Mastectomy means the surgical removal of the breast for the treatment of breast cancer. This leaves the patient often devastated as it deals a severe blow to the feminine body image. Not many people are aware that it is possible to recreate the breast surgically.

The reconstructive option has been available for the last few decades and has undergone tremendous improvisation in the last few years. Spreading awareness about this helps patients make an informed decision and brings hope into their lives.

The external breast prosthesis [a padding beneath the bra] is the only well-known alternative to a flat chest following mastectomy. Though it helps to minimize the lop-sided or unbalanced feeling of a missing breast, it is a poor match to the currently available reconstructive options in terms of patient satisfaction , emotional well-being and enhancement of body image.

Reconstruction involves recreating a breast mound to match the opposite normal breast in size, shape and texture. Further stages are added to recreate the nipple, areola and fine tuning of the opposite breast to produce better symmetry. This can be done either at the same time as the mastectomy [immediate reconstruction] or as a delayed procedure several months or years later

The basic types are using an implant or using the patient's own body tissues [autogenous reconstruction].The first procedure consists of creating a pocket beneath the chest muscle and putting a silicone gel prosthesis. This is a simpler operation with a quicker recovery period. The downside is that the final aesthetics and feel are much inferior to the second option.

The autogenous reconstruction involves a flap of tissue[consisting of muscle,fat and skin with its own blood supply ] mobilized either from the back[Latissimusdorsi] or the tummy [rectus abdominis].The latest in this list is a DIEP flap which applies a microsurgical technique. These are comparatively complex operations with longer recovery times, 3-4 weeks for the back and 4-6 weeks for the tummy. But the breast looks and feels more natural. The latest technique involves the use of a modification of the TRAM flap called the DIEP flap. This is is a microsurgical technique

With the advances in the management of cancer, more patients are cured of the disease. Reconstructing the breast is a further attempt to restore a near normal life to the patients. The benefits to the patient's psyche and partner satisfaction are well-established in several studies in the UK and US . No wonder the improvement in quality of life indices is comparable to those having a coronary by-pass operation.

Other common procedures regarding the breasts are

Mastopexy or breast lift - This involves correction of the drooping breasts following childbirth or weightloss.

Breast augmentation - This consists of improving the size and shape of the breasts using silicone gel implants for those who have small breasts.

Breast reduction - Large breasts can cause problems such as neck pain, shoulder pain , recurrent fungal infections , grooving bra straps or may be considered an embarrassment.

The reduction surgery aims to reshape the breasts into small, pert attractive structures with minimal scarrin

Dr.Vidya Subramaniyan MBBS, MS, MCh, FRCS[Edin] is a Consultant Plastic Surgeon at Lifeline Hospitals.