A breast reconstruction surgery is done for patients who may have lost one or both breasts due to breast cancer. The surgery can be done along with the mastectomy or lumpectomy to remove the affected breast/s, or later, based on the patient and surgeon’s decision.

The goal is to recreate natural looking breasts to replace the lost breasts, for a normal appearance and the patient’s self-confidence.

Whether or not you choose to undergo a breast reconstruction, is your personal choice. It is not imperative to have this surgery after a mastectomy. If you do not choose to do the surgery, you can wear breast pads, or choose to stay with your altered form.

It is essential for me that you are clear on why you are considering breast reconstruction. So, even before your initial consultation, you should reflect on some questions:

• What are your goals and expectations from the surgery?
• Will you be comfortable and confident with the changes from the surgery?
• How will the surgery affect your personal life?
• Do you accept that your breasts can change over time?

I will be asking you these questions in my initial consultation, and your answers will help me to assess whether you are a right candidate for this surgery.

If you are an adult woman, who has lost her breasts (full or partial), as a result of breast cancer, you are potentially a good candidate for breast reconstruction.

However, it is your oncologist and the plastic surgeon, who will make a final determination of your suitability for breast reconstruction surgery, and the timing thereof.

I will keenly assess your suitability for breast reconstruction, and will proceed only if satisfied that you are a good candidate.

A breast reconstruction surgery can be timed at the same time as the cancer surgery (immediate), or later, after recovery from the cancer (delayed). The choice of timing is broadly determined by your preferences, and your cancer treatment.

Immediate Reconstruction

The advantages of immediate reconstruction are fewer surgeries, and the patient does not go through the emotion of not having a breast.

If the patient needs to undergo radiotherapy after surgery, immediate reconstruction will not be undertaken. Also, chemotherapy may need to be deferred if there are any complications, which is not an advisable option.

Delayed Reconstruction

The advantage of delayed reconstruction is that the cancer treatment can be completed without any interruptions, and the patient also gets more time to evaluate all possible options.

The disadvantage is that the patient will not have breast tissue until the surgery is done, and may need to wear false breasts. The scar too, will be larger.

Breast reconstruction can be done in various ways depending upon your specific circumstances.

There are 3 main breast reconstruction techniques:

• Using Implants
• Using own body tissue
• Combination of implants and body tissue

Breast reconstruction via Implants

Under this technique, a silicone implant is inserted into the breast, and the skin is stretched over it. It offers good results for small to medium size breasts, and minimal scarring. The breast feels less natural and less mobile in comparison to natural breasts. All implants also carry a shelf life, so it would need to be replaced after that time. High quality modern implants have a shelf life of up to 15 years.

This procedure is not used in conjunction with radiotherapy.

Due to the volume of breast tissue removed during a mastectomy, patients getting reconstruction using breast implants will begin with a tissue expander, which is like an empty breast implant, that is gradually filled and enlarged to make space for the permanent breast implant.

Breast Reconstruction using own body tissue

This breast reconstruction technique, also known as flap reconstruction, uses your own body tissue from other body parts to recreate the breast. This gives a natural feel to the breasts.

This technique is suggested for women who have done radiotherapy, or have large breasts, or have had a radical mastectomy. It is not recommended for diabetic women, over-weight women, or those who have been heavy smokers.

Surgeons can obtain tissue – skin, muscle and fat tissue – from various body parts:

• Making a flap from the back
• Making a flap from the abdomen
• With skin and fat from abdomen
• With skin and fat from buttocks
• With skin, muscle, and fat tissue from thighs

Breast Reconstruction via Implants & Body Tissue

This method of breast reconstruction uses a combination of implant and body tissue.

The technique I will use for you will be determined after a complete evaluation of your medical history and condition, an understanding of your cancer treatment, discussion with your oncologist, and based on your desired aesthetic goals.

Nipple Reconstruction

Along with breast reconstruction, many women consider a nipple reconstruction surgery too, as during mastectomy, the nipple and areola are often removed.

You may choose to do the nipple reconstruction after the breast surgery. The nipple is created using a flap from the back or abdomen and tattooed to resemble the colour of a normal nipple.

