Breast reconstruction surgery recreates the shape of the breast following a mastectomy or breast conserving surgery. The aim of this surgery is to create a breast that is aligned as much as possible with a natural breast in size, shape and position. Breast reconstruction can be done at the same time as your breast cancer surgery (immediate reconstruction) or as a separate procedure at a later time, even many years later (delayed reconstruction).
At Silkwood Medical our focus is to make every effort, from the timing of the surgery and the method of surgery chosen, to expedite the process of enabling the patient to normalise their lifestyle with respect to the clothes they wear, the activities they undertake and their own self confidence as quickly as possible.
Spending time with your surgeon prior to your operation to take into consideration your body shape, current breast size, extent of tissue removed, scars from previous surgery and skin that is remaining, will ensure that the best choices for your surgery will be made.
Breast reconstruction is performed by three methods:
- Using a tissue expander/implant
- Tissue flap reconstruction: using your own tissue (autologous)
- Combination of both
Reconstruction using implants can sometimes be performed in one surgery session. However there are times when several operations are needed.
At the first operation an expander is placed under the skin and muscle at the site of the new breast. This is inflated with saline injections over a period of weeks. This act of inflating the balloon acts to recruit soft tissue for future coverage of the implant. At the second operation, usually 3 months later, the expander is replaced with a permanent silicone implant.
The main advantages of implants are:the operation is relatively simple, your time in hospital and recovery time is usually short and surgery and scarring is only in the breast area
Tissue Flap Reconstruction
Reconstruction using your own skin, fat and muscle is called ’tissue flap reconstruction’. There are two main types of tissue flap reconstruction – ‘attached flaps’ and ‘free flaps’.
Attached flaps use skin, fat and muscle from your back or abdomen. A portion of tissue and muscle is tunnelled under the skin from your back or abdomen to your chest where the new breast is formed.
Free flaps use skin, fat and muscle removed from your abdomen (TRAM flap) or buttock. The arteries and veins are cut and then attached to the blood supply of the chest wall.
The main advantages of tissue flap reconstruction are that it produces a more natural looking breast and the breast will gain and lose weight as your body gains and loses weight.
An implant can also be used alone or in combination with flap reconstruction to improve the shape and size of the new breast. This most commonly is a Latissimus dorsi flap ( a broad flat muscle in the back) which is combined with an implant being placed in the breast mound as well to get adequate volume for the reconstruction.
If the mastectomy is only on one side, surgery to the other breast may sometimes be required or requested by the patient to match the reconstructed breast. This can be in the form of a breast augmentation, breast lift or breast reduction.
The amount of time it takes to recover from breast reconstruction depends on the type of surgery performed. Usually if you undergo implant surgery, you should be able to return to work in approximately one week. If you have chosen the flap breast reconstruction using tissue from your back, it may take two to three weeks to return to work. Similarly, if you underwent flap breast reconstruction using tissue from your stomach (TRAM flap), it may take four weeks to resume light activity. All patients can usually make a full recovery about six weeks after surgery.
Frequently Asked Questions
Minor follow-up surgery may be desired or required for breast reconstruction. Should a firm capsule form around your implant, or your implant fail, an implant exchange can be performed as a day-only procedure under local anaesthetic.
There is no scientific evidence that breast reconstruction surgery interferes with the detection of new or recurrent breast cancer in either your new or recreated breast. Similarly, there is no scientific evidence that links flap or implant reconstruction with breast cancer.
With breast cancer treatment after reconstruction surgery, there is no evidence that suggests using your own tissue will interfere with radiotherapy or chemotherapy treatment. However, there is a possibility that radiotherapy can distort implant reconstruction and make it more risky. If you have concerns regarding breast cancer treatment and reconstruction, please do not hesitate to contact our surgeons.
There is a possibility that your newly constructed breast will differ from your natural breast in terms of size, shape, and feel. However, women usually undergo breast enlargement, breast lift, or breast reduction surgery on their natural breast in addition to breast reconstruction to make breasts appear more symmetrical.
Every operation carries a small risk. However, when tissue transfer operations are performed by an experienced and appropriately qualified surgeon, there is a very low probability that a tissue transfer will be unsuccessful. The risk that a flap will completely fail is less than one percent.
We can create a new nipple and areola for your breast and this is usually done during the final stage of your breast reconstruction procedure. There are a variety of techniques used to create a new nipple and areola. The simplest techniques involve using a stuck-on prosthesis or medical tattooing to create the nipple and areola. Another technique involves skin grafts. Our surgeons can help you decide which technique will best suit your cosmetic goals.
There are inherent risks associated with any surgical procedure. However, it is unlikely that you would experience any long-term complications if the most suitable breast reconstruction surgery technique was chosen. Modern free flap techniques reduce the risk of such complications as abdominal hernia. Flap methods that use tissue from the stomach or back may weaken those areas. This is usually not a problem unless you are extremely athletic or active.
You will have scars on the chest wall of your newly created breast and at the donor site where tissue has been borrowed. Your scars will initially be red in colour, but should fade within six to twelve months.
Your recovery time depends on the method used for your breast reconstruction. Patients who undergo reconstruction using an implant alone take less time to recover than those who undergo flap reconstruction. If you received implant surgery, you should be able to return to work within one week. If you underwent flap reconstruction using your back muscle tissue, you may lose some strength and function when moving your arm on that side. Because of this, it may take three weeks for you to return to your normal activities. Similarly, if you underwent flap breast reconstruction using your stomach muscle tissue, you may experience weakness of the abdominal muscles. However, you should be able to return to your normal activities in approximately four weeks.
Your breast implant is usually inserted after a tissue expander has been used over a period of weeks to months. The tissue expander gradually stretches the overlying skin so that it can hold the breast implant. Once the skin has been stretched enough, the tissue expander is taken out and a permanent silicone implant is inserted in its place
You will be seen daily in hospital by your surgeon. On rare occasions when your surgeon is working at another location, you will be seen by another member of the surgical team (the anaesthetist, surgical registrar or another surgeon in the practice).
When you go home, you will be seen within a week of your discharge. Thereafter, the follow up protocol will be determined by you and your surgeon.
Regular appointments are made to check that you have reached your aesthetic goals and that your scars and contour are continuing to improve.
You will be given a Plastic Surgery Recovery guide upon booking your surgery. This is a highly valuable document that explains in great detail all of your after care for surgery.