A few years ago, a rare breast reconstructive surgery on a double mastectomy cancer patient was performed in Dubai using state-of-the-art reconstructions methods available at that time.
Instead of silicone implants, the surgery was performed using the grafts from the same patient’s body. This method delivers almost a natural pre-surgery look of the patient’s breast.
That technique is known today as DIEP flap breast reconstruction. The word DIEP stands for “Deep Inferior Epigastric Perforators” which is the name given to the tiny blood vessels that supply nutrients to the flap taken from the lower abdomen.
A young professional in Dubai, Victoria, who was 30 at that time, who has no history of breast cancer in her family was diagnosed in 2011 with a very aggressive form of breast cancer (triple negative BRCA 1 gene mutation).
Fast forward to 2016 and today Dubai is a hub of cosmetic surgery procedures in the Middle East. Especially the interest in breast reconstruction surgery in Dubai, breast augmentation surgery in Dubai and breast Lift surgery in Dubai has increased many folds. Thanks to its medical tourism policy, patients seeking breast reconstruction treatment in Dubai are coming from all over the world.
Dubai with its cutting edge technologies, state of the art medical facilities and top of the line breast surgery experts is poised to be a leader in breast reconstruction surgery in the world.
Breast reconstruction surgery in Dubai is the process of making a new breast after its removal (mastectomy) due to breast cancer. This document has been written to provide complete guidelines about the breast reconstruction surgery and the techniques used in it. This guide aims at teaching the breast reconstruction aspirants about the advanced and up-to-date reconstructive surgery options. We hope you find the information you about the breast reconstruction in this guide.
This article covers:
How to Use this Guide
The use of this guide depends on your need. The guide provides a complete insight into this tricky procedure: breast reconstruction. It is recommended that you spare some time to review this guide before you visit your surgeon for the first consultation. Doing so, you will be able to grasp the solution suggested by your surgeon vs. what you actually want your breast to be. It is alright if you do not understand each and every part of this guide. You will be able to at least ask it to your surgeon. Take yourself and your surgeon as a team working towards solving a life changing problem. Take a decision that fits your values, priorities, and lifestyle.
The Breast Reconstruction Decision
The reconstruction decision is a game changer. The right decision at the right time can bring radical changes to your and your family’s life. Losing the breast to breast cancer is a hell of a bad experience; it makes you feel stuck and preoccupied. The idea whole of breast reconstruction gives hope to move forward with dignity, self-esteem, and confidence. It might not be easy for you to make the breast reconstruction decision at the first place. So do not make haste, find the right time and technique to get the desired results that suit you in the long run. Adopt a realistic approach; do not let emotions overwhelm you. Do consult with friends, family, and the breast reconstruction patients; take what is going to make the difference in your life in the long run.
How to Make Your Breast Reconstruction Surgery Decision
This is just a guide and we have tried our best to include important information that is going to help you with your breast reconstruction procedure. The procedure is a bit confusing in a sense that there are so many choices. So it is not a matter of amazement if you feel stuck after reading this guide. You need not worry because your surgeon will make things clear to you.
In case you are not able to make a decision, start by asking the following question to your surgeon;
- Should I have reconstruction?
- When should I have reconstruction?
- Which surgical option is best for me?
You are not going to rely on the answers of your surgeon. This guide has been designed around these three questions. Just try to go through this guide before your show up for your first consultation with the surgeon. We know the guide is a bit long but it is worth your time because you are going to take a game changer procedure and you get the best results in return if you completely involve yourself in it. By this, we mean you should know your rights and options before you visit us for consultation. Feel free to make a list of questions to ask and bring it along with you on the day of consultation.
Should You Have Breast Reconstruction Surgery?
So the first question is whether you need a breast reconstruction surgery or not. In this regard, knowing the benefits of a typical breast reconstruction procedure might help you solve the mystery. Well, the benefits might go beyond your expectations. Some of the important benefits include; you may feel more normal, balanced, confident, happy, and feminine. You will not have to think twice before buying a dress. Tight dresses will again be able to stay in your closet. Some women are afraid that if the breast cancer returns, it will be harder to detect the tumor through a reconstructed breast than through a mastectomy scar. There is no need to be worried about cancer detection.
