Breast reconstruction is a surgery for women who have lost one or both breasts due to breast removal (mastectomy) and is one of the most rewarding procedure performed today. By utilizing a variety of surgical techniques and/or devices, it is possible to create a breast that closely matches the form and appearance of a natural breast. Our surgeons completed an international fellowship in Breast Reconstruction and offer all options to our patients. Working and co-ordinating in a multidisciplinary team with General/Breast surgeons and Breast Care Nurses is a critical step in this process. During the consultation process we discuss all the options in depth so that an informed decision is made, that both the patient and surgeon are happy with.
What results can I expect from a breast reconstruction?
The surgery is intended to restore the breast to as normal and natural an appearance as possible, generally though several plastic surgery techniques. In cases where only one breast requires reconstruction, augmentation or a lift may be recommended for the other breast in order to ensure symmetry.
Immediate breast reconstruction is performed at the same time as the mastectomy. This procedure involves the creation of a breast mound to replace the breast that has been removed. This is done in the hospital under general anesthesia. This approach allows the patient to have her breast cancer surgery and reconstruction done simultaneously, accelerating both the physical and emotional recovery. Immediate breast reconstruction is usually reserved for women who are unlikely to require further treatment after their mastectomy, such as chemotherapy or radiation therapy.
Delayed breast reconstruction is offered to patients who may choose not to undergo reconstruction at the time of their mastectomy or who are not candidates for immediate breast reconstruction. The timing of delayed reconstruction will be discussed with you at your initial consultation.
Most breast reconstruction involves a series of procedures occurring over time. The initial operation is usually the most complex, and involves the reconstruction of a new breast mound. Often a second operation is performed 3-6 months later, at which time final shaping of the breast mound is achieved. At the same time, patients often undergo surgery to enlarge, reduce or lift the natural breast to match the reconstructed breast. The reconstruction of the nipple and the areola may occur at this time or under local anaesthesia at a later date.
Implant based breast reconstruction may be performed in one or two stages. The traditional approach involves the use of an expander implant (essentially a deflated breast implant), which is exchanged for a breast implant at a later date. Following mastectomy, the expander implant is inserted beneath the skin and chest muscle. Following discharge, the patient makes periodic visits to the clinic where a saline is injected into the expander, which is enlarged to gradually over several weeks or months. After the skin over the breast area has stretched enough, the balloon expander is removed and a more permanent implant is inserted. In certain women undergoing immediate breast reconstruction, an implant may be used directly without the need for skin expansion. This decision will be based on the type of mastectomy that is required as well as the anticipated size of the final breast.
As an alternative to using an implant, the breast can be reconstructed using the patient’s own skin and fat taken from other parts of the body, such as the abdomen, back or thighs. The tissue can be detached or remain attached to its original site. In general, flap reconstruction is more complex than implant reconstruction, but has the advantage of reconstructing the breast entirely with the patient’s own tissue. In some cases, there may also be the added benefit of an improved abdominal contour.
The DIEP Flap uses the patient’s own abdominal skin and fat to reconstruct a natural, warm, soft breast after mastectomy. Only abdominal skin and fat are removed similar to an abdominoplasty. The DIEP preserves the abdominal muscles, which means patients maintain their core strength long-term. The skin and fat below the belly button feels very similar to breast tissue and it is an excellent choice to replace the breast tissue removed by the mastectomy. The blood vessels that supply this skin and fat travel just beneath or within the abdominal muscle. An incision is made in the abdominal muscle to access these vessels and every effort is made not to injure the muscle. The prepared tissue (“flap”) is then disconnected from the body and transplanted to the chest using microsurgery. The surgeons then shape the tissue to create the new breast.
There all also flaps that can be used from the groin in patients without enough tissue for abdominal flap reconstruction.