1. Breast
2. Breast Reconstruction

Breast Reconstruction

 

What is Breast Reconstruction?

 

There are a number of breast reconstruction operations that restore breast shape and size after cancer treatment. Cancer treatment may involve removal of all the breast (mastectomy) or some of the breast (lumpectomy or wide local excision), which can cause a complete or partial loss of the breast.

Patients who have a partial or complete mastectomy can experience:

• Loss of femininity
• Difficulty finding bras and clothing to fit properly
• Self image issues
• Self consciousness
• Poor self esteem

Breast reconstruction surgical options involve using your own tissue and/or implants. The best option will be based on your own physical characteristics, cancer characteristics, lifestyle and preferences. Surgical options for breast reconstruction include:

• Implant based - can be subcutaneous (pre-pectoral) or sub-pectoral; can be used with an acellular collagen matrix to provide internal support in shape.
• Latissimus dorsi flap - muscle and skin flap taken from the back used either with or without an implant (autologous latissimus dorsi).
• TRAM flap - patient’s own skin, fat and muscle taken from the tummy (same region as a tummy tuck or abdominoplasty); no implant is used.
• Microvascular flap - TRAM or DIEP - patient’s own skin, fat and muscle taken from the tummy.
• Breast flaps - tissue from the same breast can be transferred to a lumpectomy defect giving a similar excellent cosmetic outcome to a breast reduction.
• Chest flaps - tissue can be mobilised from the side of the chest and rotated into partial breast defects (TAP flap; LICAP flap).
• Fat transfer - fat can be liposuctioned from another part of the patient’s body, such as tummy or hips, and transferred to a partial or total mastectomy defect.

Breast reconstruction can often be performed at the same time as the mastectomy, however sometimes cancer treatment can delay breast reconstruction six to eighteen months after the mastectomy is performed. It is important to remember that breast reconstruction should never delay or interfere with cancer treatment, which may involve radiotherapy and/or chemotherapy.

Often the cancer treatment involves one breast only which can create an asymmetric breast size and shape. Sometimes the opposite breast may also require surgery to manage the asymmetry, options include:

• breast reduction
• breast lift (mastopexy)
• breast augmentation
• prophylactic mastectomy and reconstruction

 

 

Am I a Breast Reconstruction Candidate?

 

Individuals are good candidates for surgery if they are healthy non-smokers and do not have conditions or take medicines that may impair healing. Individuals need to have realistic expectations and understand that breast reconstruction surgery does result in scarring, that although permanent are an acceptable trade-off for the improvement gained. They will also be aware that breast size and shape can change with aging, weight changes, pregnancy and breast feeding and as such their post-surgical appearance can change with time.

 

 

What is the Breast Reconstruction Process?

 

To start, at your pre surgical consultation you will meet Chris Porter and together discuss your personal goals, medical health and previous treatments, surgery and anaesthesia. A list of your current medications is required and a referral from your mastectomy surgeon is expected. Your breast characteristics will be examined and explained to you. At the end of the consultation you will have discussed:

• surgical options and have a recommended treatment plan based on your goals and individual characteristics
• the general anaesthesia required to perform your surgery
• realistic surgical outcomes
• possible risks or complications of the surgery or anaesthesia
• cost of the surgery and possible surgery dates
• any questions that you wish to ask

You will also have the opportunity to satisfy any nervousness or personal concerns, you should be comfortable discussing your feelings during the consultation. Remember, your individual goals are specific to you but are also commonly experienced by other plastic surgery patients.

On the day of surgery you will be admitted to the hospital where you will be assessed by the Anaesthetist who may administer medication to settle any pre-surgical nervousness. Chris Porter will perform pre-surgical markings and take photographs for your personal file. Following this, you will be transferred to the operating room where you will meet the surgical team and then your general anaesthetic will be started. While you are asleep under the anaesthetic your surgery will be performed and you will be given pain relief medication so you are comfortable when you wake up following the anaesthetic. Following completion of your surgery and anaesthetic you will be transferred to the ward where the nurses will keep you comfortable and guide your recovery. Typically you will have an over night hospital stay of three to five nights. On discharge you will be provided with pain relief medication, instructions to optimise your recovery, and post-operative appointments.

 

 

What is Breast Reconstruction Recovery Like?

 

Implant based reconstruction recovery is similar to that of mastectomy surgery recovery alone. Flap based reconstructions do require a longer recovery phase as they are more complex procedures. You will have some post-surgical bruising, swelling and discomfort which will subside towards the end of the second to third week. Following discharge from hospital you should not drive or return to work during the first week after surgery. During this time you need to rest at home to minimise swelling, bruising and as well as optimising your wound healing. Your dressings are sufficiently waterproof to allow showering from the first day after your surgery. Typically you will be able to return to driving and office based work in the second week after surgery, however this does depend on the exact procedure performed. I recommend that general activity is limited to gentle walking for the first three weeks, if you are progressing well at that stage then you will be able to increase your activity aiming for unrestricted activity just as you were prior to surgery at week four to six, depending on your level of exercise. A lightly supportive non-underwire bra is recommended for the first six weeks and then you can have your formal bra fitting performed for day and sportswear.