In the spirit of Breast Cancer Awareness Month, we thought it would be valuable to raise awareness around post-mastectomy reconstruction options. While one in eight Australian women are diagnosed with breast cancer before the age of 85, of those that have a mastectomy (40%), the rate of Breast Reconstruction is between 9% and 12%.
Despite a low uptake of breast reconstruction in Australia, current clinical guidelines worldwide recommend that Breast Reconstruction should be offered to all suitable women requiring or choosing mastectomy.
A big part of a surgeon’s role is to provide appropriate options and all the information needed around these procedures to make your decision-making process as easy, informative, and certain as possible. Dr Lee has significant breast reconstructive surgery experience and has previously developed innovative, minimally invasive techniques for the procedure, such as the scarless latissimus dorsi breast reconstruction procedure.
The breast reconstruction procedure can be done at the time of your mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction). Breast reconstruction often requires multiple operations, even if you choose immediate reconstruction. Along with the timing of the procedure, there are three different Breast Reconstruction options
- Implant based reconstruction
- Tissue based reconstruction
- A combination of implants and tissue
Implant based reconstruction
There are 2 types of breast reconstruction options using implants, Tissue Expander/ Implant Reconstruction, and Direct-to-Implant Reconstruction.
Tissue Expander/ Implant Reconstruction (Two Stage)
This is the more commonly performed technique in Australia. Step one of this procedure involves a tissue expander being inserted into the pocket created under your skin and chest muscle. The expander is partially inflated with saline during the operation after insertion and over a period of weeks to months more saline is inserted to gradually fill the expander. This process helps to gradually stretch the muscle and skin to the breast size desired. Once the skin over the breast has been stretched to the desired size, the expander is exchanged for a permanent implant.
Direct-to-Implant (DTI) (One Stage) Reconstruction
In some cases, there is enough skin to insert an implant under the chest muscle to replace the removed breast tissue. In these cases, there in an option to insert an implant directly without the need for tissue expanders.
Tissue flap reconstruction
There are two main types of tissue flap reconstruction – attached flaps and free flaps.
Attached Flaps
This method uses skin, fat and muscle from your back or abdomen, where a portion of tissue and muscle is tunneled under the skin from your back or abdomen to your chest. The new breast is then formed using this tissue.
Free Flaps
This method uses skin, fat and muscle removed from your abdomen or buttock, cutting the arteries and veins, then re-attaching to the blood supply of the chest wall. The breast is then formed from this tissue.
A combination of implants and tissue
In some cases, it may be necessary to use an implant and tissue to achieve the desired results. Your surgeon will be able to discuss your desired goals and the right procedure to work towards your goals.
Choosing to have plastic surgery is a serious personal decision and undertaking. Please be mindful that any surgical or invasive procedure carries risks. Breast reconstruction is a highly individual procedure and may not be suitable for everyone, however Dr Lee and his team are always more than happy to talk about your options.
Resources
Increasing breast reconstruction rates by offering more women a choice, Article in ANZ Journal of Surgery, January 2014
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