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Breast Reconstruction

Unfortunately, many women lose their breasts to breast cancer. For some, a high risk of a recurrence leads to them electing to have a mastectomy. The aim of breast reconstruction is to re-create the breast in these patients, which is an important step in restoring their sense of femininity.

Breast reconstruction, although rewarding and with a high patient satisfaction rate, can be quite a complex procedure. This is one of Dr Safvat’s areas of interest and he frequently performs breast reconstruction surgery.

Dr André Safvat - Plastic & Reconstructive Surgery - Bowral, Concord & Miranda

Technique

One of the most important decisions regarding breast reconstruction is the timing and the type of reconstruction. There are many factors that influence this including, type of breast cancer, the treatment(s) required for the cancer, the patient’s body shape, the size of the reconstruction and the patient’s preference. The decision is ultimately made by the patient following a thorough discussion with Dr Safvat about all the available options.

Breast reconstruction can be done using the patient’s own tissues (autologous) or using implants (alloplastic). At times it may be necessary to combine both of these methods to get the best result for the patient.

Both have advantages and disadvantages and will be discussed in detail in the first consultation with Dr Safvat. For example, autologous reconstruction avoids the need for implants, and as such the breast may feel and behave more naturally. However, it is more complex than alloplastic reconstruction and the recovery time is usually longer.

Alloplastic reconstruction usually requires 2 operations. The first stage is to insert an expander that is slowly expanded with saline over a period of weeks to months. Once the desired size is achieved, it is replaced with a permanent silicone implant with additional fine-tuning of the position. The operation is simpler and of shorter duration and it requires less time to recover.

Autologous reconstruction most commonly uses the patient’s own abdominal tissues (the Transverse Rectus Abdominus Myocutaneous (TRAM) or the Deep Inferior Epigastric Perforator (DIEP) flaps which offer the added advantage of giving the patient a ‘tummy tuck’ at the same time. Other tissues can also be used, depending on the patient’s body shape and wishes, including the buttock or back area.

Once the new breast has been reconstructed into its final shape, the nipple is created using local skin flaps and the areola with medical tattooing. Often, the opposite breast may need adjusting at that time in order to achieve symmetry. It may need to be lifted, reduced or augmented.

Timing

Breast reconstruction can be performed at the same time as the mastectomy (immediate) or after all breast cancer treatments are complete (delayed). Depending on the type of reconstruction, the procedure often involves multiple stages. From creating a breast mound and adjusting the shape and symmetry, to reconstructing a nipple and areola.

If immediate, the mastectomy and the reconstruction are performed using the same anaesthetic and hospital stay. Even though this makes the surgical procedure much longer, the patient wakes up with a breast mound already in place and is spared the experience of not having a breast.

The decision to do an immediate or delayed reconstruction is not only based on patient preference but is also dependent on what other breast cancer treatments are needed. For example, if post-operative radiotherapy is needed, it will compromise the final result of the immediate reconstruction. Reciprocally, the reconstruction may interfere with these potentially life-saving treatments. Dr Safvat will work closely with breast cancer surgeons to obtain the best possible cancer treatment as well as optimal reconstruction results.

Recovery

Breast reconstructions are performed under general anaesthetic in fully accredited hospitals. Depending on the type of reconstruction that’s selected, a hospital stay of 4 to 10 days is required. There will be swelling and bruising for up to 4 weeks and patients need to wear a compression garment during this time.

Breast Reconstruction Surgery Cost

Breast reconstruction has an Item number and patients will get a rebate from Medicare and their health fund. The hospital costs are covered by private health funds depending on the patients’ level and type of cover. At the first consultation, Dr Safvat will discuss all the costs associated with breast Reconstruction Surgery. This will include surgeon, anaesthetist and hospital fees. Aftercare costs such as compression garments and post-surgery follow-ups will also be taken into consideration. If you want the best possible results and a positive experience, it’s important not to choose a surgeon based on costs.

Complications

General complications are associated with any type of surgery. This includes risks associated with general anaesthetic, a collection of blood and fluid after surgery and mild to severe infections. For breast reconstruction specifically, this can also include asymmetry and complications such as capsular contracture, which is linked to implants.

Dr Safvat will go into detail about all possible complications during your consultation.

Breast Reconstruction FAQs

What you need to do before the operation?

Smoking and being overweight are shown to cause more complications after breast reconstruction. Dr Safvat will insist that patients stop smoking at least 4 weeks before their surgery. As a general rule, if a patient’s weight is stable, the result of the breast reconstruction is better and more predictable. This is because the reconstructed breast increases or decreases in size with a patient’s weight. All surgery preparation recommendations are covered during your consultation.

How much scarring can I expect after breast reconstruction?

Scarring is a natural part of the healing process and should be expected after breast reconstruction surgery. For the first three months, the incision sites will appear swollen and red. Gradually, the incisions will settle and scarring will be present. However, scars do fade, especially if they’re cared for correctly. We will show you how to care for your incision sites so that you can keep any scarring to a minimum. After about 18 months, your scars will appear much lighter and smaller.

Do I need to insert implants during breast reconstruction surgery?

Breast implants are an option and will give you a much fuller result but implants are not the only option. Patients can also choose to transfer fat and tissue to the breasts to give them more shape. Dr Safvat will take you through both options during your consultation so that you can choose an option that meets your needs. Patients must keep in mind that implants eventually need to be replaced. In most instances, this is only 10 – 15 years later though.

Will I need a revision procedure?

There is a good chance that you may need more than one surgery to achieve your desired outcome. Revision breast reconstruction procedures are generally scheduled to correct irregularities after the first surgery. If the revision surgery is done in stages, naturally, you should be prepared for more than one procedure. Most revision procedures are performed 3 months after the initial procedure.

Will my reconstructed breasts sag?

Even though the breasts are reconstructed, they are still susceptible to the effects of weight fluctuations, pregnancy and age. If implants are used, sagging is very minimal and only occurs much later in life. If only one breast was reconstructed, the natural breast may sag on its own and additional surgery may be required.