Breast Reconstruction

What is breast reconstruction?

A breast reconstruction is when the breast is rebuilt after a mastectomy. Breast tissue can be rebuilt either from an implant or from tissue taken from another part of the body, such as the back or the stomach.

Generally speaking, nipples are not rebuilt at the same time as the breast.

When can I have a breast reconstruction?

A breast can be rebuilt at the same time as the mastectomy (referred to as an “immediate breast reconstruction”) or at a later date (a “delayed breast reconstruction”).

Patients with large cancers, or who require radiation or chemotherapy, are not normally suitable for an immediate breast reconstruction.

What are the benefits of a breast reconstruction?

One of the most significant benefits is that there is no need to wear a breast prosthesis.

A reconstruction gives patients a mound, so low cut clothing can be worn. A breast reconstruction can be particularly beneficial for larger-breasted women who will feel more balanced after the procedure.

Are there any disadvantages associated with breast reconstructions?

The main disadvantage with a delayed breast reconstruction is that additional surgery is needed. This can range from a relatively minor procedure (the insertion of an expander) through to a major operation (a tummy or back flap reconstruction).

The main disadvantage of an immediate reconstruction is that the surgical process is often much more complex. Immediate breast reconstructions need to be planned for at the same time as the cancer surgery, which means the co-ordination of breast and plastic surgeons, settling on a surgery date and additional appointments.

All of this may result in a delay in the cancer surgery. There may also be additional costs if you are being treated as a private patient.

What are the surgical options for a breast reconstruction?

There are three main options for rebuilding the breast: 

1. 1. Tissue expander and implant reconstruction
   2. Latissimus dorsi flap (the back flap) reconstruction 
   3. TRAM or DIEP flap (the tummy flap) reconstruction

Tissue Expander and Implant Breast Reconstruction

In this option breast implants are made out of silicone gel. The implants are then inserted onto the chest wall, under the muscle and skin of the chest (prepectoral).

This option is completed in two separate operations:

• • Operation 1: Places a tissue expander under the chest wall to expand the area in order to make space for the implant to sit. The expander is then filled with saline solution over a period of weeks or months until it is the correct size. 
  • Operation 2: Removes the expander and inserts a permanent silicone implant +/- lipofilling

We will use a mesh to cover the implant as a barrier between the skin flap and the expander/implant.  2 types are used, a Tiloop bra pocket (synthetic mesh with titanium coating that resists infection) or a biological mesh (ADM-Flex HD) . 

The benefits of this option are:

• • Simple operation.
  • One week stay in hospital.
  • No additional scars (apart from the mastectomy scar).

There are disadvantages, which include:

• • The rebuilt breast may not look as natural as with other reconstruction options.
  • The implant does not change size if you gain or lose weight.
  • There is a risk the implant will move, become infected, develop scar tissue, or ruptures. This then means additional surgery.
  • It is not the best option for larger-breasted women. If only one breast is being reconstructed, then it is harder to match a large and droopy breast with an implant. 

There are always risks associated with any procedure that is performed. The risks of implant reconstruction are: 

• • Infection – wound or implant infection. Occasionally the implant can be salvaged with IV antibiotics. Sometimes the implant may need to be removed to control the infection and replaced at another time
  • Drains – if you have drains placed with your implants, you will have oral antibiotics while the drains are in. This is to prevent potential infection around the implant while you have the drains. The oral antibiotics can be ceased once the drains are removed. 
  • Pain – you will be given a regimen of pain relief prior to leaving hospital
  • Numbness 
  • Bleeding – During the operation all visible bleeding is stopped. However, the blood vessels will sometimes reopen and bleeding may recommence. If there is a lot of bleeding, resulting in a lump appearing underneath the wound, then another operation may be required to find and stop the bleeding. Slight bruising is common and nothing to worry about.
  • Wound breakdown and implant extrusion
  • Nipple or skin necrosis – sometimes this can be treated with dressings for an extended period of time but it may require a further operation to excise the necrotic area

• • It may feel heavier than you expect and you may experience pain associated with each expansion 
  • Scar (Keloid/hypertrophic) – in a small number of people the scar may be thick or raised or both.
  • Seroma formation– the body can produce fluid and collect around the implant. If the volume becomes large, we may need to use a needle to drain the fluid under ultrasound guidance

• • Capsular contractures– the body forms a capsule of tissue around the implant. This is a normal response to a foreign body, however over time the skin may look as if it has ‘shrink wrapped’ around the implant. This can look unsightly and less than ideal. 
  • Chronic pain – rarely the contractures can be associated with pain, weeks to months after surgery. There are methods to treat this main involving pain medications, nerve medications and nerve blocks, however an operation to remove the implant may be necessary.
  • Implant rippling– if this occurs then we can smooth out the implants with lipofilling. This is when the fat is transferred from another part of your body, typically your belly or thighs to the skin over your implant to fill out any contour deformities. 
  • Recurrence – a mastectomy can only reduce the risk of cancer recurring it does not eliminate it. Although we take out all the visible breast tissue, some cells can remain and breast cancer can grow again. This is a rare occurrence. 
  • An implant can rupture and rotate, necessitating removal or replacement. You can also experience ‘bottoming out’ over time. The implant can move under the inferior mammary fold causing the bottom of the breast to move down.
  • Anaplastic large cell lymphoma (ALCL)– this is a rare form of lymphoma that is caused by the implant itself. The incidence has been estimated as between 1:2000 to 1:20000. It has only been associated with textured anatomical implants but not with smooth round implants. We only use smooth or nanotextured implants which have had no cases of ALCL associated with them thus far.

Latisimus Dorsi Flap (the back flap) Breast Reconstruction 

In this option muscle, fat and skin is transferred from the back to create the new breast mound. An implant is then sometimes used to create volume. There is a scar on your back along the bra-strap line.

The benefits of this option are:

• • The rebuilt breast looks more natural than an implant
  • The rebuilt breast changes size if you gain or lose weight

There are disadvantages, which include:

• • An additional scar on the back 
  • Some loss of strength in the arm and limit in arm movement during the recovery period

TRAM or DIEP Flap (the tummy flap) Breast Reconstruction

This option involves using the tummy fat and maybe also the tummy muscle to create a breast mound. This will lead to a scar in the lower aspect of your belly. You will meet a plastic surgeon to discuss this operation in detail.

Advantages:

• • Good option for large breast women not wanting implant based reconstruction
  • Reliable results in the right hands
  • Durable results
  • Good option for a delayed reconstruction

Disadvantages:

• • Longer recovery time (particularly when the muscle is taken)
  • More complex surgery

Contact Warrier Practice For More Information

Remember, the decision to undergo surgery should be made with careful consideration and guidance from medical experts.

If you’re unsure which path to take, we’re here to help. Your well-being is our priority, and together, we can navigate the options and make the right choice for you.

Please feel free to reach out with any questions or concerns.