time. Tissue expansion before implants in delayed reconstruction is useful when there is not enough skin on the chest to cover and support the implants. In patients who have undergone chemotherapy, this process is a little difficult because the skin in the area reduces quality and elasticity.

Breast reconstruction using tissue flaps

Sometimes after mastectomy or chemotherapy there isn’t enough tissue or skin on the chest to support implants so reconstruction is done using flap technique. It is also called autologous reconstruction. In this procedure, reconstruction is done using flaps from the patient's own body. Skin, fat and sometimes a muscle is taken from areas such as the back, lower abdomen, inner thigh or the buttocks. These are used with or without an implant to make new breasts. A reconstructed breast with tissue flap is better in the long term and matches the other breast better. It also ages and reacts more like the normal breasts than the implants. This technique cannot be performed on women who are diabetic, overweight or heavy smokers.

There are two ways in which reconstruction is done using tissue flaps:

• Pedicled flap – the flap used in the technique is attached to its original supply at one end and just the muscle is moved to the chest to form the breasts.
• Free flap – the flap, in this case, is completely separated from the body with its blood vessels which are reattached by microsurgery in the reconstructed breasts. In rare cases, if the blood supply is poor, the tissue will die and reconstruction will fail.

There are different areas of the body from where the flaps can be taken for reconstruction. Your surgeon will guide you with the best option for your case.

After the surgery, the doctors will monitor the blood supply to the flap and will prescribe pain killers and antibiotics for the discomfort. The recovery time for the surgery depends on the type and intensity of the operation performed. Implant operation recovery is quickand the patient can be discharged the next day whereas in extensive surgeries you’ll stay in the hospital for a few days (5-6 days). The recovery process is smooth and easy when you follow all the guidelines and instructions given by the doctor. Exercises and activities will have to be avoided for quick healing. Bra support is advised to reduce the swelling and fluid build-up in the new breasts. Through the weeks the swelling and bruising will go down and the breast will start to take its shape.

Final results of breast reconstruction reduce the physical and emotional stress of mastectomy. Over the time the scars fade and the women can enjoy the regained confidence.

The decision to get breast reconstruction surgery is very personal and although rare, there are certain risks and complications associated with this surgery. These include:

• Anaesthesia risks
• Bleeding or infection
• Loss of sensation or feeling of numbness in breasts and nipples
• Weight gain or loss will only affect the natural breast causing difference in the two
• Poor healing of the incision sites
• Flap surgery has the risk of loss of flap due to lack of blood supply
• Implant rupture

The choice of your surgeon and the clinic is a big decision to be made before you consider getting the surgery. Some criteria's include:

• Qualification and certification– it is essential for the cosmetic surgeon to be highly qualified and have the necessary certification from accredited boards.
• Experience – years of practice and number of surgeries performed can give a great insight into the surgeon expertise
• Work aesthetics – before and after images of clients who have gone through similar surgeries will help you see the surgeon’s style and decide if you want that.
• Surgeons reputation – Testimonials from clients or word of mouth can give you the belief that he is the best doctor for your case
• Hospital/clinic – it is very important to know the clinic or hospital where the doctor practices. The hospital should have the newest of techniques, good staff and good doctors to make your journey smooth.

Breast reconstruction surgery requires special training and precise hands, therefore it is very important to make the right decision.