Breast Reconstruction Surgery
Why Women Undergo Breast Reconstruction
New figures in 2019 estimates that up to 1 in 8 women will be diagnosed with breast cancer in Australia. For a lot of women, losing a breast (or even both) is a daunting journey. It’s so much more than just the topic of appearance, it’s also about their self esteem and feminine identity, No matter what age you have been diagnosed, a successful breast reconstruction has been shown to renew your self-confidence, leaving you feeling happier with your appearance and increasing quality of life.
Your new breast (mound) can be created in a few different ways - by using an implant, or your own tissue (eg. thighs, abdomen, back), or a combination of both. Aesthetically, there are different reasons why one will be better for you than the other. These considerations include, the existing shape of your breast, social life and activities, any existing medical conditions and other treatment's that you may be undergoing for your breast cancer (eg. chemotherapy and radiation therapy).
Your reconstruction may be performed immediately on the same day following the mastectomy, or some time later after everything has healed up. The best time to proceed with the reconstruction will vary from patient to patient, depending on your individual circumstances.
Recovering from breast cancer physically and mentally can truly be a long journey. We understand this, and are here to help you along the way by identifying your values, wishes and expectations early on.
Types of Breast Reconstruction Techniques
Implant based reconstruction
Traditionally this involves the placement of a tissue expander (expandable saline implant “bag”) underneath the chest wall (pectoralis major) muscle. Once the wound heals over the following 1-2 weeks, expansion occurs via saline injection into a port, which is built into your expander. As your tissue expander expands with recurrent clinic visits, your chest skin also stretches to a point where the expander can then be exchanged for a permanent silicone implant at a subsequent second operation.
More recently, surgeons have started to skip the expander stage and have moved to placing implants directly into the breast envelope at the time the mastectomy is performed. However, not everyone is an appropriate candidate for this operation. If this operation is for you, it means you could potentially skip one operative stage (where you would normally require a second stage procedure to exchange a tissue expander for a permanent silicone implant) as above.
As your breast tissue has been removed during your mastectomy, any irregularities of your breast skin envelope overlying the implant will show up as contour deformities (concavities and dents). These could be subsequently corrected with revision surgeries to reposition your implant, or, with fat grafting, to smooth out the tissues. Once again, as per cosmetic breast augmentations, it is very common for most women to require some sort of implant revision surgery within 7-10 years of placement. This risk of needing this, and also at an earlier time (around 3-5 years) increase somewhat in the setting of breast cancer (breast reconstructive) related implant surgery.
The initial operation: Insertion of tissue expander takes approximately 2 hours (excluding the mastectomy surgery time) and 1-3 nights stay in hospital.
Second stage operation: The exchange of the expander for a silicone implant takes approximately 1-2 hours, and generally requires an overnight stay in hospital.
Any subsequent operations: Such as implant adjustment and or fat grafting are additional 1-2 hour surgeries and either a day or overnight stay in hospital.
Autologous Reconstruction - Abdominal Based Flap (DIEP or TRAM Flap)
This is when your breasts are reconstructed from tissue taken from your abdomen, through an incision which resembles that of an abdominoplasty (tummy tuck). There are various versions of this flap. They all involve transferring your tummy skin and fat to your chest (referred to as DIEP), but some versions require removal of some or all of your six-pack muscle (called a TRAM) along with it as well (this is in order to carry extra blood supply to the tissue being transferred). A DIEP Flap - using tummy skin and fat with no muscle taken, is our preferred method to form a breast. It results in minimal impact on your six pack muscles and hence a quicker recovery.
Regardless of the technique used, transferring a piece of tissue from the abdomen with its own blood supply, requires microsurgery to reattach those into vessels inside your chest.
This is a much more complex procedure compared to implant based reconstruction.
The initial operation: DIEP flap reconstruction takes approximately 4-6 hours (excluding mastectomy surgery time) and a 4-5 day stay in hospital.
Any subsequent operations: such as fat grafting and/or slight contour adjustments take 1-2 hours, and either a day or overnight stay in hospital.
Autologous Reconstruction - Latissimus Dorsi Flap
The big “climbing” or “Lats” muscle on your back could also be used as part of a reconstruction. This procedure involves borrowing skin, fat and the whole entire muscle from your back, which swings around to the front of your chest to make a new breast. An implant can also be placed under this flap to augment its volume. Traditionally, this is used as a means to give a smaller volume reconstruction, or import extra well vascularised tissue over an area which had previously received radiation therapy.
We will address your complete medical history during your initial consultation to ensure the best possible treatment plan. Blood thinners such as may require cessation pre-operatively - we will advise you according to your individual needs. It is also important for you to fully disclose to us all other regular medications (eg. diabetic medications, blood pressure medications and asthmatic inhalers) as they may interfere with your surgical journey and/or recovery. You will require at least a mammogram or ultrasound of your breasts to ensure all is well prior to proceeding. Smoking also greatly increases surgical/anaesthetic risks and complicates recovery - cessation of smoking at least six weeks prior and after surgery is highly recommended, although it is best to quit altogether.
You will likely need to stay overnight, or for a few days for observations to ensure you are comfortable prior to discharge after your surgery (depending on the procedure as describer above). It is typical for you to require simple pain relief (eg. Paracetamol or Ibuprofen) for two or three days initially, as some discomfort and pain are normal. We recommend that you do not drive for one week after your operation. If you feel comfortable, you may return to work (non-manual labour duties) at the 1-2 week mark, with return to heavy and sporting activities at the 6 week mark. A post-operative no-underwire bra is mandatory for extra support for 6 weeks after this operation. This will be provided to you by our practice during your inpatient stay.
General complications following any kinds of surgery include:
- Bleeding and haematoma (blod clot which may require drainage/evacuation)
- Infection (which may require antibiotics, extra hospital stay or further surgery)
- Anaesthetic risks (your anaesthetist will discuss this with you thoroughly)
- Abnormal scarring (hypertrophic, stretched or keloid scar)
Specific risks and complications:
- Fluid collection (seroma)
- Capsular contracture (which may cause pain, discomfort, and breast shape distortion)
- Altered nipple sensation
- Implant leakage/rupture
- Implant rotation/malposition (which may cause discomfort and distort breast shape)
- Implant loss (from infection or wound breakdown)
- Rippling (depending on the implant position, the type of implant, and thickness of your skin)
Rarely, breast implants have been associated with anaplastic large-cell lymphoma (ALCL), a rare type of lymphoma. However, implants are still considered safe devices. More information can be found on the Australian Society of Plastic Surgeon’s BIA-ALCL page for more information about this.
The Next Step In Your Journey
For more information, to discuss your breast reconstruction desires and expected outcomes or to seek a second opinion from a qualified plastic surgeon, click below to book a consultation.