Breast augmentation surgery is divided into:
1. Autologous fat transplantation (The higher the BMI, the body has enough fat to carry out autologous fat transplantation.)
2. Falsies implantation
Every falsies material has their own advantages and disadvantages:
The latest water droplets jelly silicone (fifth generation)
Smooth surface jelly silicone (fourth generation)
Salt water bag
 
Every falsies material has their own advantages and disadvantages:
A. The latest water droplets jelly silicone (fifth generation) (hair surface water droplets jelly silicone)
Touch: elastic, feel natural
Whether the need for massage after surgery: no, because the villi surface structure is relatively not easy to form a capsule contracture.
Surgical wound size: about 4 to 5 cm
Recommended surgical method: the lower edge of the breast> armpit> areola
Case of rupture: chest shape will not shrink, but may feel the shape change, it is recommended to do MRI inspection
 
B. Smooth surface jelly silicone (fourth generation)
Touch in case of rupture: 1.5: elastic, the most natural touch
Whether or not massage is required after surgery: Yes, because the smooth surface structure has a little chance to form a capsule contracture.
Surgical wound size: about 4 to 5 cm
Recommended surgical approach: the lower edge of the breast> armpit> areola
Case of rupture: chest shape will not shrink, but may feel the shape change, it is recommended to do MRI inspection.
C. salt water bag
Touch: a little lack of elastic feeling, sometimes squeeze the water will have a sense of volatility, may touch the edge of the fold.
need a massage after surgery: Yes.
Surgical wound size: about 3 to 4 cm
Recommended surgical approach: the lower edge of the breast> armpit> areola >navel
Case of rupture: chest shrink, salt water absorbed by the body.

On the choice of breast augmentation surgery, as well as the advantages and disadvantages of various locations:
 

1. the lower edge of the breast
   Method: surgical entrance is located at the lower edge of the breast, that is, when usually wear underwear, underwear steel ring will block the place. The incision of the location, can look directly very clear at the organization and full of stripping, not easy to cause additional damage to the nearby tissue, the pain will be the lowest.
   
   Location: The breast after the breast augmentation, just can cover the scar, is not easy to discover from the front and side, do not have to worry about the armpit exposed when wearing a thin shoulder strap, sleeveless shirt, and bikini is just cover as well. Widely accepted in Europe and the United States, in recent years, the Asian region, including South Korea, Taiwan, the ratio of selecting this surgery is also getting higher and higher.
   
   Recovery: the lower edge of the chest most of the wound recovered very well.
    
2. Armpit
   Way: choose the most depression place under the armpit for incision, and then use endoscopic for assistance, stripped the organization, put the falsies in. Because the armpit is far from the breast tissue, so it is recommended to use endoscopic assistance in order to accurately isolate the correct space to implant the falsies.
   
   Location: Although at the most depressed place of the armpit, but if the care is not perfect after surgery, occasionally also see the scar turning wide, scar appear pigmentation or scar depression, in the case of choose dressing, such as thin shoulder strap, sleeveless shirts or bikini are subject to the scars condition.
   
   Recovery: As the wound at the armpit, after surgery massage will not affect the wound healing, most of the armpit wounds are recovered well. If you have a scar body, usually used to wear the cloth easy to expose the armpit, then the surgical approach of the incision may need to be assessed.
    
3. AreolaMethod: from the lower edge of the areola proceed operation, the location of the incision close to the organization to be stripped, can clearly look directly at the organization, and can be fully peeled. Unfortunately, due to the incision through breast tissue, if the physician is lack of experience, may hurt part of the breast, may also affect the feeling of the nipple, the infection rate is slightly higher. The chance of capsule contracture is also a little higher.
   
   Location: the lower edge of the areola, and occasionally there will be wound depression or some micro-wrinkles fold and shrink. And the color of the scar is usually lighter than the areola itself.
   
   Recovery: Most of the cases, the areola wound is usually healing well.
    
4. Navel
   Method: through the location around the navel to open a cut, implant the falsies, but because the distance from the breast surgery path is far, the incision is too small, and therefore can only be placed salt water bag material falsies for surgery, cannot choose jelly silicone falsies.
   
   Location: navel upper edge.
   
   Recovery: the navel parts are easier to filth, so the risk of infection is slightly higher, and the surgical incision location is away from the place of falsies implantation location away, so the shape of the breast is not easy to control.

Breast reconstruction surgery is an orthopedic surgeon who reconstructs all or part of a breast that has been removed by surgery and can be reconstructed by using a breast implant or another part of the body. The purpose of breast reconstruction surgery is to make patients because of breast cancer cut the breasts, after wearing clothes the breast appears natural and balanced.
 
