Breast Reconstruction


1 in 8 women are diagnosed with breast cancer at some stage during their life. Whether you have been affected personally, or seen the effects of breast cancer on a friend or family member, as the second mose common cancer diagnosis in Australia breast cancer is unfortunately relatively common. Much like any cancer diagnosis, there are significant physical, psychological and social stresses for those affected. 

 

It is for these reasons that the options for breast reconstruction are so important to be discussed early on in the course of treatment. While it can often feel like a flood of information and at times overwhelming, discussion of the various options for reconstruction can also allow you to shift your thoughts to your recovery and life after your cancer treatment is completed. Often these options are available at the same time as a lumpectomy or mastectomy procedure and are designed to reconstruct and restore breast shape and volume to allow you to maintain confidence and quality of life in the long term

What reconstruction options are available to me?

 

One of the most important questions to ask your breast surgeon and reconstructive surgeon is which of the many different breast reconstruction options that are available - are actually applicable to your situation. 

 

While 20% of women who are diagnosed with breast cancer will require a mastectomy, the majority will only require localised resection with a 'lumpectomy' procedure. The advantage of this breast conserving approach is that the remaining breast tissue can be preserved and typically an 'onco-plastic' approach to your lumpectomy surgery will be attempted to allow for redistribution of the remaining breast tissue to provide a good breast shape after the surgery. Although there are limitations depending on the location of the tissue to be excised and the size o the area affected, lumpectomy with onco-plastic reconstruction can lead to very good results.

 

One factor when considering lumpectomy vs mastectomy is adjuvant treatment. Your breast surgeon may discuss the possibility of avoiding the need for adjuvant therapy if you choose to undergo a mastectomy rather than a lumpectomy. While previously, breast conservation was always considered a better option, with advances in breast reconstruction options after mastectomy, this decision is no longer as clear cut and many women will choose to have a mastectomy with reconstruction rather than a lumpectomy with post operative radiotherapy as the long term outcomes of breast shape and size may be superior for the reconstruction option compared to breast conserving therapy

Immediate vs Delayed reconstruction

One of the first decisions to be made in discussing your treatment plan with your breast surgeon and reconstructive surgeon should be timing of reconstruction. 

 

There are 3 options available:

  1. Immediate reconstruction - Breast reconstruction at the time of mastectomy with silicone implants or using your own natural tissue (DIEP / TRAM reconstruction)
  2. Delayed reconstruction - Mastectomy is performed first, any adjuvant treatment such as chemotherapy and radiotherapy are completed, then reconstruction is performed at a later date
  3. Delayed Immediate reconstruction - A temporary reconstruction is performed using place holding implants (tissue expanders) which preserve breast skin and provide shape and volume until all adjuvant therapy (if any) is completed and then the temporary implants are replaced with the final reconstruction (with silicone implants or your own natural tissue (DIEP / TRAM reconstruction)

The decision making process for which of these options is best for you will depend on your own preference, your breast surgeon and cancer team's recommended treatment and finally a recommendation from your reconstructive surgeon. There will be certain factors, such as the likelihood of need for radiotherapy post operatively which will determine whether one or all of these options are best for you and this will be discussed during your consultation to help you navigate through this decision. 

 

 


Which reconstruction option - Implants or Natural tissue?

There are two main options for breast reconstruction - silicone implant based reconstruction and natural tissue based reconstruction. Both have been used routinely by reconstructive surgeons throughout the world to provide safe, reliable results and the benefits and disadvantages of each option should be considered in your decision for which reconstructive option is best suited to you.

 

 

Implant based reconstruction

Utilising silicone implants for your breast reconstruction restores the volume lost in a skin sparing or nipple sparing mastectomy and reconstructs the breast using a safe, non-biologic material that has been used for many decades for both reconstructive and aesthetic breast surgery.

 

Advantages of silicone implant reconstruction include:

  • Restores breast volume in patients who have limited extra tissue available for tissue-based reconstruction
  • Quicker operation with less recovery involved
  • May be possible as a single stage (Direct to implant) procedure
  • Facilitates change in breast volume from pre-operative size

Disadvantages of silicone implant reconstruction

  • Silicone implants will need to be replaced on average 10-15 yearly
  • Not suitable in the setting of radiotherapy (pre-operative or expected adjuvant radiotherapy post op) due to significant risk of implant extrusion
  • Minor complications such as wound infection or fluid collections can lead to major issues and loss of implant
  • Cosmetic outcome of reconstruction can be less satisfying in patients with wider chest and larger breast volume

Autologous reconstruction

Autolgous reconstruction is the term used when your reconstructive surgeon utilises excess tissue (skin and fat) from an area of your body (most commonly the abdomen) and transfers this tissue to your chest area to reconstruct lost breast tissue. Effectively replacing 'like with like' there are significant advantages to this approach for breast reconstruction.

 

Advantages of autologous reconstruction include:

  • Provides a natural, permanent breast reconstruction that replicates normal breast tissue closely
  • May be possible as single stage, however often likely to require minor revision or tailoring procedures
  • Natural tissue is permanent, resistant to minor complications such as wound  infection.
  • Better aesthetic outcome in patients with larger breasts and chest diameter
  • Provides a 'tummy tuck' operation at the same time improving abdominal contour

Disadvantagaes of autologous breast reconstruction

  • Longer operating time and longer recovery (6 hour operation vs 2), 3-5 day hospital stay vs 1-2 days. 6 weeks return to work vs 4-6 weeks
  • Volume limited by tissue availability. Difficult to change breast volume significantly

In helping your decision for the best technique to suit your needs, several factors are again taken into account including

  • Your personal preference
  • General health and physique
  • Breast cancer pathology and need for adjuvant radiotherapy
  • Timing of reconstruction
  • Recovery timeframe

It is uncommon that both options are equally good in a patient considering breast reconstruction - for example a patient may have a large breast skin envelope and wider chest width that would never achieve a pleasing aesthetic outcome with an implant based reconstruction, or a slender patient may have prior to their diagnosis wanted to upsize their breast volume and and implant based reconstruction may be a good option to achieve this. During your consultation, Dr Ahn will be able to provide you with some guidance as to which of these options would better suit your needs and allow a good aesthetic outcome at the end of your breast reconstruction journey.