Breast Reconstruction - The Options | ExpatWoman.com
 

Breast Reconstruction - The Options

Breast Reconstruction is to restore the original shape and appearance of breast(s) following complete or partial breast removal...

Posted on

15 October 2014

Last updated on 4 June 2018
Breast Reconstruction - The Options

 

The purpose of Breast Reconstruction is to restore the original shape and appearance of breast(s) following complete or partial breast removal in cancer patients or to address problems stemming from any number of causes, including congenital breast deformities.

We at Elite Plastic & Cosmetic Surgery Group specialise in the most advanced techniques of breast reconstruction surgery and our team led by Dr Allen Rezai, Consultant Plastic & Reconstructive Surgeon provides patients with the advice and guidance best suited to their specific needs. The treatment requires in-depth analysis as well as a fully personalised surgical plan for each individual case. We feel that the more informed the patient is about Breast Reconstruction upfront, the easier it will be for her to make an informed decision.

For most women diagnosed with breast cancer, in addition to radiation and chemotherapy, mastectomy is the best option, although in many cases this leaves them with psychological problems. Following mastectomy, even though it may save the individual’s life, and in spite of the support they might receive from partner, family and friends, the resulting deformed chest can severely damage a woman’s self-image. Loss of the breast, which is a potent symbol of femininity, can have major psychological consequences. For example, it can affect their relationship with their partner or make entering into future relationships more difficult. She might also feel isolated, which can create a lot of distress not only for the individual but also their family and friends.

Using an external prosthesis, an artificial breast that is worn, is not really an adequate response to the deformity which has been created following a mastectomy and especially in a hot climate it can feel very uncomfortable.

Breast Reconstruction makes a woman feel more contented, allows her to wear all types of clothing, and also participate in activities of her choice without showing any external signs of her surgery. She will be able to return to an active and productive life, working and providing support to her family and friends, as well as receiving it from them. This is important not only for the recovering breast cancer patients themselves, but also for their families and to society in general.

So what are the available Options for Breast Reconstruction?
There are two main types of breast reconstruction: Implant Breast Reconstruction and Autologous (natural breast tissue) Breast Reconstruction, however sometimes a combination of the two is performed.
Implant breast reconstruction involves use of an artificial breast implant to recreate the breast mound. CLICK HERE to find out more about Implant breast reconstruction.

In an autologous breast reconstruction patient’s own tissue known as “Flap”, from another part of the body is used to recreate the breast.

Autologus Breast Reconstruction can itself be subdivided into two types of procedures: those involving Muscle Flaps, and those involving Perforator (tiny blood vessels) Flaps, the latter being the most advanced methods of autologous reconstruction and requiring microsurgical expertise.

Perforator flaps such as the DIEP Flap are “Free” flaps consisting of skin, fatty tissue and tiny blood vessels (perforators) which are microsurgically removed from the donor site and transferred to the chest for reconstruction of the new breast. This method of natural-tissue restoration leaves muscle intact at the donor site. CLICK HERE to read more about the different types of Perforator Flaps.

However in Muscle Flap reconstruction such as TRAM or LD flap reconstructions, muscle is removed (still connected to the donor site) from their respective donor sites in order to carry the blood vessels that nourish the flap used for the reconstruction. Muscle Flaps were used in an era well before techniques for using perforator flaps were developed. CLICK HERE to read more about the different types of Muscle Flaps.

In comparison to Muscle Flaps, the Perforator Flaps are the most advanced and less damaging to the donor site, as the muscle stays intact which results in no post- operative muscle weakness in the donor site and a faster recovery. Also it enables the surgeon to create a more natural looking breast mound, as it is a free flap (not connected to the donor site) and can be shaped as preferred, whereas a muscle “pedicle” flap is still connected to the donor site via the muscle hence it limits the surgeons ability to create a natural breast shape.

Perforator Free Flap Reconstruction such as DIEP flap procedure may be new to Middle East but it has been performed in other parts of the world for many years, and it is usually the 1st option given to the patient if patient has indication for this type of breast reconstruction.

