Breast cancer affects thousands of women each year. Some women have to go through a mastectomy, while some can fight cancer without losing their breasts. Breast reconstruction is a surgery usually done for women who have undergone a mastectomy or lumpectomy after breast cancer to restore a natural-looking breast or nipple using either your own tissues or an implant. There are several different techniques available and the option we choose depends on your individual anatomy, medical history, and personal needs. Whether the reconstruction is performed immediately after a mastectomy (known as immediate reconstruction) where the patient wakes with a “new breast” or later (known as delayed reconstruction), this procedure has a dramatic impact on a woman’s quality of life and emotional well-being.
Types of Mastectomy
There are different types of mastectomy procedures:
- Simple (total) mastectomy. This involves removing the whole breast, including the nipple, areola (the colored ring around the nipple), and most of the overlying skin.
- Skin-sparing mastectomy.This method involves the removal of the breast tissue, nipple, and areola. However, most of the skin over the breast is spared. This type of procedure is performed usually when breast reconstruction is done immediately after the mastectomy
- Nipple-sparing mastectomy. This method involves removal of all of the breast tissue including the ducts under the nipple and areola, but the nipple, areola, and the skin of the breast is left intact. Breast reconstruction is often performed right after the nipple-sparing mastectomy.
Timing of Breast Reconstruction
Once a woman has decided to undergo breast reconstruction, the next step is to decide on the best time to undergo the procedure. There are two possible timings and they are immediate breast reconstruction and delayed breast reconstruction.
- Immediate breast reconstruction: Here the woman wakes up after a mastectomy with a reconstructed breast. It is best suited for candidates of skin-sparing mastectomy and nipple-sparing mastectomy and it generally offers the best possible aesthetic outcome. Immediate reconstruction involves preserving a large quantity of the breast skin, minimizing scarring, and helping to produce the most natural-looking results.
This technique also reduces the number of surgical procedures that a woman would undergo for breast reconstruction. However, if you have to undergo radiation therapy after mastectomy, immediate breast reconstruction is often not recommended or the technique of reconstruction may need to be altered..
- Delayed breast reconstruction: Here the reconstruction is performed sometime or even years after a mastectomy. It could be due to several factors such as the woman’s own decision, or a recommendation from a breast surgeon or oncologist.
Delayed breast reconstruction can also be performed on a woman who is unsatisfied with her previous reconstruction. A woman who is unhappy with an implant reconstruction may decide to have the implants replaced or removed and replaced with her body tissue. Natural tissue can also be replaced with an implant.
Types of Breast Reconstruction
Breast reconstruction is not a cosmetic procedure but a reconstructive surgery. There are different technique options of breast reconstruction which include:
- Implant breast reconstruction. Here the reconstruction is performed with the aid of an implant to fill the volume of the breasts after a mastectomy. It can either be performed in two stages where a temporary expander is placed in the first stage and the skin and muscle are stretched over several months and then replaced with a permanent implant in the second stage, or, it can be performed in a single stage with the help of a biologic dermal mesh to cover the implant.
- Latissimus dorsi flap breast reconstruction. In this breast reconstruction technique, the back muscle, fat, and skin are tunneled to the mastectomy site but at the same time, they are still attached to the donor site, therefore, leaving the blood supply intact. The donor site is the back near the shoulder blade. The muscle used is the latissimus dorsi muscle hence the name. During the latissimus dorsi flap breast reconstruction, an oval section of the skin on the back is taken along with the underlying latissimus muscle, fat, and blood vessels, and slide them through a tunnel under the skin, under the arm, to the chest area and form it into a breast shape. The latissimus muscle reconstruction can be performed with or without an implant depending on the desired volume in the reconstruction.
- Diep flap. This technique involves transferring only the skin and fat to the chest from the donor site which is the lower abdomen thereby combining a tummy tuck with breast reconstruction. In the Diep flap breast reconstruction surgery, the Plastic Surgeon will use a flap of complete tissue consisting of blood vessels, skin, and fat from the lower abdomen. The flap is transferred to the chest area, where the Plastic Surgeon, aided by a microscope attaches the donor tissue blood vessels to the chest blood vessels and reconstructs the breast.
