Rebuild the body.Restore possibility.

Breast Reconstruction

Breast reconstruction rebuilds a breast lost through cancer surgery. There are two principal approaches.

Using the Patient’s Own Tissue (Autologous Reconstruction)

Skin and fat are transferred with their blood supply from the abdomen or thigh to the breast, and the vessels are connected under the microscope. The reconstructed breast tends to feel soft, age naturally, and remain stable over time. The trade-offs are a longer operation and a scar at the donor site.

The donor site is selected together after considering body habitus, plans for pregnancy, previous operations, and patient preference.

Using an Implant

A tissue expander is used to stretch the skin before placement of a silicone implant. This avoids creating a new donor-site scar and shortens operating time. Suitability depends on factors including radiation therapy and skin condition.

What I Emphasize

Preoperative ultrasound is used to map the vessels and select the least invasive suitable flap. For example, when an SIEA flap can be used safely, I favor it over a DIEP flap. When exposing the internal mammary recipient vessels, my standard approach is to preserve the costal cartilage.

I also use intraoperative ICG fluorescence angiography to confirm perfusion of the transferred tissue rather than relying on appearance alone.

Liposuction and Fat Grafting After Reconstruction

After breast reconstruction, concerns about asymmetry, contour, or residual hollows are common. Fat grafting can refine the reconstructed side, while liposuction may help balance the opposite side.

This is the refinement stage of reconstruction. It requires the ability to read asymmetry in millimeters and place only the required volume in a plane where the graft can survive. This is precisely where reconstructive and aesthetic techniques overlap, and it is one reason I continue to practice both.

Breast reconstruction is not always completed in a single operation. The final result includes these refinements, which are considered from the initial surgical plan.

Nipple–Areola Reconstruction

Nipple–areola reconstruction may use local flaps to create nipple projection or graft part of the nipple–areola complex. Three-dimensional medical tattooing can also recreate visual depth. These procedures are provided at appropriate partner hospitals or clinics.

Liposuction, fat grafting, and three-dimensional medical tattooing are self-funded. The other breast-reconstruction treatments described here are covered by Japanese public health insurance.

Extremity & Trunk Reconstruction After Sarcoma Resection

In surgery for soft-tissue sarcoma or osteosarcoma, complete oncologic resection with an appropriate margin is the first priority. Skin, muscle, nerve, vessel, and bone may be removed together, leaving a wound that cannot be closed or a limb that cannot function. Reconstruction fills the defect during the same operation while preserving function where possible.

Minimizing Donor-Site Burden

This has been a particular focus of my work. Even in situations where a large muscle was traditionally transferred, preoperative ultrasound mapping of vascular anatomy can often allow reconstruction with a thin flap composed only of skin and fat. Preserving muscle also preserves strength at the donor site. The clinical effect of this approach has been reported in peer-reviewed publications.

Restoring Movement

The skin of the hands, feet, arms, and legs is thin, with tendon and bone immediately beneath it. Excessively bulky coverage can prevent wearing shoes or closing the hand. A thin flap is selected, and when muscle or tendon has been lost, it may be combined withtendon transfer—redirecting a remaining tendon to replace a lost function—so that reconstruction restores movement as well as coverage.

When Bone Is Lost

A bony defect may be reconstructed with vascularized fibula or iliac crest. Because the transferred bone remains living tissue, it can unite with surrounding bone and adapt to mechanical load over time.

Reconstruction After Repeated Recurrence

Sarcoma may recur locally. By a second or third operation, previously used recipient vessels may no longer be available and irradiated skin may be fibrotic. Reconstruction in these difficult settings requires maintaining several viable options.

Sarcoma care is coordinated with orthopedic oncology, medical oncology, and radiation oncology. The reconstructive plan is designed by the team once the extent of resection is established.