What is a breast reconstruction?

A breast reconstruction is a procedure which aims to restore or replace the natural breast shape after removal of the breast (mastectomy) or from trauma.

Who does this procedure suit?

Those who have had a mastectomy due to cancer or cancer risk reduction, as well as those who have experienced trauma to the breast tissue. Breast reconstruction may also be performed at the time of mastectomy.

What’s the first step to take?

During your first consultation your surgeon will discuss what you’d like to achieve, any expectations you have, questions about the procedure, medical history and current medication. Your surgeon will examine your body and make sure you are suited to the procedure. We will provide as much information as possible so that you feel comfortable and informed, and if you feel overwhelmed in any way we encourage you to make a second consultation so that you feel confident with your decision.

How do I prepare for surgery?

Please ensure you have arranged someone to drive you home after your surgery and to help you out at home for a few days. To reduce risk of bleeding and bruising please make sure to:

• Avoid pain relievers and Vitamin E two weeks before surgery. Panadol, and vitamins B and C are safe to use. Alcohol is best kept to a minimum also.
• Inform your surgeon if you take any herbal medicines that may affect clotting and the anesthetic.
• Avoid smoking 6 weeks before and after surgery so as not to restrict circulation to the skin and delay healing. Giving up is best.
• Inform us immediately if you’ve had any infection (cold or flu) the week before your surgery.

What happens on the day of my surgery?

• We will guide you to prepare for surgery so that your procedure and recovery go smoothly. On the day bring your toiletries, any medication needed and loose clothing.
• If your procedure is in the morning – do not eat or drink anything after midnight the night before.
• If your procedure is in the afternoon – do not eat or drink anything after 8.00am.

What should I expect during surgery?

Breast reconstruction is performed under general anesthetic so that you will be completely unaware of the surgery or any pain, and sleep comfortably through the procedure.

Breast reconstruction commonly involves more than one stage. The initial surgery is often the most complex and has the longest recovery, and any surgeries after are usually shorter with a quicker recovery. If only one breast is being reconstructed, the other breast is often operated on to achieve more balance. A breast reduction, lift or augmentation can achieve a better match to the reconstructed breast.

Types of procedures:

Prosthetic Reconstruction – A temporary tissue expander is inserted under the chest muscle following the mastectomy. This helps to stretch the muscle and skin over time. Fluid is placed inside the expander during surgery to create more breast volume. You will be seen by your surgeon at a later date for additional fluid expansion which only takes a few minutes. You will then have a second operation to exchange the expander for an implant, which has a much quicker recovery than the initial surgery. Nipple reconstruction can also be performed, if necessary.

In some patients, one-stage prosthetic reconstruction may be possible through using a special donor skin which allows ‘direct-to-implant’ reconstruction in some women.

Autologous Tissue Reconstruction:

Diep or TRAM flap – Tissue is commonly taken from the abdomen area for breast reconstruction, similar to tissue used in a tummy tuck procedure. This tissue has its own blood supply, is removed from the body and reattached to a blood supply in the chest, using microsurgery. A special scan is also used to give information about the blood supply to the abdominal tissue. When it is your own tissue, this form of reconstruction can feel and look very natural for you.

Latissimus Dorsi flap – The latissimus dorsi is a muscle in the back. This flap remains attached to its blood supply and contains muscle, overlying fat and skin. In some instances there is insufficient volume in this flap and an implant is required also.

What should I expect after surgery?

• You will notice a breast mound when you wake up from surgery. In the case of the tissue expander, the mound will be smaller than the other side, and over time fluid will be inserted to match. For those having DIEP/TRAM flap reconstruction, the breast mound will be very similar to the other breast. The shape will change with time as there is always swelling after surgery that may take a few months to settle.
• You may have drain tubes in the breast and/or donor areas which allow removal of any fluid that has formed. These will be removed after a few days.
• As with all surgeries, there will be some pain experienced. To ease discomfort our staff will provide prescription pain relief and/or antibiotics.
• Following surgery, you may be fitted into a bra or compression bandage over your dressings which helps reduce swelling. Follow up appointments will be made and the staff will happily assist you.
• If your drain tubes have been removed you may carefully shower and pat dry. Apart from bathing, staying in your bra day and night for 6 weeks will help with recovery.
• At least 2 weeks off work to recover is needed and no heavy lifting for 6 weeks.

What are the risks and complications with this procedure?

• Seroma – excessive accumulation of fluid may occur and will need to be drained.
• Capsule contracture – when the scar around the implant becomes thick and contracts so that the breast shape distorts and creates pain. A new implant will be needed. Women who have received radiotherapy are at more risk of this occurring.
• Infection is rare however antibiotics help to minimize risk.
• Failure of the expander – rare however can be deflated and replaced.
• Blood clots are rare but can be life-threatening. Inform staff immediately if you experience any leg pain, swelling or chest pain after surgery.
• Total or partial flap failure – total or insufficient blood supply to the area may occur. Your surgeon will discuss options with you if this occurs.
• Abdominal hernia – may occur following DIEP/TRAM flap. Another surgery may be required to repair the hernia.