Breast reconstruction

When is breast reconstruction needed?

Most commonly, breast reconstruction follows a procedure to remove the breast (mastectomy), and involves rebuilding and reshaping the breast. However, it is important to understand that breast reconstruction is not limited only to mastectomy: deformities left by wide local excision procedures (lumpectomy) can also require reconstruction. In this case, the breast reconstruction procedure will focus on correcting shape changes and defects in the existing tissue, rather than fully rebuilding the breast.

Breast reconstruction often forms part of the initial surgery needed to address breast pathology. If it is your preference and where possible, ORBE surgeons aim to provide immediate breast reconstruction. Alternatively, reconstruction can occur down the track as a separate procedure at a time that suits you best and after your body has had a chance to recover.

Breast reconstruction has been associated with improved self-esteem, positive body image, quality of life, and overall mental health in women recovering from breast cancer. This being said, the choice of whether or not to undergo a breast reconstruction is still your own. Many women choose to use external prosthetics which can be placed in a bra instead, or completely forgo any kind of breast replacement. Your ORBE surgeon can help you understand your options and select one that best suits your needs.

If you have poor overall health, you may not be medically suitable to undergo more surgery. Some medical conditions – such as diabetes or a history of smoking – can impact your ability to heal properly. It may be preferable to defer reconstruction until your other health conditions are better managed and your body has had a chance to recover.

In addition, not everyone who is suitable for breast reconstruction will be suitable for every approach. The size and shape of your tumour, the amount of natural breast tissue that needs to be removed, and your body type may impact the reconstruction options available.

If you need to undergo additional cancer treatment, it may be advisable to delay reconstruction until after your body has had a chance to recover. ORBE Surgeons will discuss this with you during your consultation and will never recommend a course of reconstruction that could potentially delay your cancer treatment – your health and wellbeing are most important.

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It may be suitable to undergo part or all of the reconstruction during your cancer removal procedure. This means that you will wake up with breasts after the initial surgery. Some women find immediate breast reconstruction makes it easier for them to cope during their recovery.

You may, however, delay your reconstruction until after you have fully finished cancer treatments, or choose to undergo reconstruction months or years after your mastectomy or lumpectomy. It’s never too late to have a conversation about reconstructing your breast or breasts.

Depending on the size and shape of your tumour, you may be suitable for oncoplastic breast surgery. This approach may be used to avoid a complete mastectomy, and integrates defect reconstruction into the removal procedure where possible. ORBE Surgeons is a home to multiple surgeons with specialist training in this area – you can visit our oncoplastic surgery page to learn more about it.

Types of breast reconstruction

There are two main types of breast reconstruction: implant reconstruction, and autologous (flap or tissue) reconstruction.

Implant reconstruction involves inserting a synthetic implant into the breast. Often times, implant reconstruction can occur in one step. Occasionally, it requires two separate surgeries: one to insert a temporary tissue expander (like an inflatable balloon) to stretch the skin, and one to replace the balloon with a permanent implant made of silicone or saline. In between these surgeries, you will need to visit ORBE Surgeons several times to have the expander slowly filled with saline – this gradually stretches out the tissue to make room for the final implant. The expander is filled until the desired result is achieved.

Autologous (flap or tissue) reconstructions use tissue from your own body to repair and reshape the breasts. This involves taking a tissue graft, usually from your belly, thigh, or back. Autologous reconstructions generally require a longer surgery and a longer recovery time; however, they require less ongoing attention over time. They also tend to produce a more natural shape, and won’t become disproportionate if you gain or lose weight. There are many different types of autologous reconstruction, and your ORBE surgeon will help you understand which approach is the best fit for you.

Fat grafting is another tool to repair the breast or enhance a breast reconstruction. It entails a mini liposuction procedure to collect fat from the stomach, legs or buttocks. Fat is then injected around the breast or reconstructed breast.

The recovery period following your breast reconstruction can vary greatly depending on the approach used and your individual health. You may have soft drains and require dressing changes. Bruising and swelling resulting from the procedure will generally fade away after 6-8 weeks; however, it takes many months for the reconstruction to settle fully. Your surgeon will advise you as to when you can resume normal activity.

The goal of any reconstructive breast procedure is to produce a satisfactory recreated breast within the scope of what is achievable. However, it is important to understand that your breasts will have a different look and feel to their previous state: changes in size, shape, and sensation are expected. Scarring will also be present – although this will fade over the subsequent months and years, it will never disappear fully.

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