bilateral breast augmentation

breast reconstruction surgery is a vital componentof a breast cancer treatment plan. breast reconstruction surgery can be done immediatelyafter mastectomy or in a delayed operation depending on whether post-mastectomy radiationtherapy will be necessary. immediate reconstruction offers better aesthetic results if radiationis not needed. when radiation is required, delayed reconstruction is preferred to avoidpossible complications. there are two main categories of reconstructionprocedures: breast implant and natural tissue breast reconstruction.breast implant involves insertion of a prosthesis made of synthetic material. a typical breastimplant has a silicone shell and is filled with saline or silicone gel. breast implantis the simplest of all procedures and requires

the shortest initial hospital stay. however,as a result of the body's response to foreign material, the implant may be squeezed withinscar tissues leading to distorted shape, leak, rupture and infection. in fact, as many ashalf of all women will require surgery to remove the implant later in life.natural tissue breast reconstruction surgeries use the body's own tissue for the new breast.in this type of procedure, a flap - a section of skin, fat, and possibly muscle - is harvestedfrom a donor site elsewhere in the body and transferred to the chest to make the new breast.possible tissue donor sites include: lower abdomen, back, buttock and inner thigh. thelower abdomen is by far the preferred donor site as it comes with a bonus of a flattertummy after operation. the use of autologous

tissue allows the reconstruction of a breastwhich looks and feels most like a normal breast. more importantly, this also solves the problemof the new breast being rejected by the body's immune system. however, compared to breastimplant, natural tissue reconstruction requires longer initial hospital stay. it also resultsin additional scar and possible weakening of the donor site due to loss of muscle.the technique of natural tissue breast reconstruction has evolved significantly over time.the first of all natural tissue reconstruction procedures is the transverse rectus abdominusmyocutaneous flap – or tram flap. in the original technique, called the pedicled tramflap, a section of skin and fat attached to a piece of the rectus abdominis muscle – thesix-pack muscle - is cut from the lower abdomen.

the flap remains attached to the body by thepiece of muscle. the flap is then rotated together with the muscle and passed underthe skin to the new location in the chest. here, it is shaped to form the new breast.the new breast is supplied by the blood vessels that run inside the rectus abdominis muscle.a piece of synthetic mesh is placed in the abdomen to provide support for the abdominalwall. the disadvantages of this technique include weakening of the abdominal wall dueto significant loss of muscle. tethering of the flap to the body also makes it harderto be configured into the desired shape. free tram flap is an improvement from theoriginal technique. in this procedure, a section of skin, fat and part of the rectus abdominismuscle with blood vessels within it, is separated

completely from the body and transferred tothe breast location. the blood vessels of the flap – the deep inferior epigastricartery and vein - are connected to recipient blood vessels in the breast using microsurgerytechniques. free flaps are easier to sculpt into the desired shape. blood supply to thenew breast is also more robust this way. however, this technique requires microsurgery expertiseand therefore is not offered by many surgeons. the amount of muscle loss from the abdomenremains significant. deep inferior epigastric perforator flap,or diep flap, is a significant advancement from tram flaps. in this procedure, the bloodvessels – the deep inferior epigastric artery and vein - are meticulously dissected fromthe abdominal muscle. while an incision is

made in the rectus abdominis for this purpose,no muscle is removed. the blood vessels of the flap are then connected to the recipientvessels in the breast using microsurgery. because no muscle is lost from the abdomen,the abdominal wall is not weakened after a diep flap procedure.another procedure – the siea flap - is based on a different set of blood vessels - thesuperficial inferior epigastric artery and vein. these vessels supply the skin and fattissue of the abdomen and run within the fat layer. with this flap, the abdominal muscleis left untouched. this is therefore the preferred technique whenever it is possible. the reasonwhy this is not more widely used is because these vessels are not large enough in 90%of patients. commonly, these superficial blood

vessels are approached first during surgery.if they are big enough, a siea flap will be used, if not, a diep flap will be performedinstead.