The recent research studies have revealed that it is no longer difficult to detect and treat cancer in a reconstructed breast than it is through a mastectomy scar. For those women who want to breastfeed their kids, there is a bad news. They will not be able to breastfeed after the breast reconstruction. That is the problem that the part of the breast responsible for producing milk is more likely to produce breast cancer. Due to this reason, the part of the breast that produces milk is removed during mastectomy.
Having breast reconstruction may cause you inconvenience after the surgery. The treatment area takes some time to recover fully. Some follow-up surgeries or additional treatments may be needed. The total recovery time depends on the nature of the procedure the patient takes, but it might take around 6 or more months to get into normal condition.
It is your decision whether the mental and physical benefits of the breast reconstruction are worth the cost of having the surgery.
Advantages of Breast Reconstruction Surgery:
- You will be able to dump the memories of breast cancer.
- You will feel more attractive, confident, and above all, feminine.
- Your will no longer have to think twice before wearing tight clothes.
- You will feel more balanced because you will get the lost part of the body.
- You will see your body as normal and you will be able to wear the dress of your choice.
Disadvantages of Breast Reconstruction:
- You will have to put a hold on your work or social responsibilities.
- You may have to take more than one surgeries to have your breast reconstructed.
- There is no way of knowing the exact shape and size of the breast until the surgery is over.
- The newly reconstructed breast may not exactly match to the other breast (it is important to mention that natural breasts also do not match)
When Should You Have Breast Reconstruction?
Deciding the time of reconstruction is very important. You can either have it at the time of mastectomy (which is known as immediate reconstruction) or you can take it at a later time (delayed reconstruction). If the patient of mastectomy has already made her mind about the breast reconstruction, she should take it at the time of mastectomy. This way, the patient will have less recovery time, less cost, and will have no mental trauma of living without the breast. When the patient wakes up, she finds her body complete.
On the other hand, some circumstances support the delayed reconstruction. Before a mastectomy, the thought process of the patient does not work well. If is it so, it is good to postpone the procedure. This way, the patient will get some time after mastectomy to consider your options. As per the research, the women who take delayed breast reconstruction are just as happy as those who take immediate breast reconstruction. You can have the same results if you go for a delayed reconstruction.
There are some other reasons for delayed reconstruction as well. If the patient has to take radiotherapy for breast cancer, the surgeons suggest delaying the reconstruction until the radiation treatment ends. Taking radiation therapy after reconstruction can increase complication rate and may affect the appearance of the reconstructed breast. Therefore, in order to have lower complication rates and better cosmetic results postponing the reconstruction is recommended.
Surgical Choices for Breast Reconstruction
Today, increasing number of women are opting the breast reconstruction. It is so because women feel more natural and balanced with a reconstructed breast. In a broader sense, we have the following two breast reconstruction options;
- Implant Reconstruction
- Natural Tissue Reconstruction
Implant Breast Reconstruction
In this method of reconstruction, the breast is surgically reconstructed by putting an artificial breast mound, which is known as an implant.
How is the Breast Reconstruction using Implants Performed?
Synthetic implants used in this procedure are round or teardrop-shaped pouches. These implants are placed under the chest muscle skin to create the shape of a breast. The outside of implant is made of silicone plastic. It is filled later with saline (salt water) or silicone gel. The filler inside the device is either semi-filled or solid in a silicone implant. Depending on the skin condition, the size of the breast, and other factors, the process of breast reconstruction using implant may involve one or more stages.
