Breast Reconstruction

Breast reconstruction is restoring or rebuilding your breast usually after cancer surgery. Breast reconstruction is beneficial in improving your self-esteem and helping you to assuage the concerns triggered by looking at your scars following cancer surgery. Many cancer patients do not feel their cancer surgery is complete until they have had a reconstruction.

Breast cancer is never easy to deal with. We will make every effort to ensure that you are dealt with sensitively, and that the best possible advice is given to you. Our aim is to make sure that you are presented with every opportunity to make the choice that is right for you.

The goals of surgery is a symmetrical, natural result. A breast can be rebuilt from your own tissues (autologous) or with the use of a breast implant (alloplastic) or a combination of both. The choice of operation is dependent upon many factors, including your body shape and size of breast to be reconstructed, your age and general health, additional cancer treatment such as radiotherapy and of course, your personal preference.

Reconstruction is performed either at the time of your cancer surgery (immediate) or after completing your breast cancer treatment (delayed). Breast reconstruction is often a “staged” procedure with the breast mound being built in the first stage along with any surgical adjustments desired for the other breast. In the second stage, a nipple and areola are made as well as any necessary minor changes to the size and contour of the reconstructed breast.

Techniques of breast reconstruction

Your new breast can be made from an implant, tissue brought in from another part of your body, or a combination of the two. There is no single best operation, and your own cancer history, circumstances and preferences will determine which choices are available and right for you.

Autologous (your tissue) only: This reconstructive technique uses the excess abdominal tissue from your lower tummy to fashion a new breast. The tissue can either be carried up to your chest while still attached to the rectus abdominal muscle (pedicled  TRAM reconstruction) or detached from the abdomen and reattached to the blood vessels near the chest wall (free TRAM reconstruction). Both techniques produce a breast that feels and looks natural, as it is made of your own skin and fat. It has the additional advantage of using the tissue that would be taken in a tummy tuck (abdominoplasty). However, this surgery can take anywhere between four to eight hours to perform, and usually requires a 5-7 days stay in hospital.

Alloplastic (breast implant) reconstruction: Specialized reconstructive breast implants can be inserted into your chest wall at the time of mastectomy. While this has the advantage of being an “immediate” reconstruction, it can only be performed in patients requiring a small reconstruction and who have limited breast skin removed during their breast cancer). Alternatively, a tissue expander is placed under the muscle and filled with salt water (saline) over a period of months. Once the skin and muscle pocket around the expander have stretched to their new size and shape, the expander is replaced with a more natural appearing breast implant. Alloplastic reconstruction is usually offered to patients with smaller breasts and women who cannot use their abdominal skin for an autologous reconstruction.

Combination reconstruction: Many patients wish to have an immediate reconstruction of their breast following mastectomy, but do not have sufficient abdominal tissues or residual breast skin remaining. These patients are suited to a combined alloplastic and autologous reconstruction using a breast implant held in place with back muscle and skin (pedicled latissmus dorsi flap) that is moved from your back to your chest. This operation is shorter than a free TRAM reconstruction and offers the natural look and feel of using your own tissues with a breast implant for additional volume.

What to expect during your consultation

Your surgeon will listen to your concerns regarding your mastectomy, and ask what your goals are. Many women see a plastic surgeon for breast reconstruction surgery after suffering many years and after considering the surgery for a long time. Others are just going through the trials of breast cancer treatment. While breast reconstruction surgery is a safe and commonly performed operation, the consultation will be performed with sensitivity to your opinions and thoughtfulness to your concerns. Any additional health problems that might affect your treatment will be identified.

Following this, you will be examined, with clinical measurements and photographs taken. It is important to decide with your surgeon the type of breast reconstruction operation that would most suit your body shape, breast size and skin type.

We will then discuss the best course of action to address your concerns. Written information will be provided to you, so that you can consider your options. A breast reconstruction is a major operation, so you will undoubtedly have a great deal to consider after your first consultation. A second consultation is always arranged before any treatment plan is set in motion.

Does breast reconstruction affect breast screening and the risk of breast cancer?

No, the risk of cancer is not altered significantly.

When is it too late for a breast reconstruction?

