Breast Reconstruction

• For women, the most common cancer is breast cancer. It accounts for around one-third of all the cancers (Fig 1). The incidence of breast cancer is increasing day by day which is shown in Figure 2 where the incidence of breast cancer is increasing in all the cities in India. Due to the changing lifestyle, it now affects younger people than before. 25 years back, breast cancer was affecting women predominantly above 50 years. Now, there is a significant amount of women who get breast cancer in their 30s and 40s which is the age where they are building up their careers and looking to have a good social life. As part of the treatment, a lot of women have their breasts removed. With advances in medicine, the average 10-year survival rate of breast cancer is around 83% depending upon the stage of presentation. Many women beat the disease and want to forget it. But each time they see the mirror they get reminded of it. They are not able to wear clothes of their choice. They get noticed when they go for public functions and women are very conscious of this throughout their lives.


• This can be a thing of the past. While removing the breast cancer, the breasts can be reconstructed in the same operation to remove the breast (Mastectomy) or even later. We prefer to reconstruct breasts in the same operation as the mastectomy due to the following reasons


• Women wake up with the breast and they never feel sad or depressed that they don’t have a breast any time
• It is all done in the same operation. A lot of women just want to get it done all at once
• Reconstructing the breast at the same time allows us to preserve the shape of the breast as well as the skin over the breast which can make the breast look better than when done later
• The flaps take radiotherapy well


• The drawback of doing the reconstruction at the same time as the mastectomy is that it may take an additional 2 hours for surgery. With modern good anaesthesia techniques and experienced anesthesiologists, immediate breast reconstruction at the same time of the mastectomy is the standard of care worldwide.

• Some women might have had their breast removed and not reconstructed either due to ignorance or personal preference. They might have had their radiotherapy as well. Breast reconstruction can be done for these women as well. By using autologous reconstruction with the patient’s own tissue, it not only gives them the aesthetic breast but also give them additional skin from the abdomen which replaces the skin on the chest which was affected with radiotherapy.


• There are several ways to do breast reconstruction. The surgeon would have to decide according to each woman based on the need for radiotherapy, comorbidities of the patient, previous surgeries underwent by the patient, availability of tissue in the patient and the patient’s own expectations. It is also important that the surgeon chooses a method with the least complications as this will delay radiotherapy and chemotherapy for breast cancers. Accordingly, breast reconstruction can be broadly divided into


• Autologous Reconstruction
• Reconstruction with Implants
• Combination of Autologous Reconstruction with Implant Reconstruction

• In this method, the patient’s own tissues are taken along with its blood supply and connected to the blood vessels in the chest or in the armpit to make a new breast. Depending on where the patient has enough tissue we choose that area for our reconstruction. The tissues can be taken from
• The lower abdomen ( DIEP flap)
• The Inner thigh (TUG Flap)
• The lower Back (LAP flap)
• Latissmus Dorsi Flap (LD Flap)