Single Staged (“Direct to Implant”) Implant Reconstruction
If the patient has enough extra skin after mastectomy, one stage implant-based reconstruction is possible. In this approach, the surgeon places the silicone gel or saline implant at the location of the new breast, in a pocket under the skin and the muscle layer. It is possible to perform this surgery through the incision of mastectomy. This single stage method also uses the piece of banked human skin to create the inner shape of the new breast. This skin is manufactured under the names “Alloderm” or “Flex HD” and is harvested from human donors. It is radiated to prevent rejection, and it is also sterilized to avoid infections. To keep it centered and to maintain the proper shape, the resultant material is stitched inside the implant pocket. The single stage implant reconstruction brings good aesthetic results in some patients.
Two-Staged Implant Breast Reconstruction
Two-staged implant reconstruction is the most common implant-based reconstruction. As its name suggests, two staged implant reconstruction comprises on two operations or stages. A second stage involved in it due to the deficiency of remaining breast skin after mastectomy. In this method of implant-based reconstruction, a tissue expander device in placed in the first stage. This tissue expander is a silicone-walled pouch that assembles an empty balloon that resembles a small valve in its front wall. Surgeons use this valve to fill the implant with saline during and after this initial procedure. Months later, the second stage comes into play and removes tissue expander with a saline or silicone implant.
The tissue expander placed in a pocket beneath a chest muscle and the overlying skin in the first stage is later used to expand the implant pocket to accommodate the size of the implant needed to match the opposite breast or to reach the breast size desired by the patient. In general, one to two hours is needed to perform the initial tissue expander surgery. At the end of this surgery, the chest will still be flat. The downtime factor varies from person to person. The procedure could be performed on an outpatient basis. It can also require the patient to stay in the hospital for an overnight stay.
There are some restrictions after the procedure no matter the saline implant or tissue expander is placed in the chest. The post-operation instructions for each patient differ. It may include not driving for 2 to 3 weeks following the surgery; no physical work, no heavy lifting, no gym for 3 to 4 weeks.
The process of tissue expander begins somewhere between 14 to 21 days following the placement of tissue expander. The patient needs to visit the surgeon every one to two weeks. This surgeon visit is important because in each 20 to 30 minutes session with the surgeon, about 2 to 4 ounces (50 – 100 cc) of saline water will be injected through the overlying skin into the valve located on the front wall of the tissue expander. The purpose of the tissue expander is to enlarge the pocket, to grow it for the new breast implant. The expansion experience of each patient differs from other.
Some women experience discomfort or soreness during the expansion process; whereas, others describe a mild tightness a few days following the procedure. The number of outpatient expansions depends on the number of factors, such as the preferred breast size of the patient. In general, the number of outpatient expansions usually lay somewhere in between 4 to 8. Before the patient comes for the second operation, the surgeons recommend taking 1 to 3 months rest after expansions. The rest period is crucial because it makes the skin to relax and finish growing. The average time between the first stage and second stages can take 3 to 5 months, which includes the rest period.
After completing the rest, the time for the second stage of reconstruction arrives. The surgeon will now remove the tissue expander, shapes the tissue pocket, and the reconstructive implant is inserted. This procedure will take one to two hours and does not require a hospital stay in general. The patient needs to abstain driving for 2 to 3 weeks and avoid physical activities for 3 to 4 weeks. The process of the breast reconstruction is complete now if the patient does not need nipple reconstruction of fat grafting for shape adjustments.
Expander/Implant (Two Staged) Timeline
Implant Breast Reconstruction: The Numbers
2 to 3 hours of surgery are required for the one stage direct to implant approach depending on whether 1 or 2 sides being created. As far as two staged method or expander-implant reconstruction is concerned, one hour per side is required for expander placement; exchange of expander with an implant can also take about an hour per side. In some cases, these surgeries may require an overnight hospital stay. Most of the time, these expander-implant exchange is usually performed on an outpatient basis. The time to recover after the surgery varies from person to person. Usually, limitations about physical activities and driving may last between 3 to 4 weeks after the surgery. It is worth mentioning that the first stage of the expander-tissue implant approach, the time period between the placement of the expander and the exchange of expander with implant averages between 3 to 6 months.
Saline or Silicone Breast Implants?
