Breast Reconstruction in Thailand

Breast Reconstruction Surgery

Implants or prosthetics: Breast reconstruction with implants is a procedure where silicone or saline implants are inserted underneath the skin or muscle below where the breast tissue was.

• For most patients, this is done in two stages. During the first surgery, a tissue expander is placed under the remaining skin of the breast or pectoralis muscles. The tissue expander acts as a temporary saline implant that gradually stretches the remaining tissue.
• After the woman has healed from surgery, sterile saline or salt water is injected into the tissue expander on a weekly basis. This gradually enlarging balloon stretches the overlying skin and muscle until it has reached a size the woman is satisfied to have.
• When the chest tissues have healed and enough saline has been added to the tissue expander to prepare the chest for the implants, a second surgical procedure is performed.
• The tissue expander is removed and replaced with either a silicone or saline implant. The original scar is usually reopened, and therefore, typically, no new scars are left on the chest.
• This complex reconstruction may be started at the time of the mastectomy or may be delayed until after the cancer treatment is complete.

Autologous or skin flap surgery: Tissue is taken from another part of the body and moved to the chest to form a breast. The tissue to reconstruct the breast is usually taken from the abdomen but may be taken from other places on the body, including the buttock (Gluteal Flap), back (Tram Flap) or belly (Tram Flap).

• Breast reconstruction with flap surgery is a very complex surgery, as it involves transferring tissue from one area of the body to another. This surgery is done using one of two methods: free flap surgery or pedicle flap surgery.
• In free flap surgery, the surgeon completely removes the tissue and surrounding blood vessels to be placed in the breast. Blood vessels are sewn to the blood vessels in the chest where the tissue is to be placed. The blood vessels are very small, so a microscope is used to sew them together in a long and technical procedure called microsurgery.
• In pedicle flap surgery, the tissue being transplanted is not entirely cut off from all of its blood vessels prior to being transplanted. It is left attached to the body and usually rotated into the chest to create the breast. This is usually done using tissue from the abdomen or back.
• In some cases, a combination of both techniques may be used to reconstruct the breast more naturally. Additionally, some techniques can be added on to either surgery to reconstruct the nipple area if it has been affected by the cancer treatment.
• Breast reconstruction may be started at the time of the mastectomy or lumpectomy. When this is done, it is known as immediate reconstruction.
• Reconstruction can also be done after the mastectomy has healed and cancer treatments are finished. In this case, the surgery is known as delayed reconstruction.

The type of reconstruction that is best for you depends on your age, body type, and the type of cancer surgery that you had. A plastic surgeon can help you decide.

Not all women who undergo mastectomies choose to have breast reconstruction done. Some women may choose to wear a prosthetic breast form either inside their bras or attached to their bodies. These artificial body parts mimic the look and feel of the natural breast and provide the body with the weight it needs for good posture.

Recovery time and Risks

You will feel tired and sore for a week or 2 after implant surgery, or longer after a flap procedure (which will leave you with 2 surgical wounds). Your doctor will give you medicines to help control pain and other discomfort.

Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days, but required to stay in Thailand for at least two weeks before traveling home. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a small hollow ball that you’ll learn how to empty before you leave the hospital. The doctor will decide when the drains can be safely removed depending on how much fluid is collecting each day. Follow your doctor’s instructions on wound and drain care. Also be sure to ask what kind of support garments you should wear. If you have any concerns or questions, ask someone on your cancer care team.

Most women can start to get back to normal activities within about 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind: Reconstruction does not restore normal feeling to your breast, but some feeling may return over a period of years.

It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.

It may take as long as 1 to 2 years for tissues to heal fully and scars to fade, but the scars never go away completely.

Call your doctor right away if you notice any new skin changes, swelling, lumps, pain, or fluid leaking from the breast, armpit, or flap donor site, or if you have other symptoms that concern you.

Any type of surgery has risks, and breast reconstruction may pose certain unique problems for some women. Even though many of these are not common, it’s important to have an idea of some of the possible risks and side effects: Problems with the anesthesia, Bleeding, Blood clots, Tissue death (necrosis) of all or part of a tissue flap, skin, or fat, Loss of or changes in nipple and breast sensation, Problems with a breast implant, such as movement, leakage, rupture, or scar tissue formation (capsular contracture), Uneven breasts.

Infection can happen with any surgery, most often in the first couple of weeks after surgery. If an implant has been placed, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.