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: : Breast Repair and Reconstruction : :

Advanced medical technology has made it possible for surgeons to create a new breast for women who have undergone a mastectomy for cancer or other illness. The newly- created breast is remarkably close in form and appearance to a woman’s natural breast.

Breast reconstruction can often be performed in conjunction with a mastectomy procedure. There are several techniques surgeons can use to create a natural-looking breast, including skin expansion and flap reconstruction. The technique used will depend on a number of factors including the patient’s age and the desired outcome.

Is breast reconstruction right for you?
Almost all mastectomy patients are suitable candidates for breast reconstruction. It is possible for reconstruction to be undertaken as part of the mastectomy procedure, however your surgeon will first want to be sure that all evidence of cancer has been eliminated.

Some cancer patients choose to wait until after their cancer treatment is completed before considering further surgery. Others might consider the repair of their breasts as crucial to the recovery process. The decision to wait or not wait for reconstruction surgery is usually entirely personal. In some cases, the surgeon will advise a patient to delay reconstruction surgery for medical reasons, such as obesity or high blood pressure.

How is breast reconstruction performed?
    Breast reconstruction surgery is performed by a qualified cosmetic or plastic surgeon, in close consultation with your breast surgeon or oncologist.

     The two most common reconstruction methods are skin expansion and flap reconstruction. In either case, follow-up surgery may be required to perform final enhancements to the breast or to enlarge, reduce or lift the other natural breast to closely match the reconstructed breast.

     The skin expansion technique involves the insertion of a balloon expander into the chest following mastectomy surgery. Over several weeks or months after surgery, saline solution is gradually injected into the expander until the skin has stretched sufficiently to allow the expander to be replaced with an implant. The nipple and areola are then adjusted through a follow-up procedure.

     During flap reconstruction surgery, a piece of skin and its underlying tissue (a “flap”) are taken from another part of the body, such as the buttocks, back or abdomen. The skin flap is transplanted to the chest area and the blood vessels reconnected to the surrounding tissue. This procedure is more complex than the skin expansion technique and generally results in scar tissue at both the skin graft site and the reconstruction site. Patients often choose flap reconstruction surgery over the skin expansion technique if they do not wish to have implants, or if they prefer a more natural look.

     Breast reconstruction is performed under general anesthesia, however follow-up procedures may only require local anesthesia with sedation.

How long will it take to recover?
    A combined mastectomy and breast reconstruction make take up to six weeks’ recovery time. Recovery is generally faster where flaps are not used, or where reconstruction is performed separately from mastectomy surgery.

     Depending on the extent of surgery, patients are usually required to stay in hospital for around one week. A surgical drain, used to remove excess fluid from the surgical site, will often remain in place for up to two weeks after surgery. Stitches are generally removed 7 to 10 days after surgery.

     Your cosmetic surgeon will advise when normal activities and exercise can be safely resumed. Rigorous activity, such as sport, should be avoided for up to 6 weeks after surgery.

     Although continual improvements are being made in breast reconstruction technology, most patients experience some loss of sensation in the breast following reconstruction surgery, but this can often improve over time. Scarring may also fade over time but is unlikely to disappear completely.

What are the risks involved?
    All surgery carries some degree of risk, including the risk of excessive bleeding and infection.

     Where implants are used in reconstruction surgery, there are a number of complications that may occur including ‘capsular contracture’ or hardening of the skin around the implant. Rupture or leakage of implants can also sometimes occur. Both of these complications may require further surgery, in order to remove or replace the implants.

     As far as is known, reconstruction has no known effect on recurrence of breast cancer, and it does not generally interfere with chemotherapy or radiation therapy. Regular mammograms should be performed by an experienced technician familiar with techniques required for patients with implants.