According to some plastic surgeons and patients, silicone gel-filled implants have more natural look and feel than saline implants. It is due to the reason that the silicone gel has a texture that is very similar to natural breast tissue. Moreover, silicone implants are less likely to develop visible wrinkles as compared to saline implants. Some advancement has been made in implant technology and now it is possible to use solid or semi-solid gel fillers. Such kind of implant is easy to replace in case of implant leakage.
In the early 1990s, some possible adverse health effects of silicone gel implants were raised by experts. Since then, extensive research on the link between silicone gel implants and chronic health conditions has been carried out by many organizations; but as of today, no link found. An Institute of Medicine expert panel reviewed the research on this subject in 1999 and concluded that there are no risks involved in the use of silicone gel implants. After that, review of Institute of Medicine, Food and Drug Administration gradually release the restrictions on the use of silicone gel implants for reconstructive and cosmetic breast surgery.
Silicone gel implants do have some illustrious benefits as compared to saline implants but saline implants also have some important advantages. The scar tissue contracture rate appears modestly lower in saline implants than it is in gel-filled devices. It is true that the rate of leakage is same for both types of implants, but the detection of leakage is easier in saline implants. It is so because the deflation is relatively obvious as the body absorbs the salt water. On the other hand, in case the leakage takes place, an MRI scan is required to confirm the problem.
Advantages of Implant Breast Reconstruction
The best aspects of an implant-based reconstruction include shorter surgeries, little or no hospital stay, and faster recovery time. Mean to say, it involves a shorter hospital stay and shorter recovery time compared with most other reconstruction options. Usually, less recovery time is necessary because it involves less extensive surgery than other reconstruction options. If you choose immediate reconstruction, then the mastectomy is followed by tissue expander or implant surgery; thus you will have to stay in the hospital for one night. On the other hand, if you plan to take delayed reconstruction, the operation will be done on an outpatient basis. The second operation to replace the tissue expander with an implant will also be performed on an outpatient basis. The recovery time for these procedures is faster than larger flap breast reconstructions. Patients can resume normal activities 3 to 4 weeks after tissue expander or implant surgery.
Implant reconstruction is less invasive, with fewer scars. As a matter of fact, flaps are not harvested from other parts of the body, that is why only fewer scarring is involved. Moreover, the scar caused by mastectomy is often used in it to reconstruct the breast. So you need not worry about any additional scars.
Cosmetic results are generally good to excellent, particularly in bilateral (two-sided) reconstructions whether it is a bilateral reconstruction or it is a unilateral reconstruction; cosmetic results are usually good in this method.
Disadvantages of Implant Reconstruction
The results of implant surgery may not be immediate. If you need to first have tissue expander placed inside the breast, you will not wake up from the initial surgery with a new breast. If you need to first have the tissue expander placed, the surgery will take 3 to 6 months to complete. In case you need to get one breast reconstruction, it might not exactly match the size of the other one. As results, you will not able to wear all kinds of clothes. Your physical activities will also be affected in this case. In a situation like this, you can wear a prosthesis or pad your bra to make your breasts the same size.
Implant surgery may be time-consuming and inconvenient. If you need to take tissue expander devices first, additional surgery and frequent doctor visits will be required. Before you make your mind for expander-implant reconstruction, you will have to spare the time to undergo another surgery, hospitalization, and recovery period. You will also have to spare time to visit your doctor every one to two weeks.
Implant reconstructions offer less flexibility in creating shapes to match an opposite natural breast. The shape of the implants cannot be changed to fit the size of the person’s breast. Due to this reason, the size of the natural breast might need to be changed to make both of the breasts symmetrical. When touched, implant-based breasts do not feel natural.
As you age, an implant reconstructed breast may not evolve (sag) in the same fashion as a natural opposite breast. The sagging in the natural breasts is a common problem that takes place as women age. The breast implant cannot change the shape or sag itself. Due to this reason, the other breast may keep changing and sagging over time. The people with unilateral implant reconstruction may later get distinct shaped. This may lead to another surgical or non-surgical procedure at a later time. This issue does not arise in case you opt for bilateral implant-based reconstruction because the both sides will behave in a similar manner.