It is never too late to perform a breast reconstruction. Many women prefer not to consider reconstruction until well after the initial cancer treatment. Excellent reconstruction is possible even years after mastectomy.

Can private health insurance be used?

Breast reconstruction is an important part of breast cancer treatment. It is not a “cosmetic” only operation, but rather aims to restore you to as close to your pre-mastectomy body as possible. You can usually use your private health insurance for breast reconstruction surgery. It usually pays for all your operating theatre and hospital costs, including any implants and your post operative stay. Medicare and your private insurance will also contribute to the doctors’ bills. You can call your health fund and see if you are covered.

Who should perform breast reconstruction operations?

Breast reconstruction surgery should be performed with sophisticated surgical technique for the safest and best results. Your surgeon should be appropriately qualified with at least a Fellowship of the Royal Australasian College of Surgeons in plastic surgery (FRACS plast), which means that they have specialist surgical training. FRACS is the standard qualification required in Australia to perform surgery in private and public hospitals. Members of the Australian Society of Plastic Surgeons have a FRACS and specialised training in Plastic and Reconstructive Surgery, including breast reconstruction.

Our surgeons, Dr Amira Sanki and Dr Ilias Kotronakis are fully qualified Plastic Surgeons. They have both received Honours degree in their Sydney medical schools. They both have FRACS qualifications as Specialist Surgeons in Plastic and Reconstructive Surgery, and are members of the Australian Society of Plastic Surgeons. They both have extensive experience and training in all forms of breast reconstruction, including the most advanced and up to date techniques. They are committed to giving their patients the safest and best treatment available.

Where to get more information

A consultation with a qualified Plastic or Breast Surgeon is the best place to get more advice. More information on breast reconstruction is available online at the Australian Society of Plastic Surgeons website.

Plastic surgery, like any other surgical procedure, carries certain risks and potential complications. It is important for individuals considering plastic surgery to be aware of these risks before making a decision. Your plastic surgeon will explain the specific risks of your procedure and your risk profile in the context of your general health and the complexity of your procedure. Here are some of the common risks associated with plastic surgery:

1. Infection: Any surgical procedure has the risk of infection. Surgeons take precautions to minimise this risk, such as sterile operating environments and proper wound care, but infections can still occur.

2. Scarring: Scarring is an inherent risk of plastic surgery. While surgeons strive to minimise visible scarring, some procedures may result in more noticeable or keloid scars.

3. Pain and discomfort: Plastic surgery involves incisions and tissue manipulation, which can lead to post-operative pain and discomfort. The level of pain varies depending on the procedure and the individual’s pain tolerance.

4. Hematoma and seroma: Hematomas are collections of blood that can form under the skin after surgery, while seromas are collections of fluid. These fluid collections may require drainage.

5. Nerve damage: Nerves can be damaged during surgery, leading to temporary or permanent numbness, tingling, or loss of sensation in the affected area. Nerve damage can also cause muscle weakness or paralysis.

6. Blood clots: Surgical procedures carry a risk of blood clot formation, particularly in the legs. Blood clots can be serious if they travel to other parts of the body, causing complications like pulmonary embolism.

7. Anesthesia risks: Plastic surgery usually requires the use of anesthesia, which carries its own set of risks. These include adverse reactions to anesthesia, breathing difficulties, and, in rare cases, life-threatening complications.

8. Unsatisfactory results: Plastic surgery outcomes may not meet the patient’s expectations or desires. It’s important for individuals to have realistic expectations and to communicate clearly with their surgeon about their goals and desired outcomes.

9. Revision surgery: In some cases, additional surgery may be required to achieve the desired results or to correct any complications or unsatisfactory outcomes. This can increase the financial and emotional burden on the patient.

10. Psychological and emotional effects: Plastic surgery can have psychological and emotional impacts, both positive and negative. While many people experience improved self-esteem and body image after surgery, others may struggle with unrealistic expectations, body dysmorphia, or dissatisfaction with the results.

It’s crucial for individuals considering plastic surgery to consult with a qualified and experienced plastic surgeon who can thoroughly explain the risks and benefits specific to their desired procedure. Understanding and carefully weighing these risks against the potential benefits can help individuals make informed decisions about whether to proceed with plastic surgery.