- Fat injection. This technique involves harvesting fat from another area of your body such as the abdomen, arms, flank area, outer thighs, or inner thighs using liposuction via a very small opening. The harvested fat is purified then injected to the breasts, sculpting them to make sure the desired results are achieved It is usually used as an adjunct in reconstruction and not for primary reconstruction except for very small breast reconstructions as it would need several surgeries of fat grafting to create enough of a mound. Fat grafting is usually used to improve the look of breasts from previous procedures such as mastectomy, lumpectomy, radiation therapy, DIEP flaps, or previous surgeries.
Our Commitment To You
At Al Shunnar Plastic Surgery, our experts have more than 20 years of experience in Plastic, Reconstructive and Cosmetic procedures and have helped more than 10,000 patients safely achieve their dream of natural beauty and confidence. We will identify the most suitable expert for you, who will listen to you, understand and identify your individual and detailed requirements in a tailor-made consultation, advise you on what you expect from the right breast reconstruction treatment, and ultimately develop the most suitable treatment plan with you.
The Breast Reconstruction Process
a) The Consultation
The first step of a breast reconstruction procedure is having a detailed consultation and examination in the clinic with one of our Board-Certified Plastic Surgeons who specialize in breast reconstruction procedures, to determine a tailor-made plan for the patient.
b) The Surgery
Before the surgery, each patient is screened to ensure that it is safe to proceed with the surgery. This includes a pre-anaesthetic consultation, blood testing to ensure the patient is a fit candidate for the breast reconstruction procedure. Also, the procedure is carefully planned alongside the surgical and medical oncologist so the whole team is aware of the surgical plan and the medical treatment can be coordinated with the surgery.
The breast reconstruction procedure can take between two to six hours under general anesthesia after the mastectomy is completed depending on the procedure performed. Usually implant procedures are shorter than reconstructions using flaps.
c) The Recovery
Two to three hours after the procedure the patient is taken to the hospital ward where she will be admitted for 2 to 4 days depending on the procedure. Pain and discomfort are experienced in the first few days hence pain medication will be recommended during the stay at the hospital.
Vigorous activities will be discouraged but the arms can be moved slightly. The day after the surgery the patient is encouraged to walk with assistance. The patient will typically have several post-operation visits to the clinic for a month to monitor the healing process. The expert Plastic surgeon accompanies the patient throughout this entire process of recovery and healing.
Before And After Results
At Al Shunnar Plastic Surgery Dubai, we do our best to protect our patients’ confidentiality. That is why all the Before & After results are not available online, however, they will be shown during a consultation in The Clinic only.
Meet Our Team
Our Board-Certified expert Surgeons have over 20 years’ surgical experience and are trained at some of the world’s best medical schools with a proven track record in UAE, the USA and Brazil.
Frequently Asked Questions
What is breast reconstruction?
Breast reconstruction is a surgery that is performed to recreate breasts after lumpectomy or mastectomy. The aim of breast reconstruction is to create a breast that is similar in shape and size of your original breast.
Breast reconstruction can be performed immediately after the breast cancer surgery (immediate reconstruction) or it can be done months or years later (delayed reconstruction). This procedure can be performed on one or both breasts. When it is being done on one breast, the surgeon tries to reshape it to match the other one.
Who performs breast reconstruction surgery?
Breast reconstruction should be performed by a Board-Certified Plastic Surgeon who is skilled in the procedure. The Plastic Surgeon should be a member of a society of Plastic Surgeons and should meet the following rigorous standards:
- Have completed six years of training after medical school with a minimum of three years of Plastic Surgery residency training.
- Pass comprehensive and written oral exam
- Graduated from an accredited medical school
- Complete continuing medical education each year, including patient safety
- Perform surgery in accredited, Medicare-certified or state-licensed surgical facility
Can breast reconstruction be performed at the same time as breast cancer surgery?
Breast reconstruction surgery can be performed at the same time as a mastectomy or later depending on your preference and situation.