Implants do not change to match changes in body weight. One thing is clear; unlike natural breasts, implants do not change the shape or size over time. The size of the breast implanted will not change itself no matter how many changes take place in other parts of the body. If you lose or gain a significant amount of weight, the size of your breasts will still remain the same.
If you have had radiation therapy, your skin may not respond well to the tissue expander. The tissue expander might not be a good option if you have had radiation therapy during breast cancer. Due to the application of radiation on the site of breast cancer, the skin gets scarring and becomes less responsive to the tissue expansion process. Thus makes the process riskier.
Complications with the expander or implant may develop. About 4 to 5% women can develop an infection after tissue expander placement (first stage) and another 4 to 5% women may develop an infection after the exchange of the tissue expander with implant (second stage). As far as the single stage implant reconstruction is concerned, the risk rate is higher, which is about 10%. About 2% may experience bleeding (hematoma) or fluid collection (seroma) under the breast skin after these surgeries. All these complications are serious and might need hospitalization or re-operation. Your surgeon can consider removing the implant in case of infection.
In the long run, implants can also develop complications. Leakage rupture is the most common complications in this regard. Almost 10% of patients may face such kind of infection over the first 10 years of the surgery. It is worth mentioning that no reliable data is available to suggest the exact life of an implant. If an implant develops any kind of infection, the replacement becomes inevitable. This replacement surgery takes between 30 minutes to 1 hour of time. More intense surgery would be needed to remove loose infectious silicone gel implant. Solid of semi-solid silicone gel implants does not cause this problem.
Capsule formation or encapsulation is the second most common long-term complication. Scar tissue forms on the outside of all artificial devices when placed in the body. It does not cause any problem. Too much scar forms in 5 to 10% of the tissue expander reconstruction surgeries. This problem is more likely to be caused by silicone gel implants than saline implants. Scar tissue thus formed may cause pain and discomfort making implant hard when touched. In such cases, the scar tissue can be removed with a surgery. The chances are the implant also needs to be replaced. The formation of capsules can occur a few or years after the surgery.
Additional surgery might be needed if the implant shifts or settles after the surgery. As a result, wrinkle, dent, or change of position in the breast implant (contour irregularity or malposition) can be caused. As many as 7% women face this implant shift problem.
Implant – Latissimus Dorsi Flap Reconstruction
Surgeons often use the latissimus dorsi flap reconstruction, which is a variation of expander-implant reconstruction. It is used for additional coverage of the tissue expander and implant. It carries less fat than abdominally-based flaps and it is the only tissue flap that requires an implant to provide fill or volume for the new breast. If the breast site is previously radiated, surgeons generally use a combination of the lat dorsi and the tissue expander. This combination of two will provide healthy skin and muscle for tissue expansion. This technique is also used where the abdominal-based flaps are not available due to scarring from previous surgeries.
How is Lat Dorsi Reconstruction Performed?
To be specific, lat dorsi is a back muscle located next to your shoulder blade. Lat dorsi flap is raised off the underlying ribs by working through an incision in the upper or lower back (flank) thereby bringing with it an attached piece of overlying skin. The muscle skin flap is then brought from the back side to the mastectomy site. Here, the tissue expander is covered with the flap of the skin. The skin and flap are inset into the surrounding breast skin. The donor site is closed leaving a flat contour.
The tissue expansion will begin about two or four weeks after the placement. After the harvesting of the flap from the back on the mastectomy site, the process of reconstructions starts just like the ‘Two Staged Implant Reconstruction’ we have just discussed absolve. The expansion of the tissue takes place in an office or a clinic on a weekly basis. To achieve a desired level of expansion, we may need 4 to 8 expansions. At the end of the expansion, a rest period of 1 to 3 months starts. After taking the rest, patients undergo the second stage of the reconstruction. The second stage is marked by the replacement of the tissue expander with silicone gel or saline implants. The second stage is performed on an outpatient basis and after delivering general anesthesia.