You can also opt for a prosthetic nipple to match your original nipple, which can be glued to your breast.

Any breast surgery may impede your ability to breastfeed. However, it is possible to breastfeed after a breast reconstruction surgery, whether it was done with implants or via body tissue. The risks are minimized with a skilled surgeon.

If, however, the mastopexy involved removing the entire glandular tissue and milk ducts, you will be unable to breastfeed.

I will discuss your maternity plans during our consultation and determine the right technique for you based on those discussions and other pertinent factors.

A breast reconstruction surgery has lasting results if your body weight remains stable after surgery. If your surgery was done using implants, risks of implant rupture, leakage, or expiry will require a reoperation. Pregnancy may also impact your breasts.

The Breast reconstruction process typically involves multiple surgeries, spread weeks or months apart, in accordance with the stages of cancer treatment.

The time taken for the initial surgery depends on also on the technique being used – implants or flap reconstruction; and the extent of reconstruction needed, and could take between 2-6 hours.

The initial surgery will be done under general anesthesia, and you would need to stay in hospital for 1-2 days (with implant reconstruction), or 5-6 days (with tissue/ flap reconstruction).

Subsequent surgeries are usually same-day procedures.

You will be able to sit the day following your surgery, and walk within 2 days of surgery. You should typically resume normal activities within 4 weeks.

I will prescribe what exercises will need to be done to aid recovery, medication, etc. Heavy exercises should only be resumed after my consent.

Every surgery carries some risks, but at this stage of my experience and expertise, the risks that my patients have are minimal. Standard risks include:

• Anesthesia risks
• Bleeding
• Infections of any kind
• Scars (though these will fade over time)
• Reduction/ loss of sensation in nipple or breast
• Implant risks – rupture, rippling, leakage
• Damage to milk glands, nerves, ducts – inability to breastfeed

Risks are minimized in the hands of an expert surgeon, by doing the surgery in a good, licensed clinic or facility, following proper protocols; and by the patient carrying out all given instructions – both before and after surgery.

Breast reconstruction cost varies based on the following factors:

• Type of surgery and the extent of reconstruction needed
• Number of days of overnight stay required
• Hospital/ Clinic used for the surgery
• Skill & expertise of the breast surgeon

When breast reconstruction is done following a mastectomy, it is considered a reconstructive procedure, and not an aesthetic one, the cost is usually covered by insurance. Please check with your insurance provider about your policy entitlement.

Another significant aspect to take into consideration, besides just the initial surgical costs, is your comfort factor with the breast surgeon, and your faith in the surgeon’s expertise. Pay a bit more – but be sure, and be comfortable with your surgeon.

To know the cost applicable for your specific case, please book a consultation.

The choice of your breast surgeon is a decision to be made with due care. While cost is a relevant consideration, there are other more important factors that should determine your decision:

• Qualifications and certification, specifically plastic surgery related certifications and memberships, such as membership of American Society of Plastic Surgeons (ASPS)
• Years of experience as a plastic surgeon, number of surgeries done
• Number of breast surgeries done, including reconstructive breast surgeries
• Proof of work – before/ after images
• Patient testimonials
• Surgeon reputation
• Your comfort factor with the surgeon, his manners, his patience in answering your questions
• Surgeon’s philosophy regarding patient safety

You are planning a significant surgery, and one that requires very specialized training and even artistic flair, so it’s extremely important that you decide wisely. Pay more if needed, but choose a surgeon who has an extensive portfolio of successful breast surgeries. Make sure that you are fully comfortable with your surgeon.

I have done over 1,000 breast surgeries, including revision breast surgeries for patients unsatisfied with results of prior surgeries done elsewhere. You can read my full profile here.

The hospital for your breast reconstruction surgery done should be carefully chosen. Ensure that the facility is licensed.

The hospital should have a licensed anesthetist on board, competent nursing and operations staff, and the surgical room should be clean and hygienic.

Ministry of Health (MOH), Dubai regularly conducts inspection of all medical and surgical facilities in Dubai and license is granted or renewed only if the prescribed conditions regarding hygiene, safety, etc. are met.

