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Breast Reconstruction

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Breast Reconstruction

What is breast reconstruction surgery?

 

Breast reconstruction surgery aims to rebuild one or both breasts following breast cancer surgery such as mastectomy. It can be performed at the time of mastectomy or at a later time frame once the primary breast cancer treatment is completed.  Both reconstructive and cosmetic disciplines are used in order to deliver results that take each patient’s personal preference and unique anatomy into account.

At AR Plastic Surgery we offer a personalised and holistic service. We are here to listen, gently guide you and ensure you make the right decision for you.

Our specialist plastic surgeon, Dr Eddie Cheng, collaborates with a multi-disciplinary team of specialists and allied health including breast surgeons, breast care nurses, physiotherapists, psychiatrists, cancer support staff, geneticists, oncologists, and radiologists, to manage the complexities of each individual situation. This procedure can make a real and positive difference to the lives of women.

Our highly experienced team will provide support every step of the way, in a safe and caring environment.

Why breast reconstruction could be right for you

Breast reconstruction is not for all women, however, all women should have the opportunity to learn about their options and make an informed decision before having mastectomy. Women may choose to have breast reconstruction for a variety of reasons. These include making their chest look balanced, to regain shape and form, and to restore confidence and assist in the psychological and emotional recovery following breast cancer.

In certain instances, breast reconstruction is able to be performed at the same time as the mastectomy, however, in nearly all instances breast reconstruction surgery often requires more than 1 surgery.

A delayed reconstruction is also a viable option for many patients. For example, if there are unexpected complications during the initial mastectomy or the patient is overwhelmed at the prospect of making both medical and aesthetic treatment decisions. Breast reconstruction can be commenced months and sometimes years after a mastectomy has been performed.

Types of breast reconstruction procedures

Implant Reconstruction 

An implant reconstruction procedure typically entails 2 stages.  In the first stage, Dr Cheng places a tissue expansion device to stretch and expand the chest skin and tissue to allow adequate space for the breast implant to be correctly positioned. Over the course of a few months, Dr Cheng and our Nurse will gradually expand the skin by injecting saline into the tissue expander device.  This allows the skin to gradually stretch to the right proportions amd size ready for a more permanent breast implant.   Several months later the tissue expander is exchanged for a permanent silicone or saline gel implant that is placed behind the chest muscle.

How will my breasts feel and look after breast implant reconstruction?

It is important to understand that breast implant reconstruction will look and feel very different to natural breast.  It may feel cold and often feels firmer to touch comparative to natural breast tissue. Achieving perfect symmetry or matching the unaffected breast may also be difficult, particularly for women with larger breasts.  Often in these situations, refinement procedures can be performed to enhance the appearance and symmetry.

Hybrid Reconstruction

Sometimes both fat transfer and implants are combined to produce a hybrid reconstruction. For example, in cases where there is insufficient fat a small breast implant is used to augment size and shape. A key advantage of a hybrid approach is the ability to create results that may not be possible using only one surgical technique.

Autologous breast  reconstruction

Autologous or Using your own tissue including skin, fat and muscle to reconstruct your breast is also an option for some women, particularly those who have adequate or excess abdominal or tummy tissue.

TRAM or DIEP flap reconstructions involve reconstructing the breast by transferring belly or abdominal tissue containing skin, fat and blood vessels, and shaping this into a breast.

During a free TRAM flap, fat/skin blood vessels and muscle are all taken from the wall of the lower belly and transferred to the chest. The blood vessels are then attached to the blood vessels in the chest via microsurgery.

Muscle Flap with Implants 

Also known as Latissimus Dorsi Reconstruction, muscle flap reconstruction involves taking skin and muscle from the back to create a new skin envelope. The transferred skin flap contains a combination of muscle, fat and blood vessels that remain attached to their original blood supply, ensuring the blood continues to circulate. Once the flap is positioned, it is shaped to create a natural looking breast. An implant is also placed within to provide shape and volume for the breast contour.

What to expect after surgery

Each patient is different and full recovery from reconstruction surgery can take several weeks. It also depends on what type of reconstruction procedure the patient has had. For example, TRAM procedures generally have longer recovery periods than direct implants as the body needs to heal from two surgical sites both breast and tummy.

Just like after any operation, you’ll likely experience some pain or discomfort. This can vary considerably though from patient to patient. In addition, you may experience some swelling and bruising as well as some itchiness around the breast area. Proper rest and avoiding strenuous exercise are both important factors in your recovery, while appropriate medications can also be prescribed to manage pain.

How soon you’re able to return to your regular routine will depend on the type of work you do and the type of surgery involved. However, it’s critical to keep in mind that it’s natural for your body to feel more tired than usual for a period of time.

Checking your breasts after reconstruction surgery

If you’ve had a breast completely removed and reconstructed, it is generally unnecessary to conduct future mammogram screenings on the reconstructed breast. Sometimes it is recommended to conduct a baseline mammogram or MRI after reconstruction for comparison in the case anything unusual develops in the future.

To find out more about this procedure and which type of reconstruction is right for you, or to request a consultation with Dr Cheng, please do not hesitate to get in contact.

