Breast Reconstruction

Reconstruction of a breast that has been either partially or totally removed due to cancer or other disease is one of the most rewarding surgical procedures.

New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to a natural breast. The following will give you a basic understanding of the procedures - when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure. It is important to have a realistic expectation of the outcome from reconstruction. The aim is to achieve symmetry & balance whilst clothed. Frequently the outcome is aesthetically better than this, and you will be shown photos demonstrating what can be achieved under ideal circumstances. It must be borne in mind that these results cannot be guaranteed.

Most patients are suitable for reconstruction, many at the same time as the cancer surgery is performed. However immediate reconstruction is not essential and for some the option of a delayed procedure is important. Some women simply aren't comfortable assessing all the issues surrounding reconstruction whilst coping with a diagnosis of cancer. Others don't want to have any more surgery than is absolutely necessary at this time. With some types of cancer or if there are concurrent health conditions, such as obesity, diabetes, high blood pressure, or smoking your surgeon may advise a delayed procedure. In any case, being informed of your reconstruction options before surgery can help you prepare for mastectomy with a more positive outlook for the future.

It is important to realise that subsequent operations are frequently necessary to improve the symmetry of the reconstruction, revise the scars and reconstruct a new nipple. In the first few weeks after surgery the new breast can be very swollen and bruised and it takes three to six months for the final shape and position to become apparent.

Types of Reconstruction

In essence breast reconstruction is performed to restore symmetry and femininity, and there is good evidence that this type of surgery makes it easier for women to come to terms with the diagnosis and subsequent treatment of their cancer. The twin aims of symmetry and femininity can be achieved by restoring the affected breast to match the normal side, by reducing or increasing the volume of the normal breast to match the reconstruction or by a combination of these techniques. A new breast can be created using implants and/or autologous (one's own) tissue.

Expanders and Implants

Implanted materials consist of tissue expanders and permanent implants.

Tissue expanders are silicone shells, placed behind the muscles of the chest wall, that can be gradually inflated with saline over a period of weeks. Some of these are designed to be left permanently in place whilst others are ultimately removed and replaced with a silicone or saline implant. If your surgeon recommends the use of an implant, you'll want to discuss what type will be used.

Breast implants are available in an extensive range of sizes, shapes and types of fill. All implants have an outer silicone rubber layer and are filled with either cohesive (modern, 'set'-silicone) gel or saline (salt water). Your surgeon will give you more information so you can decide which implant best suits you. Despite some media reports long-term studies have not found any adverse effects from the use of silicone implants.

Autologous Tissue Transfer

Autologous tissue reconstruction involves moving skin, fat and muscle from a distant site to form a breast mound.

The two most common sites to harvest this tissue are either the back (latissimus dorsi -LD- flap) or lower abdomen (transverse rectus abdominis myocutaneous -TRAM- flap).

Autologous reconstructions have the potential to give a superior cosmetic result, however this is at the cost of scaring at the site of tissue harvest, prolonged recovery and potential restriction of daily activities. The TRAM flap usually provides significant tissue volume, which may be important, but is associated with a higher incidence of complications when compared to the extremely robust LD flap. Frequently the LD flap is combined with an expander/implant to give sufficient volume.

General Complications of Reconstructive Surgery

As with all surgery there are general complications inherent from having any surgical procedure & anaesthetic as well as specific complications from the type of procedure itself. As with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Less than 5% of women will develop a significant post-operative complication. Prompt treatment of any complication reduces the chance of long-term problems. All proven precautions are taken to minimize risk but the causes are multifactorial, and some, such as innate biological tissue variability ( the way you heal) cannot be altered.

Reconstruction has no known effect on the chance of recurrence of cancer, nor does it delay detection in the event of a local recurrence. Reconstruction will not interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon will recommend regular mammograms on both the reconstructed and the remaining normal breast.

Women who have a delayed reconstruction may go through a period of emotional re-adjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.

Planning Your Surgery

You can begin talking about reconstruction as soon as you're diagnosed with cancer. After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues and goals. Be sure to discuss your expectations frankly with your surgeon who should be equally frank with you in describing your options and the risks and limitations of each.

Breast reconstruction can improve your appearance and renew your self confidence - but keep in mind that the desired result is improvement, not perfection.

After Your Surgery

You are likely to feel tired and sore for several weeks after reconstruction. Take your painkiller regularly until you have minimal discomfort. Many reconstructive options require several surgical drains to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week.

Most women can return to work (if not too strenuous) and social activities in four- six weeks but will have less stamina during this time and should limit exercise to stretching, bending, and swimming until energy level returns. You'll also need a good sports bra or crop top for support. Do not wear an underwired bra for at least 8 weeks. Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breast settles into the final shape.

Wound Care

When you leave hospital, you will have a dressing taped over the breast which should be retained until your post operative consultation. Dissolvable sutures will have been used under the skin with further support given by a covering of paper tapes (steristrips). These tapes should be left dry for one week before being changed and then should be replaced with Micropore® tape twice a week at home for 4 weeks. This ensures the scar is supported and achieves the best possible cosmetic result. You do not have to keep changing the tape after bathing, it can be left to dry on the skin. The tape may cause an allergic reaction in people with very sensitive skin. If redness or itching develop please remove the tape.