Breast reconstruction surgery is the creation of a new breast shape, or mound, using surgery. It may be done after removal of a whole breast (mastectomy) or part of the breast (breast-conserving surgery).
You can have reconstruction at the same time as breast cancer surgery (immediate reconstruction), or months or years later (delayed reconstruction). Breast reconstruction often involves several operations to give you the best outcome possible.
There are usually different options available for breast reconstruction and your breast surgeon will explain which one is likely to suit your best.
The new breast shape can be created using an implant and/or your own tissue from another part of the body, usually the back or lower abdomen (belly). Reconstructed breasts don’t usually have a nipple but one can be created with surgery and tattooing. Prosthetic stick-on nipples can also be used.
The average cost of breast reconstruction in Iran (mastectomy in Iran) is around $2200, compared to around $5,000 in the United States or $3000 in India.
The aim of breast reconstruction is to create a breast shape that looks as natural as possible and to try to match the breast on the other side in size, shape and position. However, even with the best outcome, there will be differences between the remaining breast and the reconstructed one, and sometimes surgery on the other side can help. This can be done at the same time as the reconstruction, but waiting for the reconstruction to heal and settle into position may be better. Your specialist team will give you an idea of how long this is likely to be.
Where both breasts are being reconstructed, the aim is to recreate breasts that match and are in proportion to the body shape.
There are usually different options available for breast reconstruction and your breast surgeon and breast care nurse will explain which one is likely to suit your best. It’s helpful if you can take some time to consider these options without feeling under pressure to make a decision. You may need a couple of discussions with your specialist team before you feel confident deciding what to do.
Having a breast reconstruction will not increase the chances of the breast cancer coming back.
Types of breast reconstruction in Iran:
It is worth explaining that all these methods have their pros and cons. For example, breast implants require less invasive surgery than procedures using your own body tissues, but the results may look and feel less natural.
In preparing for breast reconstruction surgery, you may be asked to:
. Get lab testing or a medical evaluation
. Take certain medications or adjust your current medications
. Stop smoking
. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Breast reconstruction surgery in Iran is typically performed in a hospital setting, may include a short hospital stay and will likely use general anesthesia. Some follow-up procedures may be performed on an outpatient basis and local anesthesia with sedation may be used.
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – Flap techniques reposition a woman's own tissue to create or cover the breast mound
Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. In these cases, breast reconstruction usually requires either a flap technique or tissue expansion.
A TRAM flap uses donor muscle, fat and skin from a woman's lower abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.
Alternatively, your surgeon may choose the DIEP flap or SIEA flap techniques, which do not use abdominal muscle but transfer only skin and fat to the chest from the abdomen. If there is insufficient tissue on the lower abdomen, other donor sites such as the buttocks or thighs may be selected (SGAP flap, TUG flap, PAP flap).
A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.
Occasionally, the flap can reconstruct a complete breast mound, but often the latissimus flap provides the muscle and tissue necessary to cover and support a breast implant.
Step 3 – Tissue expansion stretches healthy skin to provide coverage for a breast implant
For women who do not require breast radiation and would like to avoid a separate donor site, implant-based reconstruction is an option. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it can be more lengthy reconstruction process.
It usually requires several office visits over 1-2 months after placement of the expander to gradually fill the device with saline through an internal valve to expand the skin. Newer air-filled devices may allow patient-controlled expansion at home using a remote dosage controller.
A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.
Placement of a Breast Implant
Step 4 – Surgical placement of a breast implant creates a breast mound
A breast implant can be an addition or alternative to flap techniques. Surgeons may also use an implant as a temporary placeholder during other breast cancer treatments until you are ready for more involved flap reconstruction techniques. Saline and silicone implants are available for reconstruction.
Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion. Direct-to-implant breast reconstruction may be an option for some women undergoing mastectomy with certain tumor characteristics and breast shapes.
Step 5 – Reconstructing a nipple and areola, breast revision techniques
For women who are not candidates for nipple-sparing mastectomy, breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. Techniques usually involve folding skin to create the shape of a nipple followed by tattooing. Three-dimensional nipple-areolar tattooing may be used alone to create the appearance of a realistic nipple with the illusion of projection. Breast reconstruction outcomes can often be enhanced with staged revision procedures that improve symmetry, use liposuction with fat grafting and improve the appearance of the donor site.
Following your breast reconstruction surgery for flap techniques and/or the insertion of a breast implant, gauze or bandages may be applied to your incisions.
An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
You will be given specific instructions that may include:
How to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health and when to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
Where will I be taken after my surgery is complete?
What medication will I be given or prescribed after surgery?
Will I have dressings/bandages after surgery? When will they be removed?
Will there be drains? For how long?
When can I bathe or shower?
When can I resume normal activity and exercise?
When do I return for follow-up care?
Healing will continue for several weeks while swelling decreases and breast shape/position improve. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.