Breast Reconstruction (Reconstructive Mammoplasty

Introduction

Treatment for breast cancer often requires a partial or full mastectomy. Understandably, this has a profound impact on all areas of the patient’s life. Fortunately, nowadays, modern techniques can create a new breast shape using breast reconstruction techniques. There are various options available, and the treatment plan should be defined between the plastic surgeon and the patient depending on individual requirements. Surgery is also performed to repair visible damage following trauma or burns.

Not only do breasts hold a functional purpose. i.e. breastfeeding; they also play an influential role in self-confidence and femininity. Breast reconstruction surgery after a mastectomy is an integral part of the recovery process.

Below we answer the questions that are posed to us most frequently during consultations for breast reconstruction.

 

When can Breast Reconstruction Surgery be performed?

Patients should undergo reconstructive surgery as soon as possible after a mastectomy. The psychological impact of cancer treatment must be considered when defining a suitable treatment plan. In most cases, surgery can be performed at the same time as the mastectomy (immediate reconstruction). This method allows the patient to begin reconstruction immediately after surgery to remove cancer cells, meaning fewer operating sessions. Other patients, for a variety of reasons, decide to postpone breast reconstruction (delayed reconstruction).

 

Can Breast Reconstruction Surgery interfere with the disease or affect breast screening?

This procedure does not affect the disease’s progression in any way, nor does it create complications with breast cancer treatment. Furthermore, breast reconstruction does not interfere with future screening check-ups to evaluate breast health.

 

What is the difference between Breast Enlargement and Breast Reconstruction?

Understandably, there is a fair amount of confusion surrounding what these two quite different procedures can achieve in terms of results and residual scarring. Breast enlargement enhances the size of healthy breasts, and the incision lines are well hidden. Breast reconstruction surgery, on the other hand, re-creates a new breast shape following a full or partial mastectomy. This form of surgery leaves more extensive scars than with breast enhancement

 

Which techniques are used to remove breast cancer cells?

There are several basic techniques:

1. partial mastectomy (or lumpectomy) – to eliminate cancer cells and some healthy tissue but not the breast
2. subcutaneous (nipple-sparing) mastectomy – to remove all breast tissue but not the nipple/areola
3. full mastectomy – to remove the entire breast, including lymph nodes, and the nipple/areola, and in rare cases, the muscle in the chest wall.

How does the surgeon determine the right technique?

Undoubtedly, certain physical factors related to mastectomy surgery heavily influence the reconstruction choice. However, other factors should be evaluated, including the patient’s physique, the shape and size of the healthy breast, lifestyle habits (for example, smoking), and the presence of any underlying health issues.

Either way, the most important factor to consider when defining a treatment plan is the patient’s well-being.

 

Can Breast Reconstruction Surgery restore the original breast shape?

Every effort is made to match the original, natural breast. However, it is essential to establish with the patient that it is not possible to identically reconstruct this area. Some patients may require cosmetic surgery on the healthy breast to balance overall symmetry, size and position. Unfortunately, reconstructive surgery cannot eliminate the residual scarring from breast cancer treatment. In some cases, non-surgical procedures can be used at a later date to minimise the appearance of scars. Incision lines gradually fade but do not disappear.

 

Which breast reconstruction techniques are available?

The following techniques can be applied in breast reconstruction:

1. implant-based reconstruction to create a new breast mound.
2. implant-based with flap reconstruction
3. flap reconstruction without breast implants, using the patient’s tissue harvested from other areas of the body

What is implant-based reconstruction, and who is an ideal candidate?

Breast reconstruction with implants is used when breast cancer surgery has left an adequate amount of tissue, and the chest muscle is still intact. There must be enough healthy tissue to cover and support a breast implant. In some cases, a tissue expander is used to stretch the skin to create a new breast pocket. The surgeon gradually inflates the expander with a saline solution. Once the desired volume is achieved, and the skin has stretched enough to accommodate the implant, the tissue expanders can be removed. The surgeon should discuss the advantages and disadvantages of each reconstructive option in order to decide on the most suitable technique.

