Note: this article is expanded on from a video of mine about Breast Reconstruction Surgery. If you would like to view that video, you can view it here.
In this article I talk about breast reconstruction surgery for breast cancer patients, a topic that is a little closer to home for me as my mother has been diagnosed with breast cancer. Although she is doing well, she is a patient who was not well enough to have a breast reconstruction and so, she has had to deal with using a prosthesis. For her it can get fairly, I guess, cumbersome, especially during the hot summer months.
Considering Your Breast Reconstruction Options
When discussing breast reconstruction surgery, I like to introduce to my patients the thought of two general ways that we can approach reconstructing a breast. That is reconstructing a breast with implants or with your own tissue and there are obviously pros and cons with either of these options.
Broadly speaking, the implant based reconstruction tends to be a quicker operation, taking about three to four hours to do if it is performed at the same time as the mastectomy, and has both the breast surgeon and the plastic surgeon being involved. It can also depend on at what juncture of your breast cancer treatment you are having the operation performed.
In comparison, surgery using your own tissue for a reconstruction takes much longer per breast. When performed at the same time as a mastectomy, you are looking at an operation that takes around six to eight hours for an average patient.
Hospital Stay & Recovery
Typically a patient that has had a tissue-based reconstruction will be in hospital for around a week after surgery, and around one to three days of hospital stay for an implant based reconstruction. This also varies depending on how quickly we get you moving around and when we determine it is safe for you to go home.
When it comes to post-surgery recovery, an implant-based reconstruction generally takes around two to three weeks, during which time you may still have drain tubes after the operation. The recovery process following use of your own tissue is longer, as you will have additional scars at the places where donor tissue has been taken from that also needs to be contended with and heal at the same time.
In terms of driving and recovery, those who have a reconstruction with their own tissue will find that it takes a little bit longer before you will be able to get in and out of a car by yourself without assistance. Generally, at around the three to four week mark, whereas for an implant based reconstruction that timing will be a little bit quicker as the overall recovery process is a little faster.
Implications for Reconstruction Options
When it comes to choosing the right reconstruction procedure for you, there are a few things that you need to be thinking about as well as consideration of the subsequent long-term effects of needing future surgeries.
One of the main implications to consider is the behaviour and feel of the two options. Implants at the end of the day are foreign objects inside your body. They will never quite behave like your own breast tissue, whereas a tissue-based reconstruction is of course going to behave more like human tissue. If you put on weight it might gain volume, if you lose weight it might lose volume. Implants however will not behave in the same way, and thus fluctuations in weight can result in implants that become more pronounced and noticeable (as can occur with normal breast augmentation surgery). However, some may prefer an implant based reconstruction as it has arguably a quicker recovery time, and less scar burden – without the additional donor site mobidity (as we are not taking tissue from another part of the body to create a new breast).
Implications for Initial & Subsequent Surgeries
Implant Based Surgery
Implant reconstruction can sometimes be done at the same time as the mastectomy where we insert a silicone implant in during the operation. In some cases, however, we may first need to place a tissue expander within the breast cavity to assist with expanding the skin envelope, so that it can tolerate a silicone implant later down the track. In these circumstances the reconstruction procedure requires two operations rather than being able to be completed in one. Whether you need radiation therapy or chemotherapy may also alter the timing at which you have the implant put in and additionally affect whether subsequent surgeries are needed in the future.
After an implant has been placed, occasionally a scarring process called capsular contracture can occur around the implant that leads to you requiring further operations down the track. When this does happen, it is typically at around the five to ten year mark post the initial implant placement. We tell all implant based patients that they may need follow on revision surgery within five to ten years, but this does vary from patient to patient.
Tissue Based Surgery
Conversely, for a tissue-based reconstruction, it is generally one single big operation, followed by subsequently smaller operations to fix tiny concavities, volume discrepancies, nips and tucks to make it as nice looking and as perfect as possible. Creating a new nipple is also a separate procedure that can be performed after the main breast mound is formed. This entire reconstruction process occurs over multiple stages. Some patients that decide that they do not want to put up with having multiple operations later on in life consider a tissue-based surgery for this reason.
Deciding on what is best for you.
Making a decision on which surgery is right for you, is a very personal choice. Some patients prefer to have an implant-based reconstruction as they do not want to be in hospital for as long a period and they want the quickest and fastest operation to get them the results that they are happy with. They want to move on and go back to work, look after their family, and loved ones or if they run their own business or if they are really time poor. Conversely other patients choose tissue-based surgery as they prefer not to have an implant or do not want to consider having revision surgery in the future.
These are only some of the reasons why a patient would prefer to choose one option over another and is not a decision you need to make alone. Your surgeon is their to help you determine which works best for you and your body, and which will give you the result you’re after. We do this to ensure that whatever procedure you decide is one that you are going to be happy with.
If you’d like to discuss a potential breast reconstruction surgery or you’re planning your mastectomy and just want to know your options for the future, I’d love to have a conversation with you to see how I can help. To get in contact with me, you can request a consultation here
Dr Marion Chan.