When it is done at the same time as mastectomy surgery, it is known as immediate reconstruction. This is done as soon as the breast cancer surgeon removes the breasts. It involves the Plastic Surgeon reconstructing the new breast using either an implant or tissue taken from another area of your body (and sometimes both). Most of the time only one surgery is required and you wake up with new rebuilt breast/s. This approach requires both the breast cancer team and Plastic Surgery team to coordinate.
The other breast reconstruction approach is known as delayed reconstruction. This is when the breast reconstruction surgery is performed after mastectomy or lumpectomy as well as after chemotherapy, radiation therapy, or the other targeted therapies have been completed. The reason for this is that the cancer treatment therapies can cause undesired changes to the reconstructed breast such as loss of volume and change in color, texture, and appearance.
Some women can opt to undergo the breast reconstruction surgery years later when they are ready. Others opt to remain flat, while others opt to wear a prosthesis.
What are the types of breast implants used for reconstruction?
There are several types of breast implants that can be used for breast reconstruction. Most of the implants are made of a flexible silicone outer shell and contain silicone gel or saline.
Saline breast implants are filled with sterile salt water once inserted and in place. The advantages of a saline implant is that if it ruptures it contains sterile saline which is safe. Unfortunately it has more rippling than silicone implants and feel less natural.
Silicone breast implants feel more like natural breast tissue and are made of cohesive gel which is thicker. Other types of silicone gel implants include the form-stable implants which are the thickest ones and are also known as gummy bears or highly cohesive breast implants. They tend to keep their shape even when the shell is broken or cut and are firmer than regular implants.
Both saline and silicone breast implants come in different shapes and sizes and they can either have a smooth or textured surface. Implants need to be replaced if they leak, rupture, or develop capsular contractures.
How are tissue flap procedures performed for breast reconstruction?
There are two ways in which the tissue flap surgery can be done:
- Pedicle flap. In this technique a flap of tissue from the belly or back is moved to the chest area without cutting off its original blood supply. It involves pulling the tissue under the skin up to the chest and attaching it.
- Free flap. In this technique the blood vessels and tissue are cut. Once the flap is in position, the blood vessels in the flap are sewn to the blood vessels in the chest area.
What is the work of drains after breast reconstruction surgery?
Surgical drains perform an important role during the healing from breast reconstruction surgery. Fluid often builds up at the surgical site and if not drained it causes discomfort and delays healing. Drains are placed in the regions where fluid is expected to accumulate. Drains are usually left in place for about one to two weeks. Before leaving the hospital you will be taught how to empty the drains and take care of them to avoid infection.
How long will it take to heal after breast reconstruction?
After breast reconstruction with implants you will likely feel sore and tired for a week or two and longer after a flap procedure. Most women go home after 2 to 4 days from a breast reconstruction and are able to resume normal activities within 4 to 6weeks. If implants were used, the recovery time might be shorter.
The bruising and swelling might take about 8 weeks to subside but it can take a year or two for the tissues to fully heal and the scars to fade –though they never fade completely.
Can I wear a bra after breast reconstruction?
After the breast reconstruction surgery, you will be put in a surgical bra that you will wear during the recovery. It helps in tissue healing and offers comfortable support. You will receive specific instructions on what type of bra you should wear and what to avoid.
Wearing a bra after breast reconstruction surgery is a personal preference.
I had breast cancer and go for a mastectomy, dr Boutheina was there to save the situation with a perfect immediate reconstruction, I am so happy with the result.Beside this she a very caring person she made me feel safe and happy, the atmosphere is amazing, clinic is very clean with the beautiful soul around especially Leila.I am so thankful to dr hourya and dr Boutheina as they turn out my surgery to a bundle of joy and happiness.
Dr. Sawan and his staff were amazing! I had a very challenging breast reconstruction done that two other surgeons couldn’t do. My results were so much better than I expected!! I absolutely love my new girls! Thank you Dr. Sawan!!
Would you like to understand the best options for Breast Reconstruction in Dubai? Meet one of our experts at Al Shunnar Plastic Surgery for a personal consultation, to develop a tailor-made plan for you. Contact us or book an appointment and our patient care coordinators will identify the most suitable expert for you.