Breast Reconstruction surgery is a broad category of reconstructive surgery.
The precise type of reconstruction depends on your general health, previous treatments, downtime acceptance and also your suitability for any given procedure.
Breast reconstruction should be planned in advance of any breast cancer treatment ideally and it is aimed at replacing what is missing. It can be performed at the time of the cancer removal surgery (immediate) or afterwards (delayed).
It often involves more than one surgery for further adjustments to create symmetry.
Breast Reconstruction surgery is a broad category of reconstructive surgery.
The precise type of reconstruction depends on your general health, previous treatments, downtime acceptance and also your suitability for any given procedure.
Breast reconstruction should be planned in advance of any breast cancer treatment ideally and it is aimed at replacing what is missing. It can be performed at the time of the cancer removal surgery (immediate) or afterwards (delayed).
It often involves more than one surgery for further adjustments to create symmetry.
Reconstruction can be broadly categorized into using your own tissue (autologous) or using a breast implant. There can also be combinations of these approaches. For the purposes of this description, reconstruction of your breast with your own tissue (autologous reconstruction) using excess abdominal tissue to reconstruct one or both breasts will be described.
This technique is known as a DIEP flap surgery. DIEP stands for ‘deep inferior epigastric artery perforator’ flap and describes the blood supply of the abdominal tissue. This is the most advanced technique in breast reconstruction. It offers the advantage of being your own tissue which behaves like normal breast tissue and so therefore is a ‘like for like’ when it comes to tissue replacement.
The surgery requires adequate abdominal tissue to be available as tissue is removed much like a tummy tuck. This is performed through a very low incision that usually runs hip to hip depending on the extent of the laxity of the skin and the excess fat. It also involves cutting around the existing belly button. This results in a low scar from hip to hip and also a scar around the belly button.
This tissue is removed from its blood supply and reconnected to blood supply in the chest and the tissue is shaped to recreate a breast shape.
This is a lengthy, highly technical reconstructive procedure and is performed under a general anaesthetic.
What is the aim of breast reconstructive surgery?
To reconstruct missing breast tissue. This can involve skin, breast gland (volume), areola and nipple tissue on one or both sides.
How long will the results last?
There are changes in the breast tissue with age, weight gain, exercise, weight loss and also pregnancy.
The results of the breast reconstruction will withstand well over time but the above factors will inevitably have effects on the tissues especially untreated breast tissue.
This varies from patient to patient and can be difficult to predict.
It often involves more than one surgery for further adjustments to create symmetry.
What happens on the day of surgery?
Prior to the day of surgery you will be given the following information and it is critical to know these details ahead of time:
On the day of surgery you will be checked in by a nurse and all your details will be confirmed and you will be changed into a surgical gown.
Dr Rory will see you before your surgery to run through all the details of the surgery, the consent forms as well as performing all your surgical markings. Multiple ID checks and procedure confirmation will be performed prior to your operation as safety is a priority.
After your surgery Dr Rory will notify your friends or family to let them know the procedure has finished and put their mind at ease. Depending on the procedure he will see you after the surgery and discuss the procedure.
When you are feeling comfortable, the team will then allow you to be discharged as planned that morning. All medicines and instructions will be given to you on your discharge.
You will be discharged with a binder, which is an adjustable support garment.
How long will the surgery take?
If done in isolation, the surgery takes approximately four to five hours. This is highly variable as other procedures are performed in conjunction with DIEP flap reconstruction.
This does not include anaesthesia time. In total, the whole procedure may last longer.
Will the procedure be painful?
No, one of the primary aims of any procedure performed by Dr Rory is to create a pain free experience.
A long acting local anaesthetic agent is injected at the end of the procedure within the tightened muscle (if performed) and the wound to make you comfortable and a garment will be applied to help minimize swelling and add support.
In terms of recovery, there will be some tenderness in the surgical areas and some discomfort.
As your abdomen has been tightened up you will inevitably be hunched over for the first few days and your back will start to ache. This resolves once you stand up straight. The point at which you can stand straight varies between individuals.
Dr Rory does not used drains which again makes the procedure more comfortable. He use a drainless abdominoplasty/DIEP flap technique with internal stitches.
