What is breast reconstruction?
Breast reconstruction involves the restoration of a breast which is deformed, damaged, or has been partially or completely removed as part of breast cancer treatment. If the breast reconstruction is a part of your breast cancer treatment, the reconstruction surgery can either be performed at the same time as the original breast surgery or at a later date.
The two major methods of breast reconstruction include flap reconstruction, where tissues are taken from another part of the body to replace the breast tissue and implant reconstruction, where breast implants are used to replace the breast tissue.
Who is it for?
Women who have had mastectomy surgery due to breast cancer can choose to have breast reconstruction to restore the shape, size, and symmetry of their breast/s at the same time or at a later date.
Patients with all types of breast cancer or premalignant disease, and at all stages of treatment, can be referred to Cosmetic Surgeons for breast reconstruction. This includes women who have:
- Been diagnosed with DCIS (a pre-invasive type of breast cancer),
- Had a positive gene test for breast cancer in which a preventative mastectomy was recommended, or
- Already been treated for breast cancer but were recommended to delay the breast reconstruction.
It is important to note that the decision to undergo breast reconstruction is a personal choice that can impact you emotionally and physically. We suggest you consider factors including your lifestyle, job requirements, recovery length, and your current and desired breast shape and size.
When considering breast reconstruction, it is vital to discuss your options with your Oncologist and your Cosmetic Surgeon.
How is breast reconstruction performed?
When it comes to your breast reconstruction surgery, the techniques your Cosmetic Surgeon undertakes will depend on whether they use implant or tissue grafts. The incisions used will also vary with every effort being made to make visible post-operative scarring as inconspicuous as possible. This procedure is generally performed under general anaesthesia and may require a couple of nights in hospital.
The first step in an implant breast reconstruction procedure is to place the implant into the pocket from which the breast tissue was removed. If there is a shortage of skin, the process is undertaken in 2 separate procedures scheduled several months apart. Firstly, a balloon-like device called a tissue expander is used to stretch the breast skin. Over the next several months, the tissue expander is expanded through the injections of small amounts of saline. This results in the skin stretching over the top of it.
After the skin is stretched sufficiently, your Cosmetic Surgeon will perform the second procedure. This involves removing the expander and placing a permanent breast implant inside. During this procedure, the nipple can also be constructed.
Each procedures takes approximately 1 to 3 hours and the recovery time is much more speedy than with other types of reconstruction. The first stage of this procedure requires a stay in the hospital, while the second is usually performed as day surgery.
Possible complications from implant breast reconstruction include:
- Wound breakdown,
- Blood clots under the wound,
- Poor shape,
- Excessive firmness,
- Poor scars and
- Possible deflation of implants requiring further replacement.
The flap reconstruction method involves using a living piece of your body tissue (called a 'flap') to reconstruct the breast. For most patients the tissue is taken from the lower abdomen, which is then repaired as a tummy tuck. Other patients may have tissue taken from the back, buttock or inner thigh area.
Once the tissue is secured, it is transferred onto the chest and the blood supply is connected to an artery and vein in the chest wall via microsurgery. Because the implant is created from living tissue the Cosmetic Surgeon can achieve a greater variation of the final shape. The reconstructed breast can be easily modelled to look like the opposite breast. Nipple construction is done in a second procedure. This results in the breast feeling more natural than when implants are used.
One disadvantage to flap reconstruction is that it takes longer than the implant reconstruction procedure. You will need to stay in hospital for at least 7 days and will have a longer recovery time than implant reconstruction. It’s important to note the reconstructed breast ages naturally with the patient, resulting in a long-lasting result.
Possible complications from flap breast reconstruction include:
- Wound breakdown,
- Haematoma (blood clots under the wound),
- Tissue loss of the new breast (1% risk),
- Delayed healing,
- Donor site problems,
- Poor scars,
- Possible fat necrosis resulting in hard lumps in the new breast, and
- If tissue from the abdomen has been used there is a low risk of a hernia because the abdominal wall may have been weakened.
After the breast reconstruction, most patients will benefit from day surgery to do a final shaping of the reconstructed breast after 6 months. During this procedure scars can be improved and nipples can be constructed.
This follow-up procedure is usually a simple one with a fast recovery time. Most women only require only a couple of days off work. If you’ve had a nipple construction, a medical tattooist can match your other nipple.
What is recovery like after breast reconstruction?
Recovery time after breast reconstruction will depend on the reconstruction technique your Cosmetic Surgeon uses. After your breast reconstruction procedure, you’ll be taken to a recovery area until you wake up where your pulse, blood pressure and oxygen level will be closely monitored. To prevent blood and fluid from building up, you may have a dressing over your breasts and drains in. Your Cosmetic Surgeon and their medical team will give you information on post recovery care, including which pain medication to take.
You are likely to feel tired and sore for 2 to 3 weeks after breast reconstruction surgery. Most women can get back to normal activities within 6 to 8 weeks. Bruising and swelling is normal and can take up to 8 weeks to resolve. Your scar tissue can take 1 to 2 years to fully heal and while the scars will fade, they will never disappear. It is important to note that breast reconstruction does not restore normal feeling to your breast. Over a period of years some feeling may return.
Breast reconstruction is a cosmetic procedure and some patients are dissatisfied with the results. Patients that have had radiation treatment can present unique challenges with this procedure because the breast tissue will have tightened. In some cases recovery can be more painful and prolonged than for patients who have not had radiation treatment.
Key facts about breast reconstruction
Women consider breast reconstruction surgery for many reasons including: wanting to feel ‘whole’ again, having their breasts match each other, being able to wear clothing without needing prostheses, feeling more comfortable and confident with their partner.
While Cosmetic Surgeons can reconstruct any type of breast shape after any type of breast cancer procedure, the most important priority is to treat the breast cancer. A breast reconstruction cannot compromise the treatment of your breast cancer.
Not every patient is able to have their preferred type of breast reconstruction surgery. If you have had radiotherapy, the treated area can become hard, tight and painful which eliminates implant reconstruction as an option.
You will need to have one or more consultation visits with the Cosmetic Surgeon before the surgery to develop a plan for the breast reconstruction. The surgical plan depends upon your body shape, the cancer treatment you have had, and the shape of the other breast.
Depending upon your occupation, you will need to take at least 2 weeks off from work. If you flap has been used, you will need 6 weeks off work.
Find the best Australian Cosmetic Surgeons who specialise in breast reconstruction surgery
Breast reconstruction surgery is a cosmetic operation to improve the shape of your breast. You should consider the options carefully and have realistic expectations about the results. While it is usually safe and effective, complications can happen.
Before you have reconstruction surgery of your breasts, it is very important to get all of your questions answered by your Cosmetic Surgeon. We suggest you ask questions that include:
- What types of reconstruction could I have and which one would best suit me?
- How long would it take me to recover from each type of procedure?
- How many of these breast reconstruction procedures have you performed?
- Will the reconstructed breast match my other breast?
- Could I have the nipple reconstructed if I choose to? How would this be done?
- How will my reconstructed breast(s) feel to the touch?
- If using a tissue flap, will there be pain, scars, or other changes in the parts of my body where the tissue is taken from?
- If I get a breast implant, how long will it last?
- What kinds of changes to the breast can I expect over time?
- How will aging affect the reconstructed breast?
Find the best Australian Breast Reconstruction Cosmetic Surgeons here.
Important to know
So you can make an informed decision, your elected Cosmetic Surgeon will discuss the possible risks associated with breast reconstruction. Although the majority of patients do not experience these complications, it's important to understand how they can be managed in the event that they occur.