Lat Dorsi Flaps: The Numbers
Lat dorsi flap typically requires 1 or 2 days hospital stay. This kind of reconstruction takes 2 or 4 hours to perform. For the next 4 weeks after the surgery, the patient needs to limit physical activities. Some women may heal completely before 4 weeks and get back to work. The process of healing and expansion can take between 2 – 3 months. The average time period between the initial flap/expander placement and later expander-implant exchange is between 3 to 5 months. The surgery for replacing expander with an implant is performed on an outpatient basis and limits the activities of the patient from 3 to 4 weeks.
Advantages of Lat Dorsi Flap Reconstruction
The advantages of lat dorsi flap reconstruction include the delivery of healthy and reliable skin and muscle for tissue expansion in the patients with previous radiation. Lat dorsi flap is the most reliable flap reconstruction after mastectomy as compared to all other flap reconstruction. It may suffer from circulation problem.
On the other hand, if the patient is not suitable for any other flap reconstruction, chances are lat dorsi flap may suit that patient. The people with medical issues and the people who have already donated abdominal flap can consider it as an option. Moreover, the people with excess fat or lack of fat can also take it.
Disadvantages of Lat Dorsi Flap Reconstruction
One of the disadvantages includes the used of the tissue expander and implant. Therefore, it also brings the disadvantages of tissue expander and implant-based breast reconstruction. For more details, you can refer to the disadvantages of implant reconstruction discussed above. If a patient plans to use her own body tissue for reconstruction without implants. It is still a major option for reconstruction. It leaves a new scar in the area outside of mastectomy site. It scar thus caused might become difficult to hide in summer clothes.
Just like other reconstruction methods, lat dorsi technique also has some risks. It is regarded as the most reliable flap but circulation problems may arise in the first few days of after surgery. 1% people may experience total flap loss; whereas, partial flap loss can also occur in 5% patients. 3 or 4 out of 100 patients may experience infections. 2 out of 100 patients may experience abnormal bleeding. So these problems discussed in this paragraph may require hospitalization or surgeries.
Breast Reconstruction Surgery in Dubai
Dubai has become a hub of plastic surgery especially the breast reconstruction surgery. With state of the art medical & healthcare facilities, your breast reconstruction surgery in Dubai is going to be hassle free. At breast surgery clinic in Dubai we offer the complete range of breast reconstruction procedures under supervision of expert and certified surgeons.
Breast Reconstruction Cost in Dubai
Breast Reconstruction Cost in Dubai starts from $1,350 or AED 50,000 and can increase depending upon the type of treatment you have opted for.
Due to the difference in the techniques of reconstruction, the Breast Reconstruction Cost in Dubai varies with each technique. Moreover, the breast reconstruction cost in Dubai also depends on the nature of the problem facing the patient. We are going to give a hint of estimated starting cost of breast reconstruction techniques. So the following are these different techniques;
- Breast Reconstruction Cost Using Flap Technique:
As its name suggests, a flap of the skin of the same person is used to reconstruct the breast. A flap reconstruction costs more than an implant reconstruction. The cost of flap breast reconstruction at Breast Surgery Clinic Dubai starts from $28,000 or 100,000AED per breast.
- Breast Reconstruction Cost Using Implants Technique:
As its name suggests, an implant is used to give the breast the right shape and volume. The cost of implant breast reconstruction at Breast Surgery Clinic Dubai starts from $28,000 or 100,000AED .
- Breast Reconstruction Cost Using Fat Grafting:
Fat can also be grafted into the breast to reconstruct it. The cost of the combination of implant and flap breast reconstruction at Breast Surgery Clinic Dubai starts from 100,000AED ($28,000) for one breast.
Breast Surgery Clinic Dubai is the leading breast treatment clinic in the UAE. We provide all kinds of breast surgical and non-surgical treatments at a reasonable cost. If you need more information, please sign up for a free consultation with one of our board-certified plastic surgeons in Dubai.