Key Questions about Breast Reconstruction

Before Procedure

What is a mastectomy?

A mastectomy involves the removal of all the breast tissue and is performed by a Specialist Breast Surgeon. Your mastectomy may also involve the removal of lymph nodes under the armpit depending on the type of breast cancer you have and at the recommendation of your Breast Surgeon.

Do I get to keep my nipples?

This depends on your individual breast pathology that will be discussed with your Specialist Breast Surgeon who will provide you with advice on performing a nipple sparing procedure.

If I have breast cancer in only one breast, will I need a mastectomy of the other breast?

This depends on the type of breast cancer, your previous history, family history and potentially genetic testing. Your Breast Surgeon will be able to provide advice if a prophylactic mastectomy of the other breast is recommended.

What are my options for breast reconstruction?

Dr Cheng (Specialist Plastic Surgeon) will work together with your Breast Surgeon to reconstruct the breast after mastectomy. The more common method for breast reconstruction is the use of temporary tissue expanders. When you have your mastectomy, due to the removal of all the breast tissue, the skin is tight and needs to be gradually stretched to eventually accommodate a permanent breast implant. Tissue expanders can be placed in the same surgery as your mastectomy (immediate reconstruction), or at a later date (delayed reconstruction).

Other methods for breast reconstruction include; Latissimus Dorsi Flap, a Transverse Rectus Abdominus Muscle Flap (TRAM) and Deep Inferior Epigastric Perforators Flap (DIEP). At your consultation with Dr Cheng, you will be able to discuss all the possible reconstruction options available to your individual case. Dr Cheng will take into account your diagnosis, your medical history, your availability of abdominal tissue, if radiation treatment is required and your desired aesthetic outcome to achieve the best possible result.

When and where will I get to have my surgery?

If you are having an immediate reconstruction (mastectomy with either a tissue expander, latissimus dorsi flap, or TRAM) it will be performed at the Wesley Hospital and will require both your Specialist Breast Surgeon and Specialist Plastic Surgeon to be available for a combined procedure. As we don’t have permanent scheduled days for combined procedures, we appreciate your flexibility whilst your two surgeons and anaesthetist liaise together to organise a suitable time appropriate for your individual case.

How many surgeries will I need?

This depends on which type of reconstruction you will be having. Breast reconstruction with tissue expanders is usually performed as two stages. The first stage involves your mastectomy with the Breast Surgeon, and insertion of temporary tissue expanders by Dr Cheng. These expanders will be progressively filled to their volume capacity to stretch the skin to accommodate your future permanent implants. Tissue expanders can be exchanged with permanent breast implants after a minimum of 8 weeks after your last tissue expander fill.

What does a tissue expander fill involve?

Your first tissue expansion fill will likely be performed 4 - 5 weeks following your initial surgery. Your tissue expansion will be performed in our clinic rooms by Dr Cheng or one of his nurses on a weekly - fortnightly basis until we reach the volume capacity of your expander or until you are happy with the size. Your individual circumstances may alter the progression of these fills.

Can I have tissue expander fills during chemotherapy?

You may be able to have tissue expander fills during your chemotherapy treatment, depending on the type of treatment and how you are feeling. We would usually perform the fill just before the commencement of each chemotherapy session, whilst you are feeling well. If you don't require radiation treatment in addition to chemotherapy, we will generally wait until you finish your chemotherapy to commence your tissue expansion. After your last chemotherapy session, Dr Cheng will wait approximately 6 months before exchanging your tissue expanders for permanent implants.

What if I have to have radiation?

Ideally, we would aim to complete your tissue expander fills prior to the commencement of radiation due to the effect radiation can have on the skin. Your exchange of tissue expanders for permanent implants normally occurs after a period of at least 6 months after you complete your radiation treatment.

If I need a hysterectomy, can I have this performed at the same time as my mastectomy?

No, unfortunately due to the complexity of both of these procedures it would compromise your recovery.

When can I exercise after surgery?

We would not recommend strenuous activity before 6 weeks post-operatively. You will likely be given exercises to assist with your range of motion by the physiotherapist during your hospital stay. You will be able to discuss your return to activity with your nurse and Dr Cheng at your post-operative appointments.

When can I go swimming after surgery?

Unfortunately, swimming increases the risk of infection in a newly healing wound. It is not recommended that you go swimming (either the pool or the beach) until your wound is completely healed. This is generally not before 6 weeks after your procedure.

Will I need a special bra after surgery?

After the first stage of your reconstruction with tissue expanders, you won’t require a special bra. You are able wear anything that is comfortable, or no bra at all. You may find a soft singlet/camisole comfortable. After your second stage of reconstruction with permanent implants, you will be fitted by our nurses for a supportive post-operative bra that you will wear full time for the first 6 weeks after your surgery. If you are having a TRAM procedure, you will be fitted for a bra at your first post-operative appointment.
If you are having only one breast operated on, you may need to visit a special Prosthetics and Lingerie Service offered through Choices. Your nurse will be able to provide you with these details.

During Procedure

After Procedure

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