Breast reconstruction is a crucial aspect of breast cancer treatment that aims to restore a woman's sense of femininity, confidence, and overall well-being. It is a complex procedure that involves rebuilding the breasts' shape, size, and symmetry after a mastectomy.
In recent years, India has emerged as a leading destination for breast reconstruction surgeries, offering high-quality healthcare services at lower costs than other countries. With its state-of-the-art medical facilities, skilled surgeons, and compassionate care, India has become a sought-after choice for women seeking breast reconstruction.
As part of breast cancer treatment, mastectomy (surgery to remove the breast to treat or prevent breast cancer) can result in many psychosocial issues, poor mental health, anxiety, stress, and loneliness.
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Breast reconstruction after mastectomy helps reduce most of the above problems. Hence, the Association of Breast Surgeons of India strongly recommends immediate breast reconstruction.
In India, breast reconstruction surgery costs 1000 USD to 7000 USD based on the kind of surgery and the hospital facility where it is carried out. The cost may double for women with hereditary breast cancers where both breasts are reconstructed in the same sitting.
What is Breast Reconstruction Surgery?
Breast reconstruction is surgery done to make a new breast after removing the breast or part of the breast. The surgery aims to make a breast of similar size and shape to the original breast. But they won't be identical.
Many Indian women present at Stage 2 (23%–58%) and Stage 3 (29%–52%) of cancer. With most patients presenting with advanced disease, radiotherapy needs to be given to most women. In irradiated patients, high levels of failure of reconstruction in implant reconstruction (29.4%) when compared with autologous reconstruction (4.3%) have been reported.
For Indian patients, autologous reconstruction would be safer as it has been associated with higher satisfaction levels and psychosocial and sexual well-being. Also, most women prefer autologous reconstruction (79.6%) to implant reconstruction (29.4%).
How Surgeons Use Implants for Breast Reconstruction?
After a mastectomy, implants are placed beneath the skin or chest muscle. In most mastectomies, performed using a technique called skin-sparing mastectomy, the breast skin is saved for use in reconstructing the breast.
The procedure of implant placement:
- First, the surgeon places a device (tissue expander) under the skin left after the mastectomy or under the chest muscle.
- The patient undergoes periodic visits to the doctor to fill the expander with saline after surgery.
- Once the chest tissue has sufficiently relaxed and healed, the expander is removed, and an implant is inserted.
- The chest tissue is prepared for the implant procedure within 2-6 months following mastectomy.
The implant is sometimes placed in the breast during the same surgery as the mastectomy.
How Surgeons Use Tissue from a Woman's Own Body for Breast Reconstruction?
In autologous tissue reconstruction, tissue (called a flap) containing fat, skin, blood vessels, and sometimes muscle is taken from a woman's body and used to rebuild the breast. Flaps used for breast reconstruction may come from the back, abdomen, thigh, or buttocks.
Depending on the source, flaps can be pedicled or free.
- In a Pedicled flap procedure, tissue and its attached blood vessels are moved as a single unit to the breast area. The blood vessels need not be reconnected since the blood supply to the reconstructed tissue remains intact.
- In a Free flap, the tissue is cut free from its blood supply. The tissue is attached to new blood vessels in the breast area using microsurgery (gives the reconstructed breast a blood supply).
Abdominal and Back Flaps
- DIEP flap - The tissue used in the abdomen flap consists of only skin, fat, and blood vessels, without underlying muscle, making it a free flap.
- Latissimus dorsi (LD) flap - The tissue used for breast reconstruction is taken from the middle and side of the back and is pedicled.
- SIEA flap (SIEP flap) - The tissue from the abdomen is used as done in a DIEP flap but includes different blood vessels. This free flap does not involve cutting the abdominal muscle.
- TRAM flap - The tissue from the lower abdomen is used as done in a DIEP flap but includes muscle. It can be either pedicled or free.
Thigh or Buttock Flaps
Women who have undergone major abdominal surgery or lack abdominal tissue for breast reconstruction can use flaps taken from the thigh or buttocks. These flaps are referred to as free flaps and are often combined with implants to achieve the desired breast volume.
- IGAP flap - The buttock tissue contains only skin, blood vessels, and fat.
- PAP flap - The tissue from the upper inner thigh, without a muscle, is used.
- SGAP flap - The buttock tissue is used as in an IGAP flap. This includes a different set of blood vessels and contains only blood vessels, skin, and fat.
- TUG flap - The upper inner thigh tissue, including a muscle, is used.
In some cases, implant and autologous tissue may be used when enough skin and muscle are not left after mastectomy to allow for implant expansion.
New Developments in Breast Reconstruction after Mastectomy
- Oncoplastic Surgery - In some women with a lumpectomy or partial mastectomy for early-stage breast cancer, plastic surgery techniques to reshape the breast are performed. This breast-conserving surgery, called oncoplastic surgery, may use reconstruction through breast reduction surgery, local tissue rearrangement, or transfer of tissue flaps.
- Autologous Fat Grafting - This involves the transfer of fat tissue from one body part to the reconstructed breast. It is mainly used to correct asymmetries and deformities that may appear after breast reconstruction. Sometimes, fat grafting is also used to reconstruct an entire breast.
What are the Possible Complications After Breast Reconstruction Surgery?
- Infection
- Blood clots
- Accumulation of clear fluid causing a mass or lump within the reconstructed breast
- Hematoma within the reconstructed breast
- Implant rupture
- Formation of hard scar tissue
Which Top Aesthetics and Plastic Surgeons in India Provide Breast Reconstruction Surgery?
Some of the leading Plastic Surgeons in India are listed below:
- Dr. Vipul Nanda: He is one of the best Plastic & Cosmetic Surgeons with over 19 years of experience. His area of expertise includes Breast Implant Revision Surgery, Breast Lift Surgery, Breast Augmentation, Breast Reduction, Breast Implants, Facelifts, etc.
- Dr. A. Sivakumar: He is among the best Cosmetic & Reconstructive Surgeons with over 24 years of experience. His areas of expertise include Abdominoplasty, Breast Reduction, Breast Augmentation / Mammoplasty, Breast Implant, Microvascular Surgery, Lip Reduction, Gynecomastia Treatment / Surgery, etc.
- Dr. Richie Gupta: He is a Plastic, Aesthetic, and Reconstructive Surgeon with over 30 years of experience. He is experienced in all aspects of Plastic Surgery, such as aesthetic surgery, cosmetic injectables, aesthetic breast surgery, body contouring, surgery for congenital disabilities including cleft lip and palate, microvascular free flap, post-cancer reconstructive surgery, etc.
- Dr. Srikanth V: He is a renowned Plastic Reconstructive & Cosmetic Surgeon with over 21 years of experience. His field of expertise includes Field of Expertise Cosmetic Surgery (Liposuction, Tummy Tuck, Rhinoplasty), Microsurgery (Super Micro Surgery), Breast Enhancement, Stomach Tightening, Breast Reduction, etc.
- Dr. Anil Behl: He is a Plastic and Reconstructive Surgeon with over 38 years of experience. His area of interest includes complex reconstructive and aesthetic surgeries, hair transplants, and burns care.
Key Takeaway
Breast reconstruction surgery in India has transformed the lives of countless women who have faced the challenges of breast cancer. The hospitals in India are fully equipped and have a dedicated team of specialists, experts, and medical professionals who provide comprehensive care and approach. Breast reconstruction restores physical appearance and helps rebuild confidence, self-esteem, and emotional well-being.
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