Around one in eight women in many developed countries will develop invasive breast cancer at some stage in their lives. While an increasing number of women are able to have breast conserving therapy for the disease, for many women who develop breast cancer a mastectomy is a necessity to help ensure the cancer does not return. In this case, breast reconstruction is undertaken by a significant proportion of women. We look at the advanced techniques that Thai cosmetic surgeons are using to help women who must have mastectomies, as well as the future of breast reconstruction materials and processes.

Much of the help that Thai cosmetic surgery hospitals like Bangkok Hospital, Phuket Hospital and Koh Chang International Clinic have had with breast reconstruction has come from new products and materials available. In recent years, many surgeons at Thai cosmetic hospitals have begun using Alloderm to support the crease inside the breast, the inframammary crease. Then the tissue expander and implant can be covered by real tissue. Alloderm is a biological product which supports the body\'s own efforts to heal. It is basically donated human tissue, however with some components, like the cells that can lead to tissue rejection and the epidermis removed. A matrix of natural biological components is left for the Thailand cosmetic hospital to implant, which the body can build on by itself.

Medical tourism for cosmetic surgery is also often preferred by women, for the advanced techniques like oncoplastic breast reconstruction being offered in Thailand. The principles of aesthetics and plastic surgery are applied to the reconstructive process, and the process starts not with the Thai cosmetic surgery doctor, but with the oncological surgeon at a major hospital like Wattanosoth Cancer Hospital. If all of the breast skin can be left behind during mastectomy, but all of the tissue taken, a much more successful reconstruction can be made. Previously, surgeons would always make an elliptical cut to remove breast tissue, but with modified skin incisions the reconstruction process is much more natural looking. Incisions are now placed vertically, creating a more protruding, slightly conical breast, with the scars preferably placed.

In the future, it is expected that one of the major advances in breast reconstruction at cosmetic surgery hospitals will be the use of synthetic products to complement a patient\'s own fat and tissue. Alloderm is one example, and the same company that makes this revolutionary product makes a supporting one called Strattice. This reconstructive tissue matrix is derived from pig, rather than human skin, so is more freely available, but just like Alloderm the components that cause xenogeneic rejection are removed. With Strattice, white cells begin to migrate as soon as 2 weeks after implantation, and the network of blood vessels has matured as soon as 6 months after implantation.

Thai cosmetic surgery hospitals like Pattaya Hospital are also open to new ideas like the muscle sparing flaps, as well as gluteal free flaps. The muscle sparing flaps don\'t need the rectus abdominus to hold the weight of the skin pedicle, while gluteal free flaps are more of a microsurgical specialty. The cosmetic surgery hospital must liaise with the oncological hospital (Wattanosoth or other large cancer hospital) to ensure that the right skin and tissue is preserved for this reconstruction technique, while still removing all possibly cancerous tissue.