My medical center – Cocoona Center for Aesthetic Transformation, Dubai is an MOH-licensed clinic, and we are permitted to perform surgeries under local anesthesia. We also have competent anesthesiolgists on board, and a full team of caring and professional nurses, patient counselors, and other support staff.

Since your breast reconstruction surgery will need to be performed under general anesthesia, we will do it at another hospital of your choice, or where we have a tie-up.

After I’m through with my initial questions to you, and upon getting an idea of your expectations from the surgery, I will do a breast examination. I will evaluate the following:

• Breast proportions – size, symmetry, nipple height and position
• Breast footprint
• Volume and quality of breast tissue
• Skin elasticity

I use computer morphing to display and discuss the final post-procedure possibilities. That gives a visual idea of the possible outcome. I discourage extensive computer morphing, as it can be unrealistic and causes misunderstanding between patient and doctor.

Based on my findings from the examination and our earlier discussion, I will determine which method of breast surgery would be most suited for your specific case.

The basic breast reconstruction process involves recreating the normal shape and appearance of the breast using implants or your own body tissue, taken from your back, abdomen, buttocks, or thighs.

Your initial surgery will be done at the hospital where you are undergoing cancer treatment, or another hospital of your choice, or where we have a tie-up. The initial surgery is the major one. Subsequent surgeries can be done either at an accredited day care surgical facility such as my medical center in Dubai – Cocoona or a hospital, depending upon your choice, and anesthesia considerations.

Understanding the process involves knowing about anesthesia, basic surgery steps, post-procedure recovery, return to normalcy, risks involved, and expected results.

• What anesthesia is used?

The initial surgery involves general anesthesia. Depending on the extent and nature of changes required during subsequent surgeries, they may be done under general or local anesthesia.

• What type of breast reconstruction will be done for you?

The type of breast reconstruction technique that will be followed for you is a decision that I will arrive at based on your anatomy, the extent of changes that are needed to achieve the desired shape, your cosmetic expectations from the surgery, the course of your cancer treatment, discussion with your oncologist, and your motherhood plans.

There isn’t one best approach and technique – I will customize your surgery plan exclusively for you.

• How is a natural looking shape attained?

The key to performing a natural looking breast reconstruction surgery is to understand the proportions of the breast in relation to the rest of the anatomy – which is both a science and an art, correct the aesthetics, and have minimal visible scarring.

It’s also important to understand that a breast size or height that looks beautiful and natural in another person, might look out-of-place in your body, as each person’s natural anatomy is differently proportioned.

As a surgeon who takes immense pride in his work, I always strive for results that look perfectly natural relative to my patients’ body contours. That objective is best achieved, not by excessive changes, but by proportionate changes.

At this stage, you are likely to have few more questions for me to clarify. Some such questions are covered herein. I will be glad to answer these and any other concerns you have.

• What is the recovery phase immediately after the procedure? 

After the surgery, you will be taken to the recovery room for 2-3 hours. Once awake, you will be asked to stretch and move your hands. You will have an IV fluid drip, and a urinary catheter.

Following the surgery, your breasts will be bandaged. There will be swelling, bruising, pain, and soreness for 2-3 weeks, which will be minimized through medication. You will be prescribed ointments, pain medication and antibiotics to help recovery. You will be given instructions on changing your bandages, keeping your wounds clean, and bathing.

Most of my patients return to normal activities in 4-8 weeks after surgery. Intensive exercise can be undertaken only after my express consent, and could take many more weeks.

• What should be done post-surgery to improve the results? 

Strictly follow the recommended post-surgery plan for faster recovery – including taking your medications, and keeping your follow-up appointments schedule. The surgical wounds will require regular dressings and you will be given the schedule.

You will be provided a special bra to provide comfort to your breasts.

Keep a generally healthy lifestyle to retain your results. Do regular breast mammogram or ultrasound to check your breast health and condition.

• When will the results be visible? 

Your new breast shape will be visible within 3-5 weeks once the swelling has subsided, and the skin around the breasts has settled.