It is also possible to perform reconstructive implant surgery using immediate breast tissue expanders filled with compressed air. The expander is filled with air and then adjusted to make space for the implant.

 

Does Breast Reconstruction Surgery interfere with radiotherapy treatment?

Radiotherapy damages and weakens breast tissue. For patients who have undergone cancer treatment and have insufficient tissue to support the breast implant, reconstruction surgery with implants can pose a problem. These patients require grafts using healthy tissue from other areas of the body to create the new breast mound.

 

How is the nipple-areola complex reconstructed?

In some cases, nipple and areola reconstruction surgery can be performed as an outpatient procedure. Patients should undergo nipple reconstruction as the final step in the reconstruction process after any swelling has subsided, and the breasts are more symmetrical. In other cases, nipple reconstruction is performed in the same operating session, meaning the patient endures fewer operations. However, this method can lead to errors when re-positioning the nipple.

 

Can breast implants increase the risk of cancer?

Breast implant surgery neither affects nor increases the likelihood of developing cancer.

 

Can breast implants cause difficulties with breast screening?

Nowadays, radiologists have considerable experience in screening women with breast implants. Mammography screening and MRI screening can be periodically carried out to monitor breast health and implants.

 

How long do implants last?

Breast implants must be replaced approximately every ten years.

 

How long does Breast Reconstruction with implants take, and what type of anaesthesia is used?

Breast reconstruction surgery is carried out under general anaesthesia and typically, takes about an hour for breast tissue expander placement and the same amount of time for implant placement. The operation may last longer if the patient requires plastic surgery on the healthy breast to create a more symmetrical appearance.

 

What about scars following the surgery?

Generally, the scars are similar to mastectomy scars. The same incision sites are used during the reconstructive surgery, allowing the plastic surgeon to improve the appearance of the original scars and avoid creating further damage

 

When is implant-based reconstruction and flap reconstruction with living tissue used? What do these techniques involve?

Flap reconstruction can be used when there is insufficient tissue (due to radiation therapy) to cover a breast implant or tissue expander. For this reason, the reconstruction technique involves transferring tissue (flaps), from other areas of the body to cover the implants. This technique is sometimes used for immediate reconstruction to avoid further operating sessions, as required with the tissue expansion technique.

 

Which is the most common area to be used in flap reconstruction?

The lastissimus muscle (shoulder) is the most common area used in flap reconstruction. This procedure involves rotating the lastissimus muscle (without detaching it) from the back to the breast area to reconstruct a new breast mound.

 

What about scars following flap reconstruction?

Unfortunately, there is some residual scarring on the patient’s back at the donor site. Post-mastectomy patients also have residual scars from the stitches around the skin graft to cover the chest.

 

How long does flap reconstruction take? Which form of anaesthesia is required?

This procedure takes between two and three hours, and it is performed under general anaesthesia.

 

Which techniques are used in flap reconstruction without implants?

Reconstructive surgery without implants involves using only skin, fat and muscle to remodel a new breast. The advantage of this technique is that tissue from the donor site is similar to natural breast tissue, and so it ages and stretches in a similar way.

Flap reconstruction without implants involves removing tissue, or rather, flaps of skin, fat and sometimes muscle from other areas of the body. The flaps are then grafted to sculpt the new breast shape.

 

Who is an ideal candidate for flap reconstruction without implants?

There are a variety of factors that determine this choice:

1. the patient decides against artificial implants;
2. the healthy breast is too large, and the patient does not wish to undergo further procedures to improve breast symmetry
3. insufficient tissue to cover an implant.

 

Which are the different types of flap reconstruction, and how are they performed?

There are various types of flap reconstruction; all of them involve transferring muscle and tissue from either the abdomen, buttocks, or thighs. Surgery is performed under general anaesthesia and can take up to eight hours, depending on the technique applied. Residual scarring is also dependant on the surgical procedure.

Given the complexity of the issues discussed above, for more information on the techniques, advantages, preparing for surgery, complications and follow-up-care with Breast Reconstruction Surgery, please Contact Us