Breast Reconstruction

The most important thing to remember with breast cancer is simply to beat it. In some cases, this requires the partial or full removal of one or both breasts, which, while absolutely vital for their health and wellbeing, can lead to a loss in confidence. Breast reconstruction is designed not only to recreate the natural shape of a woman’s breasts, but also to recreate her sense of self and confidence.

Breast reconstruction is a surgical procedure to restore the shape of the breast for women who have had their breasts removed completely (mastectomy) or partially (lumpectomy) for the treatment of breast cancer.

Several types of procedures are available for breast reconstruction. Your breast can be reconstructed using a breast implant, your own tissue flap, or a combination of both. A tissue flap is the skin, fat, and sometimes muscle moved from a donor site elsewhere from your body to your chest.

Breast Reconstruction with Implants: A breast implant is a round shaped silicone casing filled with salt water (saline) or silicone gel. Once the cancer surgeon removes your breast tissue, your plastic surgeon may immediately place the implant in the space created by removing your breast tissue. Your surgeon may also use a special graft or an absorbable mesh to provide support for the implant.

Alternatively, if there is a shortage of skin/soft tissue, a temporary implant known as a tissue expander will be placed in the empty space created by your mastectomy. The expander helps the empty space to remain open as the skin heals from the mastectomy. The expander has a small valve through which your doctor can inject saline and progressively expand it to create a breast mound, which gradually stretches your chest skin over time. Once the expander is fully expanded, your surgeon will perform another surgery to remove and replace it with a permanent implant. Some expanders can also be left in place as the final implant.

Tissue Flap Procedure: During this procedure, tissue from your abdomen, back, thighs, or buttocks are used to reconstruct your breast. One common technique is to include the transverse rectus abdominis muscle flap (TRAM) and its variant, the deep inferior epigastria perforator (DIEP) flap, which use tissue from the lower abdomen. The second technique involves the latissimus dorsi flap, which uses tissue from your upper back. During a TRAM or DIEP flap procedure, skin, fat, blood vessels, and part of the rectus abdominis muscle are moved from the abdomen and transferred to the chest area. This flap can either be a free (using microsurgery) or pedicled transfer.

Another procedure, known as the latissimus dorsi flap procedure, moves the skin and muscle from your upper back to your chest area. This is usually combined with an implant and is not our preferred technique for breast reconstruction.

For bigger flap procedures, it will take around 6 months to get back to normal activities with normal energy.

• Following the surgery your breasts will be bruised, swollen, and may ache for a day or two.
• All sutures are usually removed within a week or two after surgery.
• Loss of sensation around the nipple and areola may take six weeks or more to return to normal.

Some private health funds offer funding access for breast reconstruction, so be sure to check with your provider.

What can you expect after breast reconstruction surgery?

• You may be fatigued and tender for a few weeks after surgery.
• Your doctor will prescribe medications to control your pain and prevent infections.
• You may have thin tubes attached to your surgical site to drain away any excess fluid that accumulates.
• You may have scarring which will require 6 months of scar management to encourage fading.
• You will be instructed on activity restrictions, such as to avoid heavy lifting and avoiding strenuous activities.
• It may take up to six weeks for you to get back to your normal activities following breast reconstruction.
• You will have to follow up with your plastic surgeon/cancer surgeon on a yearly basis.

What are the indications for breast reconstruction surgery?

The best candidates for breast reconstruction surgery do not have any pre-existing conditions that may prevent or prolong the healing process, such as:

• Diabetes
• High blood pressure
• Obesity
• History of radiation to the chest wall
• Smoking

What are the risks and complications of breast reconstruction surgery?

As with any surgical procedure, breast reconstruction also carries its own potential risks of bleeding, anaesthesia, infection, and wound healing problems.

An immediate breast reconstruction can carry the risk for seroma formation (fluid collection in the breast pocket) and infection. If you are undergoing a flap surgery technique, you are at risk of loss part or all of the flap and donor site pain/numbness. The use of implants carries the risk of implant rupture and capsular contracture (the formation of hard scar tissue).

Additionally, changes to your chest skin as you age can alter the shape of your breast, and you may need revision procedures to address this further down the track.