Breast Reconstruction

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Breast reconstruction is a surgical procedure that restores shape to your breast after mastectomy or deformity from trauma such as burns or developmental abnormalities.

  • Breast Reconstruction

Breast Reconstruction

Breast reconstruction is a complex procedure performed by a plastic surgeon. Many patients will require several procedures to achieve maximum symmetry. An initial procedure will be planned to create a new breast mound. A second stage to achieve shape symmetry by reducing, enlarging or lifting the opposite beast is often required and finally small procedures to reconstruct a nipple and tattoo the nipple and areolar complex will finalise the process.

Are there methods of reducing deformity after partial mastectomy?

Yes. Depending upon the degree of deformity and desired breast size methods may be straightforward such as reducing the opposite breast or adding tissue or an implant to a smaller altered breast. In others where the deformity is severe the best results may require a total reconstruction as scarring and changes from prior surgery and radiotherapy prevent reshaping a new breast.

What general types of reconstruction are there?

  • Implant based reconstruction. This may involve a preliminary tissue expander. The expander is like a balloon that is inserted and gradually inflated to encourage new tissue growth and stretch of existing tissue. When the tissue envelope is large enough the expander is removed and a breast implant is inserted to give a ore natural shape and feel.
  • Flap based reconstruction. A flap moves tissue from one location to another on the body. The commonest sources of tissue for breast reconstruction are the back (latissimus dorsi muscle) and the abdomen (TRAM or DIEP flap). An implant that uses only your own tissue is an autologous reconstruction.
  • A combined procedure utilising a flap and an implant if the amount of tissue available is still too small to create and adequate breast volume.

Why are there so many types of reconstruction?

Every woman has a different breast shape, a different desired outcome and a different level of expectation regarding the final outcome. As a consequence one technique will not solve every problem.

In general:

  • The more complex the reconstruction, the more natural the result.
  • The more complex the surgery, the longer the recovery.

What is the best option for me?

There is no substitute for a consultation to reach the right decision for you.

Choices come down to the pathology and treatment requirements, the body (past surgery, general health, existing breast shape) and the desired outcome.

Many women will have multiple options appropriate to them and it is uncommon for no form of reconstruction to be available.

The desired outcome is an important factor in choosing a reconstructive method. For some women they simply want to avoid the use of an external prosthesis so they can swim comfortably with their children/grandchildren. Others would like a breast that is as natural as possible. What Dr Magnusson commonly experiences is that the initial goal may be simple yet the goal posts shift once the process begins and woman will frequently desires the most natural results after starting with modest expectations.

In general:

  • A modest to medium breast size that doesn’t hang can be reconstructed using an implant based reconstruction to create a very nice result. This method may also be appropriate for some fuller figured women with simple goals if the skin is not tight.
  • Reconstructing a breast that hangs when there is no spare skin (especially when the mastectomy has already been performed) will often require bringing new skin to the breast. This will mean a flap reconstruction with or without an implant as well to get the most natural result.
  • Reconstructing after radiotherapy will usually also require a flap to overcome the changes associated with radiotherapy. An implant based reconstruction on its own without a flap after radiotherapy has an increased chance of problems with wound healing and infection and the breast shape will be less predictable.

Is further surgery required after completing the breast reconstruction?

Breast reconstruction often involves multiple stages/operations to create a breast mound, symmetry with the other side, a nipple and also colour around the nipple and areolar area. Once complete the result usually requires very little attention then well into the future.

All breast implants will require a reoperation in due course however modern breast implants tend to last for very long periods. The usual duration for most implants before removal and replacement is 15 – 25 years. Some will last longer and a small number require earlier revision.

For women having reconstructions without implants (autologous reconstruction) there may never be a need to consider further surgery.

Can a breast reconstruction be performed at the time of mastectomy?

A breast reconstruction can be performed either at the time of mastectomy (immediate reconstruction) or at sometime after the completion of treatment for breast cancer (delayed reconstruction).

Which is best, immediate and delayed reconstruction?

The important priority is management of the breast cancer. The pathology dictates treatment options offered for surgery, chemotherapy, radiation and reconstruction.

In some instances the cancer will be small and expected treatment predicted with relative certainty or the breast (or both) is being removed because of the risk of developing cancer although there is no cancer at present. These women are ideally suited to an immediate reconstruction.

For others they may be uncertainty about further treatment or a more urgent need to press on with chemotherapy and radiotherapy after mastectomy for a more advanced cancer. A delayed reconstruction may be best in these circumstances.

Receiving a recent diagnosis of breast cancer is a nasty surprise and can be hard enough to come to terms with on its own. Breast reconstruction is a complex process to consider and if dealing with the breast cancer is proving difficult then a delayed reconstruction is possibly the best option regardless of the reasons for mastectomy and stage of the tumour.

What impact does a mastectomy have on a woman?

The breast is a unique symbol of femininity. The removal of a breast is associated with a psychological impact that can be profound is some women and relatively mild in others. Some women will only realise the impact when a reconstruction is performed and the changes following mastectomy are corrected.

The psychology and surgical literature show that:

  • “the only psychiatric solution to the disfigurement of mastectomy is reconstruction”
  • “immediate reconstruction is associated with less psychological stress than delayed”

Will radiotherapy effect my reconstruction?

Radiotherapy has an unpredictable effect on the results of breast reconstruction. For some there is very little obvious change and yet another woman treated with the same dose and a similar area may have dramatic changes with loss of volume, tightening of the skin and the development of new blood vessels over the treated area.

Very good results are achievable with delayed reconstruction.

If radiotherapy is likely Dr Magnusson will usually suggest a delayed reconstruction to achieve the best possible final breast shape.

How soon after adjuvant treatment can I have a reconstruction?

There will be limitations for some based on your pathology and your breast surgeon will guide you in this respect. In general a reconstruction can be undertaken 3 – 6 months after your mastectomy and completing chemotherapy and radiotherapy.

Is there assistance with Medicare and my health Fund?

Yes. This surgery is reconstructive and not cosmetic. This includes surgery for the opposite side to achieve symmetry after breast reconstruction. This is still true for in most instances even if an implant is used to increase the size of the normal breast after a reconstruction. More precise information will be available at your consultation.

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