With the progress of breast cancer treatment, there are many options of breast reconstruction surgery, plastic surgeon can be in the mastectomy or after the mastectomy re-establishment of a breast, but also to correct breast deformity after breast surgery, suitable for breast reconstruction patients:
• Diagnosis of breast cancer, will carry out breast cancer and mastectomy (surgical resection of the tumor and all breasts)
• Diagnosis of breast cancer, breast cancer resection and breast preservation surgery, such as partial mastectomy or breast tumor resection (surgical resection of the tumor and part of the breast)
• Discovery genetic mutations in , will have preventive mastectomy (resection of non-cancerous breasts for breast cancer prevention)
 
Immediate and delayed reconstruction: In most cases, breast reconstruction can be done at the same time with mastectomy and is called "immediate reconstruction", if proceed in weeks, months or years later, this is the so-called "delayed reconstruction". The decision on immediate and delayed reconstruction depends on many factors, including:
• Breast cancer stage
• your condition
• Your preferences and lifestyle
• whether other treatments are needed (for example radiotherapy)
 

Benefits of immediately rebuilt: Can reduce social or emotional problems Beauty effect is good May reduce the number of operations and the cost of surgery Unrelated to cancer recurrence and development speed Unrelated to detect local cancer recurrence Will not delay cancer treatment	Benefits of delayed reconstruction: Additional cancer treatments (such as radiation therapy) do not affect reconstruction So that patients have more time to consider the breast reconstruction program
Disadvantages of immediate reconstruction: It is more difficult to detect if the skin of the breast has a problem during surgery Longer hospitalization and recovery time More scars	Disadvantages of delayed reconstruction: Chest mastectomy scar Need to re-operation and recovery time Sometimes it's hard to rebuild scars

 
Breast reconstruction surgery can be divided into three categories:
1. Implant (tissue dilator, saline falsies, jelly silicone falsies, water droplets jelly silicone falsies)
See article: Breast Reconstruction (II) Reconstruction with Implants
2. Your body tissue (rectus abdominis flap, back muscle flap)
See article: Breast Reconstruction (III) Abdominal tissue reconstruction
3. Implant combine with their own body tissue (falsies+ back muscle flap)
 
In October 1998, the US Congress passed the Women's Health and Cancer Rights Act, which required group medical and personal health insurance to cover the mastectomy after breast reconstruction surgery. Under normal circumstances, the law states that these should include:
• Breast reconstruction after breast surgery
• The operation of the side breast makes it a symmetrical appearance with the reconstructed breast
• All stages after implants (falsies) and mastectomy include rehabilitation
 
Dr. Xie Chenghan: In Taiwan, the current health insurance does not pay, and part of the commercial insurance will pay full or partial payment. Please contact your insurance company to ensure that your operating costs are provided by the insurance company.

Q1. Do I need a breast reconstruction surgery?
Ans: Some breast cancer patients decide that they do not rebuild, or do not want to undergo any further surgery. However, breast cancer patients can still choose to wear prosthesis (artificial breast), or the use of clothing shelter.
 
Q2. What breast reconstruction options do I have if I will receive a mastectomy?
Ans: Reconstruction surgery can be divided into three categories:

1. Implant (tissue dilator, saline falsies, jelly silicone falsies, water droplets jelly silicone falsies)
2. Your body tissue (rectus abdominis flap, back muscle flap)
3. Implant combine with their own body tissue (falsies+ back muscle flap) 

All reconstruction operations may require one or more surgeries and take some time to complete.

Q3. How long do you need to prepare for breast reconstruction?
Ans: The time required for breast reconstruction varies from person to person, depending on how much surgery is needed and need to cooperate with the treatment of cancer. The reconstruction process generally takes 6 months to one year, especially early cancer without further treatment. There is a common rebuild schedule:

1. The first operation to rebuild the breast shape, waiting for about three months to heal, if you need chemotherapy or radiation therapy the time will increase.
2. Surgical modification or balance the already been do the first reconstruction operation breast, waiting for about 2 to 3 months to heal, if necessary, the steps can be repeated.
3. Surgery reconstruction of nipples and areola.

