Breast reconstruction restores the breast after a mastectomy carried out to treat cancer. It is planned with the team treating the cancer, and its timing follows the oncological plan rather than a fixed rule.
Dr Colson reconstructs. He does not treat the cancer, he does not prescribe the mastectomy, and he does not decide the oncological calendar. Those belong to the breast and oncology teams, and reconstruction is planned around them.
The Department of Plastic Surgery at Sheikh Khalifa Medical City includes a breast surgeon, Dr Hamda Al Zarooni, with whom Dr Colson works. Oncoplastic surgery — removing the tumour and reshaping the breast in the same operation — is her field, not his. The breast pathway at SKMC is described on the One Stop Breast Clinic page at Sheikh Khalifa Medical City.
Dr Thomas Colson is Head of the Department of Plastic Surgery at Sheikh Khalifa Medical City, with eighteen years of experience. He holds Interstate Diplomas in Microsurgery and in Robotic Surgery, and completed his residency at Nancy University Hospital, a Level I trauma centre. He is double board certified by SOFCPRE and EBOPRAS and licensed by the Department of Health Abu Dhabi under licence GD47532. The department’s surgical activity is described on the Department of Surgery page at Sheikh Khalifa Medical City.
Immediate reconstruction begins during the same operation as the mastectomy. The breast surgeon removes the tissue, and reconstruction starts before the patient leaves theatre.
Whether it is possible is a decision of the multidisciplinary team, not a rule that can be set in advance. It depends on the oncological plan, on whether radiotherapy is anticipated, and on the condition of the skin envelope. Dr Colson takes part in that discussion; he does not decide it alone.
Delayed reconstruction is carried out after the oncological treatment is complete, sometimes years later. It is the usual course where radiotherapy has been given, because irradiated skin behaves differently and the tissues need time to settle.
There is no deadline. A woman who was treated several years ago and has never been offered reconstruction can be assessed on the same terms as one who has just finished treatment.
Implant-based reconstruction rebuilds volume with a prosthesis rather than with the patient’s own tissue. It is the shorter operation and it does not create a second surgical site.
Where the skin envelope will not accommodate a final implant straight away, a tissue expander is placed first and filled progressively over several outpatient visits. It is exchanged for the definitive implant in a second, shorter operation.
An acellular dermal matrix may be used to support the implant and control its position. Whether it is required is decided at the time of planning, on the thickness and the quality of the skin envelope.
Flap reconstruction rebuilds the breast with the patient’s own tissue. It is the longer operation, it creates a second surgical site at the donor area, and the reconstructed breast ages with the rest of the body rather than remaining fixed.
Dr Colson holds an Interstate Diploma in Microsurgery and trained during his residency at Nancy University Hospital, a Level I trauma centre. Microsurgical activity at the department is described on the Department of Surgery page at Sheikh Khalifa Medical City.
The DIEP flap takes skin and fat from the lower abdomen, with its own artery and vein, and transfers it to the chest where the vessels are reconnected under the microscope. The abdominal muscle is left in place.
The latissimus dorsi flap brings tissue from the back to the chest while keeping its original blood supply, without microsurgical reconnection. It is often combined with an implant where the volume from the back alone is not sufficient.
Lipofilling transfers the patient’s own fat, harvested by liposuction, to the reconstructed breast. In a reconstructive context it is used to correct a contour irregularity, to add thickness over an implant, or to soften an area of the skin envelope. It is usually carried out in more than one session, because not all of the transferred fat survives.
Used in reconstruction, the indication is the correction of a defect. That is a different intent from the aesthetic use of the same technique, which is covered on the page for breast aesthetic surgery.
Reconstruction is rarely finished in a single operation. Two further stages are common, and both are part of the reconstructive plan rather than an aesthetic addition to it.
Where the nipple has been removed, it can be reconstructed as a final stage, once the volume and the position of the breast are stable.
The unoperated breast may need a reduction, a lift or an augmentation so that the two sides match. The indication is the asymmetry created by the mastectomy, not a change requested for its own sake — which is what distinguishes it from the same procedures performed aesthetically.
A reconstruction carried out years earlier may need to be revised: an implant that has changed position, a contour that has altered after radiotherapy, or a result that no longer matches the other side. Revision is assessed as its own problem, with its own consultation, and the original operative report is useful when it is available.
The two sections below are not breast reconstruction. They are separate conditions with their own assessment, set out here because they arise in the same pathway.
Lymphoedema of the arm is a possible consequence of the treatment of breast cancer, in particular after axillary lymph node surgery or radiotherapy of the axilla. The lymphatic drainage of the limb is interrupted, fluid accumulates, and the arm swells.
It is a distinct condition from breast reconstruction, with its own assessment. The first line of management is medical and is led by lymphoedema therapists: compression, manual drainage, and skin care. Surgery is considered where that management has been organised and the limb remains symptomatic.
Both surgical options are microsurgical. Dr Colson holds an Interstate Diploma in Microsurgery. Whether either applies, and which, depends on the assessment of the lymphatic system, and is decided in consultation.
LVA connects a lymphatic vessel of the arm directly to a nearby small vein, under high magnification, so that lymph that can no longer pass drains into the venous circulation. The incisions are short and the procedure is superficial.
Lymph node transfer moves a small group of lymph nodes, with their artery and vein, from a donor site to the affected region. The vessels are reconnected under the microscope, and the transferred nodes are intended to re-establish drainage locally.
Prophylactic mastectomy is the removal of breast tissue before any cancer has developed, in a woman carrying a documented genetic predisposition. It is a preventive decision, and it is not a service that is offered.
The decision is taken by a multidisciplinary team, on a genetic indication, and after genetic counselling. The woman is seen by the geneticist, the oncologist and the breast surgeon before any surgical discussion begins. Surveillance without surgery is one of the options considered, and it remains a legitimate choice.
Dr Colson takes part in that pathway only for the reconstructive component, once the preventive decision has been taken by the team and the patient. He does not prescribe the mastectomy, and reconstruction is never presented as a reason to undergo one.
Where the anatomy allows and the team has retained a nipple-sparing approach, the endoscopic route uses short incisions placed away from the breast itself, with the operation carried out under camera control.
The robotic route uses the same principle with a surgical robot. Dr Colson holds an Interstate Diploma in Robotic Surgery. Whether the approach applies is determined by the anatomy and by the team, not by the technique available.
There is no single answer, because it depends on the oncological plan. Reconstruction can begin during the same operation as the mastectomy, or be carried out after treatment is complete. Which applies is decided by the multidisciplinary team, with the patient, and not in advance of that discussion.
Where radiotherapy is planned or has been given, it changes how the tissues behave and it is taken into account in the timing. That is a matter for the team treating the cancer to determine together with the surgeon. It is not a rule that can be stated in advance of the individual case.
Reconstruction is rarely finished in a single operation. A reconstruction with an expander involves a second operation to place the definitive implant. Lipofilling is usually carried out over more than one session. Nipple reconstruction and symmetrisation of the other breast, where they are indicated, are further stages. The sequence is set out at the planning consultation.
The assessment considers the condition of the skin envelope, whether radiotherapy has been given, the availability of donor tissue, and what the patient wants to undergo. An implant is the shorter operation and creates no second surgical site. A flap uses the patient’s own tissue and ages with the rest of the body, at the cost of a longer operation and a donor site. The choice is made in consultation.
No. Dr Colson carries out the reconstruction. The removal of the tumour and the oncological treatment are the responsibility of the breast and oncology teams. At Sheikh Khalifa Medical City he works with Dr Hamda Al Zarooni, breast surgeon in the Department of Plastic Surgery.
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