Surgery after Sickness: Breast Reconstruction

Sickness-and-surgery

Choosing to have breast reconstruction surgery following cancer treatment can be an empowering and positive step on the road to recovery for many women, but it is not one to be taken lightly.

There are many options available to women in this position and it is important to be aware of all the facts and have realistic expectations about the outcomes.

Specialist Melbourne-based plastic surgeon, Dr. Morris Ritz has performed many breast reconstructions and offers the following information to anyone considering this life-changing decision.

What is Breast Reconstruction?

Breast reconstruction is a surgical procedure available to anyone who has lost a breast as a result of cancer, or women at high risk for breast cancer who choose to take a preventative measure against the disease.

The aim of breast reconstruction is to create a new breast as similar in form and appearance to the original breast, which has been lost.

There are many choices, both physical and psychological, involved with reconstructive breast surgery and Dr. Ritz ensures all patients engage in comprehensive consultation prior to surgery, to help every patient make the best decisions to suit their individual circumstances.

Options to consider include:

When is the best timing for a Breast Reconstruction procedure?
Reconstructive breast surgery can either be performed immediately following a mastectomy, or as a separate surgery down the track.

If you have not already had a mastectomy or lumpectomy at the time you are considering reconstructive surgery, it is up to you whether or not to combine these procedures.

Dr. Ritz works together with leading breast cancer surgeons and where possible, will perform a combined mastectomy and reconstruction at the same time, if this is what the patient desires.

What is involved in a Breast Reconstruction procedure?
Breast reconstruction can be a one-step, two-step (and sometimes three-step) procedure. How many steps you would like to undertake is up to you.

Step 1: Reconstruct the breast mound to as close as possible to the original size and shape using either a patient’s own tissues or an artificial implant filled with silicone or saline. In choosing to use your own tissue, several options exist, which we explore later in greater detail. We also outline the pros and cons of tissue vs. implants.

Step 2: Once the breast mound has been established, a nipple can be created, using local flaps of skin from the new breast tissue, a skin graft from elsewhere on the body or you can opt for a nipple prosthesis, which is attached to the breast with special glue. Medical tattooing is then used to finish the desired effect.

Some women are happy with the look of their new breast without a nipple, and so do not undergo this step.

Step 3: In some cases, once the new breast has been created, the opposite breast may need to be lifted or reduced so as to achieve symmetry.

What different types of Breast Reconstruction are available?
Breast reconstruction can be performed using implants, a woman’s own tissue, or a combination of both. If choosing to use your own tissue, several sites exist around the body as donor site options and fat grafting can also be considered. It is also possible to use tissue from the remaining breast. This is called a breast sharing reconstruction.

Here we look at the pros and cons of the two most popular options:

Implants
Implant reconstruction is typically performed using silicone or saline implants, similar to a regular breast augmentation procedure. In this type of operation, implants are most commonly inserted under the chest muscle onto the chest wall.

Advantages:

  • Relatively simple procedure
  • Fast recovery time
  • Surgery and scarring limited within the breast area

Disadvantages:

  • May not feel as natural as other types of reconstruction options
  • May be more difficult to match the shape of the existing breast (Step 3 is commonly required)
  • Weight gain or loss can cause a difference in breast size, as the implant may no longer match your other breast
  • Scar tissue can form around the implant

Using your own tissue
Using your own tissue for breast reconstruction involves taking skin, fat and muscle from other sites (donor sites) on your body and attaching them to create a new breast. This can be done in the form of ‘attached flaps’ or ‘free flaps’.

Attached flaps use skin, fat and muscle from your back or abdomen. In this option, tissue and muscle is channeled under the skin from these donor sites to your chest, in order to form the new breast.

Free flaps use skin, fat and muscle from your abdomen or buttock. In this option, the arteries and veins are also cut and subsequently reattached to the blood supply at the chest wall.

Advantages:

  • Produces a more natural looking breast
  • No artificial substances are implanted into your body
  • New breast gains and loses weight in proportion to the rest of your body

Disadvantages:

  • More extensive surgery and recovery time
  • Additional scarring and may affect muscle strength in donor sites
  • There is a slight risk that the flap may die due to lack of blood supply. If this occurs, further surgery may be required.

What is recovery like following a Breast Reconstruction?
Following breast reconstructive surgery, some patients may be required to stay the first night in the Intensive Care Unit (ICU) for monitoring, after which you can return to the ward. Most patients spend approximately one week in hospital, dependent on the type of reconstruction performed.

Following the procedure, you will have drain tubes fitted, and once these are removed, you will be fitted with a special bra to wear fulltime for approximately six weeks. Once discharged, you will be monitored bi-weekly, then once a week as your recovery progresses.

It is important to note that you will be unable to drive for at least two weeks, and cannot do any physical exercise, heavy lifting, or gym work for a minimum of six weeks.

Remember to keep realistic expectations
Dr. Ritz understands that having a breast reconstruction is an intensely personal and sometimes confronting decision. Given the number of options available, it can also be overwhelming and highly emotional.

Through his experience in performing breast reconstructive surgery, he has guided many women to help them make the right decisions for this next chapter of their recovery.

To learn more about reconstructive breast surgery, contact specialist surgeon Morris Ritz of Melbourne by completing a contact form or calling (+61 3) 9508 9503.