The term DIEP is an acronym for the expression "Deep Inferior Epigastric Perforators" which is the name given to the tiny blood vessels that supply nutrients to the flap taken from the lower abdomen.
DIEP Flap breast reconstruction is suited to most women who have some quantity of lower abdominal tissue, enough to reconstruct one or both breasts, depending on the circumstances. If there is insufficient abdominal tissue or the tissue is scarred due to previous abdominal surgery, such as a tummy tuck, the patient may have to consider other types of Perforator Free Flap breast reconstruction employing donor sites other than the abdomen.

However the DIEP Flap is our preferred choice simply because it gives the most natural looking results, and so whenever possible we aim to use this in breast reconstruction surgery but in the rare event that the individual’s anatomy does not allow for a DIEP flap reconstruction to be performed, other types of perforator flap procedures and even muscle flap reconstruction may be considered.

As with all types of autologous breast reconstruction, the DIEP Flap Reconstruction, can be performed in one or two stages, depending on the type of mastectomy and also if it is possible for the patient to undergo immediate reconstruction, meaning having mastectomy and breast reconstruction in one operation.

However, if immediate Breast reconstruction is not possible and the patient has had full mastectomy, i.e. breast and nipple areola has been removed, a 2-stage surgery is necessary with a minimum of 3 months between the two stages.

During the 1st stage, the DIEP flap Breast Reconstruction is performed and depending on the patient’s circumstances, the 2nd stage, consisting of nipple reconstruction and possible minor refinement of the breast shape can be carried out after 3-6 months following the initial surgery.

Complications are generally low with this form of reconstructive surgery. In comparison with other types of breast reconstruction, the DIEP flap carries a lower risk of donor-site morbidity than other types of reconstructive surgery, as the muscle in the donor site stays intact which also results in less post-operative pain and faster recovery. However, as with all surgical procedures there are some general complications such as bleeding, infection, delayed healing etc… that may occur but in experienced hands the complications are minimal.

Women considering ANY types of breast reconstruction, especially DIEP flap reconstruction must not be smokers and should be in good general health.

“I strongly believe that breast reconstruction plays an important factor in a woman’s psychological and physical recovery after having mastectomy; however, it is the individuals’ choice to undergo a breast reconstruction post mastectomy. But as a surgeon I have a responsibility to provide patients with ALL the treatment options available to them, explain pros and cons of each option and leave it up to them to make an informed decision.

Unfortunately there seems to be a lack of awareness in the Middle East, when it comes to Perforator Free Flap Reconstruction Procedures and I believe this is simply due to the lack of skilled and experienced Surgeons in the advanced techniques of microsurgery.

Our skilled and dedicated Team at Elite Plastic & Cosmetic Surgery Group has a vast amount of experience in microsurgical reconstructions not only involving the breasts but also in head and neck, trauma, burn and hand surgery. We are all trained and highly experienced in Perforator Flap techniques and prefer these techniques to others since we believe it will provide the patient with the best possible outcome and freedom to live her life as she wishes without any physical obstacles holding her back.

For all types of Perforator Flap procedures, including DIEP flap, thorough pre-operative consultations are required in order to discuss the types of procedures available to each patient, including the pros and cons of each one, and allow the patient time to reflect on the information received and then make an informed decision about which she prefers. Once the type of treatment has been established, a tailor made treatment plan will be drawn up and all aspects of the procedure will be discussed with the patient.

After all, this is a life changing procedure for a patient and we believe that she should be involved in the decision-making process from start to finish.”

Dr Allen Rezai

Breast Cancer Awareness

CLICK HERE to read Victoria’s Story, One of Elite Plastic & Cosmetic Surgery Group’s patients who underwent DIEP Flap Breast Reconstruction in Dubai, under the care of Dr Allen Rezai and his team.
 

Breast reconstruction

 

CLICK HERE to view an educational video of an actual DIEP breast Reconstruction Surgery performed by Dr Allen Rezai and his team.