 
Q4. What if my rebuild breast and my original natural breast asymmetry? How to do?
Ans: The ultimate goal of breast reconstruction is to create a symmetrical breast, especially when wearing clothing cannot found the difference, but the reconstruction and the original natural breast to be exactly the same is very difficult. For some patients, the following can be used to improve the asymmetric situation:

1. Implant the implant into a natural breast to make it larger (breast augmentation surgery)
2. Reduction of natural breast tissue (shrinkage surgery)
3. Improve breast position (breast fixation)

Q5. If I need chemotherapy?
Ans: Breast reconstruction should not delay the chemotherapy, usually your oncologist will wait for your mastectomy and rebuild the wound after healing before starting, if there are complications such as wound healing problems or infection, chemotherapy may be delayed. If you are receiving tissue expansion (tissue dilator), chemotherapy can be done on time, until the chemotherapy is completed, your plastic surgeon usually wait at least a month later, and then consider further reconstruction surgery.
 
Q6. What if i need radiotherapy (electrotherapy)?
Ans: You may have to complete the radiotherapy until you have to undergo a delayed breast reconstruction because radiotherapy may damage your rebuild and affect the final cosmetic effect. If you need radiotherapy, your plastic surgeon may advise you to use your organization for delayed breast reconstruction. If the "implant" is used for breast reconstruction, the risk of reconstruction will be higher because radiotherapy often leads to incidental complications include:

• Infection
• Severe capsular contracture (Hardened scar tissue around the implant)
• Hydrops
• Poor cosmetic performance

If you need radiotherapy, mastectomy can still be placed tissue dilator after mastectomy, tissue dilator can keep the skin "area", it provides a breast shape, 6 to 8 weeks after radiotherapy treatment, you and your doctor can plan the next reconstruction, you can use the choice of autologous tissue or falsies to implant, but this still needs detailed planning and discussion.
 
Q7. The risk of breast reconstruction surgery?
Ans: Pain, bleeding, infection, wound healing problems, sensory changes, fluid accumulation (such as hematoma and serum swollen), scarring, hernia, flap partial or complete loss, implant loss, asymmetry, limited cosmetic effect and so on.

In October 1998, the US Congress passed the Women's Health and Cancer Rights Act, which required group medical and personal health insurance to cover the mastectomy after breast reconstruction surgery. Under normal circumstances, the law states that these should include:
• Breast reconstruction after breast surgery
• The operation of the side breast makes it a symmetrical appearance with the reconstructed breast
• All stages after implants (falsies) and mastectomy include rehabilitation
 
Dr. Xie Chenghan: In Taiwan, the current health insurance does not pay, and part of the commercial insurance will pay full or partial payment. Please contact your insurance company to ensure that your operating costs are provided by the insurance company.
 

Reconstruction of the breasts with implants (tissue dilator and falsies) is usually a two-stage operation:
Implant-based breast reconstruction is a more widely accepted surgical procedure, without the use of another part of the body and get acceptable aesthetic results. In addition to the first stage of the reconstructed tissue dilator, the second stage of breast reconstruction has two types of implants: physiological saline falsies and jelly silicate yogurt falsies (including round jelly silicate falsies and water droplets jelly silicate falsies).
 
These two kinds of implants have a large number of shapes, sizes and, contour and the FDA has been confessed to the safety of silicone falsies, and your surgeon will help you determine which implant is best for you, The implant is usually not sagging, but in the upper part of the breast will be more obvious.
 
Depending on the lifestyle and preferences, the patient can choose implant(falsies) based reconstruction, use implant (falsies) to reconstruct which is more suitable is that the patient has enough skin "area" to implant (keep the skin for breast resection), it is not suitable for patients who do not have enough tissue to do self-tissue breast reconstruction, or do not want to use own tissue to rebuild, or even have a history of radiation therapy.
 

Advantages of implant (falsies) breast reconstruction Reduce surgery and recovery time Less scars Good shape

Disadvantage of implant (falsies) breast reconstruction The tissue expansion process requires more frequent retreat Two-stage process: After the expansion of the tissue then replace the permanent implant (falsies) Because the skin is thin, it is more difficult to rebuild the nipple More difficult to have symmetrical and natural breasts More than at least one operation (two stages)

 
About the mastectomy, orthopedic surgeons will be placed in a tissue dilator (balloon filled with saline) under the muscle and skin to form a pocket with the chest wall, after wound healing, and then gradually add the physiological saline solution into the tissue dilator, Stretching the muscles and skin to the desired size to create a suitable skin area that will shrink slightly when the tissue dilator is removed and replaced with permanent falsies.
 
