What is breast reconstruction?
Breast reconstruction aims to re-create a natural-appearing breast mound to restore the physical and emotional well-being of the patient. After a mastectomy (surgical removal of the breast), most patients contemplate breast reconstruction to restore shape and volume to their breasts. Apart from restoring the appearance of the chest by creating a new breast(s), breast reconstruction helps restore the patient’s sense of self and way of life.
Breast reconstruction may be done to reconstruct one (unilateral) or both (bilateral) breasts. Patients undergoing mastectomy and breast reconstruction are usually treated by a multi-disciplinary team (MDT) which may comprise of an oncologic surgeon, plastic surgeon, oncologist, radiologist, and radiation oncologist.
Length of procedure: 1 – 6 hours (depending on the technique).
Type of anaesthesia: General anaesthetic.
Length of stay: 1-2 days.
What to expect post-op: Some swelling, bruising, tenderness or bleeding may occur at the wounds. Some discomfort at the tissue donor site.
Recovery time: Depending on the technique, wound healing takes approximately 2 weeks, but you should avoid strenuous activity for 1 month.
Results: Swelling decreases and scars reduce over time. Follow up procedures may be needed to ‘touch-up’ the final results. Most patients who undergo breast reconstruction are very happy with their reconstruction and experience a return of self-confidence.
Who might benefit from a breast reconstruction?
Women who have undergone a mastectomy for breast cancer or who have had disfiguring trauma or surgery to the breast previously may consider breast reconstructive surgery. Breast reconstruction is usually performed for women who want to have a natural-appearing breast mound, in place of their mastectomy scars, so that they might go about their lives without feeling self-conscious and be able to wear clothing of their choice.
What does a breast reconstruction procedure involve?
Following a mastectomy, breast reconstruction is often performed in stages. The initial breast reconstruction surgery, involves Dr Isabel do Vale creating a new ‘breast mound’ which is normally performed immediately at the time of the mastectomy or it may be performed later as a separate procedure (delayed reconstruction). A variety of breast reconstruction techniques exist, and the type of procedure performed will depend on your general health, size and stage of the tumour, breast size, body type and shape, lifestyle, need for radiation therapy and your personal choice. Techniques for breast reconstruction following mastectomy are divided into various groups:
- Flap-based reconstruction: Involves using the patient’s own tissue, from another part of the body, as ‘donor’ tissue to create a new breast. The plastic surgeon transfers skin, muscle or fat (or a combination) from a donor area (lower abdomen, buttocks or back) and moulds this tissue to create a new breast of the desired breast shape and size. This type of breast reconstruction may make use of either a:
- Pedicled flap: which uses donor tissue that is locally available (close to the breast) and rotates or moves this tissue into the defect, where it is reshaped to form a breast. The flap remains attached to its original site, and blood supply by a 'pedicle' and the donor site is sutured closed.
- Free flap: A free flap uses donor tissue that is further from the breast site, and as such, the plastic surgeon must completely disconnect the flap tissue from its blood supply and the patient's donor area, in order to transfer it to the mastectomy defect. The free flap is then connected to blood vessels in the chest wall to re-establish blood flow to the flap, before moulding the flap into a new breast. A DIEP flap is a commonly used free flap for breast reconstruction that uses lower tummy skin and fat to create a new breast. Apart from being a good breast reconstructive option in the right candidate, one advantage of this surgery is that it leaves the abdomen flatter than it was before.
- Implant-based reconstruction: This type of breast reconstruction involves Dr do Vale using a silicone breast implant to reconstruct the breast mound. This procedure may be performed immediately at the time of mastectomy in cases where a skin-sparing mastectomy is feasible and where there will be sufficient coverage of the breast implant. Alternatively, it can be performed as a delayed procedure, but this generally requires the use of a tissue expander (inflatable ‘balloon-type’ silicone implant) that is regularly filled with saline to stretch the overlying skin and tissue to create an adequate pocket for a breast implant. The expander is subsequently exchanged for a silicone breast implant.
- Combined flap-and-implant-based reconstruction: This type of breast reconstruction involves using a flap to cover an implant-based breast reconstruction (or expander and implant). This may be necessary to provide additional protective tissue covering over the implant and adds tissue bulk/ volume.
- Breast-Conserving Therapy (BCT): In some instances, the oncologic surgeon will suggest a wide local excision/ lumpectomy to remove cancer whilst preserving the rest of the uninvolved breast tissue- this is known as Breast Conserving Therapy (BCT). BCT usually requires that a plastic surgeon reconstructs the defect resulting from the tumour removal, by carefully rearranging the remaining breast tissue to create a reconstructed breast that is typically smaller than the patient’s original breast size. Dr do Vale will also perform a matching procedure on the opposite breast to create symmetrical looking breasts. Radiotherapy is required after Breast-Conserving therapy to decrease the risk of breast cancer recurrence. BCT is usually only considered for smaller, early-stage, tumours.
- Nipple Areola Complex Reconstruction: This is often performed in the final stages of breast reconstruction after a suitable breast mound has been created. To reconstruct the nipple, Dr do Vale will create small skin flaps, then shape and suture these to form a nipple. The areola can be reconstructed through medical tattooing to create a darker area of skin around the nipple.
Recovery after breast reconstruction:
Recovery after breast reconstruction may vary depending on the type of breast reconstruction, any adjunctive treatments and individual factors such as your general health. Some swelling, bruising, tenderness or bleeding may occur at the wounds. Dr do Vale will discuss potential risks as part of your pre-operative consultation. In general, wound healing occurs over several weeks, but it may take a few weeks or months to feel as though you have fully recovered after breast reconstructive surgery. With time swelling decreases and scar, lines lighten and improve. Avoid strenuous activity for 1 month, but you can usually return to normal activity after this.
Depending on the type of reconstruction performed, Dr do Vale will advise on what to expect during recovery. Regular follow-up and future screening are indicated, as guided by the treating oncologic surgeon. The patient should experience a return of her self-confidence and will be able to wear normal clothing. Most patients who undergo breast reconstruction are very happy with their reconstruction.
For more information on Breast Reconstruction, request a consultation below or call 0109003999 to schedule your detailed consultation with Dr do Vale.