Kamol Hospital - Thailand Cosmetic & Plastic Surgery

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Breast Surgery @ Kamol Hospital - Thailand Cosmetic & Plastic Surgery


Breast reconstruction



Breast Reconstruction

in Bangkok, Thailand

          Breast reconstruction surgery is a surgical procedure to rebuild the new breasts after mastectomy for breast cancer, correction from burns, and transgender conversion. The patients who want to have breast reconstruction after mastectomy for breast cancer must have permission or agreement with their surgeons who did a previous mastectomy to make sure the diseases are completely treated and cure.

 

A good candidate for breast reconstruction

  1. The patient must have complete the therapy of breast cancer
  2. The patient needs to revise the breast scar that causes burn or accident.
  3. No previous radiation on the breast areas
  4. Stop smoking
  5. No active connective tissue diseases such as SLE, Rheumatoid disease, and scleroderma              

 

Kamol Cosmetic Hospital offers two main options for breast reconstruction

  1. Reconstruction with implants: the surgeon uses silicone gel or saline-filled prosthesis inserting inside the cavity under the muscle. In the case of fragile skin and scarring, the surgeon may use tissue expander technique before insert the implants.
  2. Reconstruction with flaps: Kamol Cosmetic Hospital offers a variety of flaps for breast reconstruction as follows:
    1. TRAM flap (Transverse rectus abdominis muscle flap): the surgeon uses the skin, parts of the rectus muscle, and fat below the umbilicus with the vascular pedicle Then, it moves to the breast area. This technique is most reliable, but the patient will lose parts of the rectus muscle and might have a weakness of the abdominal wall.

      TRAM flap (Transverse rectus abdominis muscle flap)
       
    2. DIEP flap (Deep inferior epigastric perforator flap): the surgeon uses skin and fat without muscle then moves to the breast area with a microsurgery technique. This method can preserve the abdominal muscle function but takes risks of vessel thrombosis with the microsurgery.

      DIEP flap (Deep inferior epigastric perforator flap)
       
    3. Other flaps such as LD-flap (latissimus dorsi flap) may be used as an alternative flap depend on the patient preference and other limitations.

 

Preparation for breast reconstruction

  • Consult with the surgeon to your goals, lab test, and medical evaluation
  • Stop smoking at least two weeks before and after surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements that may increase bleeding

 

Postoperative care for Breast reconstruction.

  1. Reconstruction with implantation
    1. Keep bandage for 7th days after surgery
    2. Remove stitches at 7th day
    3. The patient may need breast massage depends on the type and shape of the implants.
    4. The nipple and areola reconstruction can be reconstructed at the second stage.
  2. Reconstruction with flaps, the patient needs more specialized care.
    1. In the case of pedicled TRAM-flap is used, the patient needs to keep light activity for at least two weeks after surgery.
    2. For DIEP flap with microsurgery technique, the patient needs hospitalization for at least seven days and limited activity for four weeks.

 

Risks and complications

  1. Flap loss: Basically, the surgeon will use the most reliable flap for each patient. However, in some situations and individualize, the patient might have poor wound healing and deficiency blood supply due to the previous treatment.
  2. Delayed wound healing: mostly occurred in case of fragile skin
  3. Loss of breast sensation
  4. Bleeding, hematoma, and seroma
  5. Surgical wound infection
  6. Abdominal wall weakness/Loss of sensation at the donor site
  7. Unfavorable results: the patient might notice the unequal, symmetry, or unnatural look of the new breast, particularly in flap reconstruction.

 

Recovery

          The recovery of breast reconstruction varies depending on the surgical technique performed.

  1.  The patient who has reconstruction with the implants needs two weeks for the recovery time
  2. In the case of using a tissue expander, the patient needs to expand the pocket by gradually increasing the volume for about 4-6 weeks before inserting the implants. The patient will need to stay longer than simple implantation.         
  3. The patient who has undergone reconstruction with flap needs to stay for the recovery around 2-4 weeks.
  4. The patient who has undergone with flap technique needs to wait for 6-12 months to have secondary nipple-areola reconstruction.





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