What is the recovery period?
This is a major procedure and so the recovery is two weeks.
During this time you can fully mobilise and are encouraged to walk around and use your arms and are encourage to do so with care.
The golden rule is no heavy lifting for the first month following the surgery or any abdominal (core) exercises.
What should I consider when recovering from the procedure?
There will be a specialized skin glue placed on the surgical areas of the breast and the abdomen and a splash proof dressing. This will allow you to shower with care. The garment should be removed before showering.
No heavy exertional activity that will cause excessive sweating, heavy lifting or jerking abdominal movements in the four weeks. This is to protect the repair of the abdominal muscles and also avoids tension in the scar.
The specialized skin glue will peel off at week three to four. At this time, a silicone based strip or gel should be applied to the dry healed scar in order to minimize the final appearance of the scar.
The garment should be worn for four to six weeks after your DIEP flap reconstruction.
The final results in terms of resolution of swelling will be at approximately four months and also the new breast shape will develop due to gravity over six to twelve months.
As you attend your wound check appointments you will see the skin glue as purple and very often the skin can appear gathered at the wound edges. This gathering of the skin will flatten over time.
The final appearance of your scars will be at eighteen months.
The scar from a DIEP flap are similar to that of an abdominoplasty scar in that it is like the handle bars of a bicycle and curves down at the edges. This is to ensure your scar is hidden by the bikini line.
What is the cost of the procedure?
The cost of the procedure starts at 125,000 AED (excluding VAT).
The final cost is determined on a case by case basis dependent on complexity and additional procedures. Combination surgeries will lower the price of individual surgeries if done together.
A full surgical no-commitment consultation with Dr Rory will provide all the necessary details for your particular case.
What are the risks of the procedure?
These include some discomfort, infection, risk of bleeding, seroma (collection of fluid), swollen abdomen, degrees of asymmetry, back pain, dog ear (bumps at the ends of wounds), recurrence of the muscle gap due to activity in the healing phase, wound breakdown, delayed wound healing, flap failure and other additional procedures.
Very often you can feel bloated after the surgery and there can be a change in your bowel habit. This varies between patients.
The final results in terms of resolution of swelling will be at approximately four months. This varies between patients.
Smokers face increased risk of flap failure, delayed wound healing and poorer quality scars generally from most surgeries. Dr Rory is therefore very strict when it comes to smoking and DIEP flap surgery surgery. You are advised to stop smoking one month before and after this surgery.
In the event of DIEP flap failure, other techniques using implants and muscle and skin from the back are used.
There is also the risk of stretching of the scar and excessive scarring such as hypetrophic or keloid scarring.
Anything in particularly important I should know about the procedure?
It’s a lengthy and technically demanding procedure requiring a three to five day stay in hospital with very high satisfaction rates if you are willing to accept the scarring which will fade over time.
Its critical not to heavy lift in the first four weeks.
The back pain during recovery is something most people experience due to not being able to stand up stand for the first few days.
Very often you can feel bloated after the surgery and there can be a change in your bowel habit.
The final results in terms of resolution of swelling will be at approximately four months. This varies between patients.
It is most commonly performed in conjunction with other procedures over time.
What is the follow up after the procedure?
Each patient has a follow up schedule that is different.
You will be advised by Dr Rory and his team your particular follow up journey.
Typically it involves seeing the team a week after surgery for a wound check, then protective dressings until the glue falls off.
Thereafter, scar checks are performed at the six week point. This schedule will differ between individuals.
You will have a separate follow up for cancer surveillance.
Who is involved in my care?
Dr Rory is the primary physician in charge of all your care. He performs all procedures himself and is meticulous about every aspect of your care.
Once he has performed a procedure on you he is available for you as your on-call doctor.
He will provide you with contact details and will be available for you. If you have any questions or concerns at any time he is available to support you.
He has trained his team around him to an exceptionally high standard from his aesthetic coordinators to aesthetic nurses.
In some instances, for example, for photography, garment fitting, wound dressings, checks or removal of stitches, his highly trained team will perform the care liasing directly with Dr Rory with real time updates.
