Breast Reconstruction FAQ

Having breast reconstruction is a very personal thing. Most patients find they have a much better quality of life and rediscover their self confidence post-breast reconstruction. Their lives are a lot simpler being able to walk out the front door every morning without needing to worry about what to wear, which prosthesis to choose, and which bra looks better with the prosthesis. These things can be particularly embarrassing and debilitating for patients during hot summer months.

It's done if you have either breast cancer and need a mastectomy, or have uneven breast size and shape due to cancer or congenital reasons.

This might mean making one side larger or smaller in order to match the other side. To make a breast smaller we can utilise standard breast reduction techniques. If we need to address the issue of shape as well as volume, lifting techniques may need to be utilised to achieve this. To "build" a breast, we often need either your own tissue or an implant to "add" volume. There are many ways to do this.

• Implants
• Your own tissue (abdomen, thighs, back)
• A combination of both the above
• Fat grafting

It is a long journey, and often requires multiple stages of operations, some long and some short, in order to arrive at the final result. The thought of having multiple operations can be daunting for some patients, but most patients find that the results are worthwhile (provided you are medically fit to have these procedures done).

Breast reconstruction can be performed as an "immediate" procedure at the time of the mastectomy, or be done as a "delayed" procedure some time after the mastectomy has occurred. The options available to you at each juncture may depend on your health, medical co-morbidities, the type of cancer you have/had, and if you require any adjuvant therapy such as chemotherapy and/or radiation therapy.

An implant based reconstruction may require multiple stages:

• If a silicone implant could not be inserted at the initial operation, a tissue expander may be inserted at the time of surgery instead. If this is the case, you will need to return to the clinic for recurrent expansions with saline prior to having it exchanged for a permanent implant a few months later.
• Once the silicone implant is in place, it is not uncommon for patients to undergo revision surgery of the pocket in which the implant is seated, and potentially address small contour deficits with fat grafting.
• A separate procedure will be required to make a new nipple to finish off the reconstruction if your nipple was removed at the initial mastectomy.

If your own tissue has been used to reconstruct your breast, you may still require:

• An initial operation to transfer your own tissue to make a new breast (longer procedure than an implant, with a longer hospital stay and recovery).
• You may - or may not - require small subsequent procedures to address little contour problems - fat grafting, tidying up of excess skin areas. These are often very small procedures which are day cases.
• A separate procedure to make a new nipple to finish off the reconstruction if your nipple was removed at the initial mastectomy.

A soft supportive bra without an underwire is required for 6-8 weeks after the operation to help minimise swelling and discomfort.

There are many types of different implants with different coating and materials on the market. It can be extremely daunting for patients to choose out of these many types. The good news is that there are pros and cons with each type, and the implant of choice will often depend on how the reconstruction is performed - which will vary with each patient.

Most breast reconstructions - for cancer and congenital causes - will have rebates offered by medicare and health funds.
There will likely be an out of pocket fee if performed privately via a health fund/insurance.

• Implant reconstruction - Hospital stay of 1-2 days and can drive in about 1-2 weeks.
• Tissue reconstruction - Hospital stay of 3-5 days and can drive in about 3-4 weeks.

Both reconstructive techniques there must be no heavy lifting, manual labour or exercise for 6-8 weeks. You'll be able to return to work probably around the same time as driving if light duties are only performed  (admin/desk work).

Once your anaesthetic has worn off, you may experience some pain at the surgical site. Generally Panadol (every 4-6 hours, maximum 8 tablets a day) and /or ibuprofen (every 6 hours, maximum 6 tablets a day) will be sufficient to manage any post surgery pain. If it is expected that you may experience more discomfort, a stronger analgesia will be prescribed and given to you prior to your discharge from hospital.