Breast Reconstruction

The female breast is a key component of emotional and mental well-being. When breasts need to be removed as part of treatment for breast cancer, this can be a significant cause of distress with a loss of confidence and a potential impact on personal relationships. Breast reconstruction surgery may also involve an implant-based reconstruction or breast augmentation and is aimed at restoring natural and aesthetically pleasing breasts, with the final result often being an enormous improvement in emotional and mental well-being.

Breast reconstruction expected results

• A natural look to the breasts
• Restoration of breast symmetry
• Improved appearance of the nipple-areola complex
• Enlargement of female breasts with a better look beneath clothing
• An improvement in self-confidence

Ideal candidates for breast reconstruction include those who have had or are soon due to have a mastectomy. Compared with treatment for breast cancer, breast reconstruction surgery is strictly not medically necessary. It is, therefore, very important for all women to make sure the procedure is being done for themselves without undue pressure from others.

The best candidates for breast reconstruction are:

• Patients who have good physical and mental health and do not have significant medical conditions
• Have a clear understanding of the breast reconstruction method recommended by your surgeon
• Have realistic expectations of what the procedure can achieve

Every woman will present a unique situation when it comes to planning a breast reconstruction procedure. The specific type of breast reconstruction procedure is tailored to the individual patient. Breast reconstruction is performed under TIVA general anaesthesia and ranges in duration from one to three hours to complete. Sometimes, more complex procedures may take much longer to perform.

There are two main techniques used in breast reconstruction: implant-based reconstruction and flap-based reconstruction. The technique which your surgeon uses will be based on the physical characteristics of your breasts and your goals for treatment. In some cases, it may be necessary to perform more than one breast reconstruction procedure, which is staged to take place over a period of three to six months to achieve optimal results. The final part of breast reconstruction is to create an aesthetically pleasing nipple and areola.

Breast reconstruction can be performed either at the same time as a mastectomy procedure, or it can be performed as a delayed procedure where it is performed several months later. Sometimes, the reconstruction can be performed a year or more later. The ideal treatment approach will be determined by a patient’s overall state of health and their preferences for treatment. In cases where breast reconstruction is being performed only for one breast, then your surgeon may recommend a simultaneous breast symmetry procedure on the opposite breast. This may be a breast augmentation with an implant or fat grafting, breast lift or a breast reduction. These procedures can help to improve breast aesthetics for improved self-confidence.

Implant-based reconstruction

In an implant-based reconstruction, the breast may first require skin expansion to stretch out the skin to enable the placement of an implant. Skin expansion is the most common technique of breast reconstruction performed today. A tissue expander is surgically inserted beneath the skin and pectoralis muscle before being inflated with saline to slowly stretch the overlying skin over one to six weeks. The stretched skin facilitates the placement of a breast implant at a second stage procedure. Silicone breast implants are most commonly used.

Flap based reconstruction

In flap reconstructions, tissue and overlying skin are transferred from a nearby location, such as the abdomen, thighs or breast, to refashion a new breast mound. The tissue is to be transferred and meticulously placed in the recipient area. The surgeon may need to perform microsurgery to join up blood vessels for the newly transferred tissue flap. This is known as a free flap reconstruction. In other types of flap reconstruction, the tissue flap is tunnelled to the breast region with the existing blood supply preserved, and there is no need to perform microsurgery to rejoin the blood vessels. Once the new tissue has been transferred, a new pocket for a breast implant can be created, or a new breast mound can be made from the transferred tissue alone.

TYPES OF FLAP PROCEDURES

• Latissimus Doris Myocutaneous (LD) flap. The LD muscle located on the back is transferred to the chest to recreate a new breast mound, or a pocket is created for the insertion of an implant.
• Transverse Rectus Abdominis (TRAM) flap. A tunnelling technique transfers the rectus abdominoplasty muscle of the abdomen to the chest region. Breast implants are not required in TRAM flaps, as the robust TRAM flap provides sufficient soft tissue support to create a new breast mound.
• Deep inferior epigastric perforator (DIEP) flap. Abdominal skin and underlying fat are used to recreate breast tissue. In a DIEP flap, muscle is not removed from the abdomen.

At Centre for Surgery, our surgeons strongly believe that the success of any surgical procedure including breast reconstruction surgery is optimised with following all of the surgeon’s pre-procedure instructions.

We always strive to go above and beyond to ensure that all our patients are optimally prepared for breast lift surgery—physically, mentally, and emotionally. Breast reconstruction surgery should be viewed as a process that may involve more than one procedure. Our team is experienced in guiding women through their journey for optimal outcomes.

Recovery after breast reconstruction surgery should take several weeks, and it is not unusual to experience mild discomfort and tenderness of the newly reconstructed breasts. It generally takes up to six months for the wounds and breast tissue to heal fully and for any residual swelling to settle down. All women should avoid strenuous exercise and lifting heavy objects for six weeks. You should be ready to return to light work duties after about two weeks.

A degree of swelling and bruising is to be expected after breast reconstruction. Any discomfort is well controlled with prescription painkillers, which should be taken regularly in the early postoperative period. Your surgeon may have placed suction drains to remove any excess fluid, and these are usually removed between 3 and 5 days later. Postoperative compression garments should be worn continuously to reduce swelling. Sutures, if permanent, will be removed about 10-14 days after the procedure. It is expected to observe scars in the region where tissue was removed and on the newly reconstructed breast. The scars should fade over time, although they may be visible even after six months. The benefits of breast reconstruction significantly outweigh the drawbacks of having surgical scars for the vast majority of women.

Modern breast reconstruction is a very safe and effective procedure with an established record of producing excellent outcomes in appropriately selected patients. Despite this, complications can always occur, even in the best hands. Our surgeons have years of experience performing breast reconstruction procedures of all types and complexity using the most advanced techniques. All our surgeons understand that the decision to have breast reconstruction is an extremely personal one. Your surgeon will be able to explain the potential risks of the planned reconstruction at your consultation.

Potential complications of breast reconstruction:

• Anaesthetic risks
• Bleeding and haematoma
• Surgical site infection
• Excessive scarring
• Seroma formation
• Nerve injury
• Implant complications – capsular contracture, malposition or rupture
• Flap compromise
• Fat necrosis
• Requirement for a revision procedure