The process of tissue expansion usually takes 2-3 months, but if other cancer treatments patients are needed, such as chemotherapy, the expansion process may take longer. Once the "skin area" has reached the desired size, the tissue dilator will remain in the same place to keep the same size, continue stretching the skin for about 1-3 months, then arrange for the outpatient surgery, remove tissue dilator and implant permanent Implant (falsies). Permanent implants will use brine falsies, jelly silicone or water droplets jelly silicate falsies.
 

Abdominal wall flap (transverse rectus flap): Exclusive blood supply includes skin, fat and muscle tissue.
Use the abdomen to re-create a breast to provide the most natural results, the specific results depend on your abdomen's tissue size, health level and your plastic surgeon skills and experience.
 
Your belly wall is composed of multiple layers, the skin is the outermost layer, under the skin is a layer of fat. This is followed by another layer of tissue, called fascia, which is firm and helps to prevent your intestines from protruding, the fascia has a layer of muscle called the rectus abdominis, the tissue taken from your abdomen includes a few of these several layers, so surgery will not enter the abdominal cavity, after surgery can immediately drink water, will not be affected, your intestines are completely undisturbed, strictly speaking, this is more easy surgery compare to the caesarean section area surgery.
 

Advantages of abdominal wall flap breast reconstruction: Natural chest type, texture consistent (completely self-tissue) Improve the abdomen shape (reduced abdomen) No implant

Disadvantage of abdominal flap breast reconstruction: Longer operation time Need plastic surgeons with experience and technology There are scars on the stomach Longer hospitalization and recovery time

After getting your satisfaction from the shape and size of the breasts, you may consider taking the reconstruction of nipples and areola. The first thing to remind that is the nipples created by your plastic surgeon will not be like your natural nipples, it will not be flattened or changed by temperature, touch, and will not feel, so many people get satisfied breast shape and size, even if there is no reconstruction of the nipple is still quite satisfactory.
 
Nipple reconstruction method:

1. The skin used for your breast reconstruction
2. Take a part of the natural nipple from the other side of the breast (if it is large enough) and transplant it to the reconstructed breast. This does not require hospitalization, just arrange outpatient surgery.

Areola reconstruction method:

1. The most common reconstruction method for areola is tattooing. (There are a variety of colors available to create a natural areola, the areola tattoo is usually painless, and can be carried out in the outpatient environment, the tattoo will fade with time, so it may need to re-pattern after a few years.
2. Skin graft, usually take the skin from inside your lips or waist skin, re-implanted to the reconstruction of the nipple.

Before surgery, please look at the following contents and explain, mark the unclear place, and communicate with the physician at the clinic.
 
一、Preoperative precautions

• The clinic accept scheduled surgery date three months in advance, and is retained until the last week for the final confirm, If the clinic is unable to confirm for the time being, the clinic may transfer the scheduled date to another surgery patient.
• Surgical X-ray and physical examination should be completed one week in advance, the most urgent need three days to complete. (This clinic must accept the medical report of other medical institutions, must be within three months, and meet the requirements of surgical examination items.
• X-ray and physical examination results will be informed by telephone to the surgery patient, meets the surgical safety standards then can confirm the operation; does not meet the standard, it is recommended to give up surgery, or to suspend surgery. Re-test after three months, if still does not meet the standard, it is recommended to give up surgery.
• Try to relax and stay physically before surgery, stop all noninvasive drug intake, including diet pills, anticoagulant drugs or traditional Chinese medicine, and nutritional supplements for unknown ingredients.
• One day before the operation, the clinic will interview by telephone to remind the anesthesia before the note, and do the surgery final confirmation.
• Surgery patient should arrange at least one week after surgery necessities of life,  avoid inconvenient going out after postoperative swelling. (For facial bone surgery to be prepared with liquid food and children's toothbrush)
• Do not drive yourself on the day of anesthesia. Please arrange for family or friends for transfer, or the clinic will arrange for transportation.
• Remember to carry sunglasses, hats, masks or scarves when perform a facial surgery, convenient for cover when return home, to avoid embarrassment.

 
二、Take the initiative to inform the physician whether the abnormal physiological condition or disease, including:  
三、The need for facial bone surgery to complete the following preoperative examination items

Ａ. X-ray photography:

• P-A View
• Cephalometric View
• Panoramic View

Ｂ. Physical examination:

1. Electrocardiogram (EKG)
2. Blood test

• General blood test (CBC routine)
• Prothrombin Time (PT)
• APTT
• Blood type
• Rh factor
• Glucose AC
• Cholesterol
• Liver function (GOT / GPT or AST / ALT)
• Renal function (BUN, Creatinine)
• Hepatitis B (HBsAg)

Ｃ. Urine examination