A candidate opting for Breast Reconstruction should fill up these criteria for better results

1. You should be motivated enough to undergo the procedure.
2. You should be preferably a non-smoker.
3. You should really know well about what surgery you are planning to undergo.
4. You should have a positive vibe about your body image

Questions to be asked with Dr Amit Agarwal about Breast Reconstruction surgery

1. Are you a good candidate for the breast reconstruction procedure?
2. What is the best time to have reconstruction of breast–with mastectomy (removal of breast) or a year after breast removal? Primary or immediate reconstruction of breast is the best. Immediate reconstruction may allow for preservation of chest skin and may help reduce psychological anxiety associated with breast removal. Delayed, or secondary, reconstruction should be an option for women who would like to wait and for women whose treatment prevents immediate reconstruction.
3. What is the best procedure (implant or flap) and how is it done?
4. If flap is done, from where will it be taken?
5. Any flap donor site complication?
6. Where will there be scars post-surgery?
7. How long do you have to stay in the hospital?
8. How long is the recovery period?
9. When can you return to work and daily routines?
10. What is expected of you to change in your lifestyle to get better results?

Breast Reconstruction procedure includes

The procedure would depend on the timing of the breast reconstruction whether it is immediate or delayed in cases of breast cancer or done for absent or deformed breasts, and technique to be used (implant or autogenous tissues with microsurgery or both). If it is immediate reconstruction, the raised skin flaps for removal of breast will be used to support the flap or implant chosen. If it is delayed reconstruction, then a new pocket is created in the chest region for the transfer of the flap. If implant reconstruction is preferred by the lady in delayed reconstruction, then a tissue expander is placed in the chest in first stage to expand the pocket gradually over 2 months and then implant is exchanged with the expander in second stage to reconstruct the breast.

1. It's important for you to be comfortable during the surgical procedure. So, in the first step, general anaesthesia is given.
2. Tissues on the chest wall are insufficient to recreate a breast after mastectomy (breast removal). So, breast is reconstructed using a 'flap technique' or 'Implant'.
3. There are different FLAP techniques which are used for this reconstruction.
• TRAM Flap: In this technique, the donor site is usually the lower abdomen from where the muscle, fat and skin are used for the reconstruction. The Flap taken from the donor site is detached over a vascular pedicle and breast mound is formed from it and vessels are anastomosed in axilla or chest with microsurgical techniques. The flap donor area is closed primarily and given a abdominoplasty type closure and a scar which is hidden under panty line and an abdomen which is tighter, flat and better cosmetically.
• DIEP Flap: This flap is similar in constituents and technique to TRAM flap, but muscle is not included in the flap taken from the lower abdomen. So only lower abdominal skin along with fat is taken and transferred to the chest with native vessels to recreate breast using microsurgical techniques.
• Flaps from other sites such as buttocks or thighs may be chosen for reconstruction in appropriately selected women.
• Latissimus Dorsi Flap (LD Flap): This technique uses the skin of the back region along with fat and Latissimus Dorsi muscle of the back. The benefit factor of using this flap for breast reconstruction is that it is adjacent to the chest region, it remains attached to the donor site with the vascular pedicle which leaves the blood supply intact and can be swung to chest to reconstruct the breast

These Flaps can reconstruct the breast mound as per the requirement of the reconstruction technique which differs from person to person.

4. Breast Implant Reconstruction is an alternative form of reconstruction for women who prefer to avoid transfer of tissues from any other part of the body for reconstruction of the breast. The breast implant of the correct size is chosen to match the opposite breast and inserted in the created pocket (during breast removal in immediate reconstruction) or after creating pocket (with tissue expander technique in delayed reconstruction)on the chest covered by a skin substitute or a LD flap for better results.
5. Breast Implant can also be an addition to the Flap Technique where more volume is required for breast reconstruction. Usually it's the Latissimus Dorsi Flap (from the back region) which provides necessary tissues and muscle to support and covers the breast implant. This will be decided by you and Dr Amit Agarwal will come up with the best possible technique and suggestion for you.
6. After reconstruction of the breast mound in first sitting, nipple and areola will be reconstructed later once everything heals. It is done under local anaesthesia.

Drains are placed under the skin to remove excess blood or fluid from the surgery

The outcomes of the surgery can be enhanced by revision procedures which include improvement of the symmetry of both the breasts and improving the appearance of the donor site.

Thus, the final outcome of the surgery will help you reduce the physical and emotional impact of Mastectomy. Minor changes such as improvement and healing of the scar lines and returning of the breast sensations will be experienced as the time passes by but majorly it boosts up your confidence to feel whole and improve your quality of life.

After getting discharged, if you may experience shortness of breath or unusual heartbeats, immediately seek a medical attention and consult your surgeon.

The results of breast reconstruction are good but you should always follow your surgeon's instructions.

Risk and complications post-surgery

The complications and aftermaths of the surgery vary from person to person and her physical well-being. The factors which affect are poor circulation, a history of blood clots, diabetes or heart, lung or liver infection.

Like every surgery, Breast Reconstruction also involves some risks and complications which include

1. Rare risks related to General Anaesthesia-General Anaesthesia is very safe in present times and with best machines and a qualified anaesthetist, chances of encountering any complication are less than 0.1 percent in a healthy individual. But no one can predict who will land up in complication. We at Kayakriti Plastic Surgery and Dental Centre are equipped with world class anaesthesia workstation, other equipments and two very qualified intensivists for the surgical procedures to be very safe and smooth.
2. Risks related to Microsurgical reconstruction of flap technique like thrombosis or blood clot in the vessels of the flap, re-exploration / re-surgery to remove these clots, and flap failure is seen in less than 10 percent of cases.
3. Risks related to higher BMI like medical condition or higher the BMI, higher are the risks.
4. Seroma formation or fluid accumulation can be there which usually deceases with time.
5. Rare chances of infection which responds to prolonged antibiotic therapy.
6. Bleeding or haematoma formationcan occur which might require drainage.
7. Poor wound healing because of poor blood supply of flaps. Seen more commonly in smokers, diabetes, hypothyroidism and women with multiple comorbidities.Poor wound healing can lead to skin discoloration which can cause marginal or total skin necrosis
8. Numbness or altered skin sensation over the created breast.
9. Scars will be therealong the incision line which will fade with time. Scars can get hypertrophied if you are prone for it.
10. Rare event of Deep vein thrombosis, pulmonary or cardiac complicationscan occur or precipitate in patients with multiple pre-existing diseases diagnosed or undiagnosed by routinely available standard tests
11. Possibility of revision surgery.

These are the risks and possible complication which should be discussed by you with Dr Amit Agarwal before the procedure.

The total benefits of Breast Reconstruction will be seen after the swelling subsides. You should always follow a healthy lifestyle to maintain your profile and confidence.

Frequently Asked Questions

Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.

MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)

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