Unfortunately, many women lose their breast to Breast Cancer, or because of their high risk of getting another one, elect to have a mastectomy as prophylaxis against further Breast Cancer. The aim of breast reconstruction is to re-create the breast in these patients, and it’s an important step to restore their sense of femininity.
Breast reconstruction, although rewarding and with a high patient satisfaction rate, can be at times quite a complex procedure. This is one of Dr Safvat’s areas of interest and he frequently performs Breast Reconstruction.
One of the most important decisions about breast reconstruction is the timing and the type of reconstruction. There are many factors that influence this including, type of Breast Cancer, the treatment(s) required for the breast cancer, the patient’s body shape, the size of the reconstruction and the patient’s preference. The decision is ultimately made by the patient after thorough discussion with Dr Safvat about all the available options.
Breast reconstruction can be done using the patient’s own tissues (autologous) or using implants (alloplastic). At times it may be necessary to combine both of theses to get the best result for the patient.
Both have advantages and disadvantages and this will be discussed in detail in the first consultation with Dr Safvat. For example autologous reconstruction avoids the need for implants, and as such the breast may feel and behave more naturally. However it is more complex than alloplastic reconstruction and the recovery time is usually longer.
Alloplastic reconstruction usually requires 2 operations. The first stage is to insert an expander that is slowly expanded with saline over a period of weeks to months. Once the desired size is achieved it is replaced with a permanent silicone implant with additional fine tuning of the position. The operation is simpler and of shorter duration and it requires less time to recover.
Autologous reconstruction most commonly uses the patient’s own abdominal tissues (the Transverse Rectus Abdominus Myocutaneous (TRAM) or the Deep Inferior Epigastric Perforator (DIEP) flaps which have the added advantage of giving the patient a ‘tummy tuck’ as well. Other tissues can also be used depending on the patient’s body shape and wishes such as the buttock area or the back area.
Once the new breast has been reconstructed into its final shape, the nipple is made, using local skin flaps and the areola by medical tattooing. Often the opposite breast may need adjusting at that time in order to achieve symmetry. It may need to be lifted, reduced or augmented.
Breast reconstruction can be made at the same time as the mastectomy (immediate) or after all the treatments for the breast cancer are completed (delayed). Depending on the type of the reconstruction, it often involves multiple stages from creating a breast mound to adjusting the shape and symmetry to reconstructing a nipple and areola.
In immediate, the mastectomy and the reconstruction are done with the same anaesthetic and hospital stay. Although this makes the surgical procedure much longer, the patient wakes up with a breast mound already in place and are spared the experience of not having a breast.
The decision to do an immediate or delayed reconstruction is not only based on patients’ preference but also is dependent on what other treatments are needed for the breast cancer. For example if post-operative radiotherapy is needed it will compromise the final result of the immediate reconstruction. Reciprocally the reconstruction may interfere with these potentially life-saving treatments. Dr Safvat will work closely with breast cancer surgeons to obtain the best possible cancer treatment as well as optimal results for the reconstruction.
Breast reconstructions are performed under General Anaesthetic in fully accredited hospitals. The operation time for autologous reconstruction is bout 5-8 hours, and for alloplastic about 2-3 hours. Hospital Stay is also from 7 to 10 days for autologous vs 4 to 7 days for alloplastic (1st stage). Patients often require about 4-6 weeks to recover from alloplastic and 2-3 months for autologous reconstruction. There will be swelling and bruising for up to 4 weeks and patients need to wear a Garment for this time.
Breast Reconstruction Surgery Cost
Breast Reconstruction has an Item number and patients will get a rebate from Medicare and their health fund. The hospital costs are covered by private health funds depending on the patients’ level and type of cover. At the first consultation Dr Safvat and his team will discuss all the costs associated with breast Reconstruction Surgery.
Any surgical procedure can be associated with some general Complications. These include risks associated with general anaesthetics, collection of blood (heamatoma) or other fluids (seroma), and mild to severe infection.
Autologous reconstruction is more complex. Often a muscle is sacrificed to reconstruct the breast. There may be weakness or a bulge in the area where the muscle is removed or dissected. Also if blood flow problems develop in the reconstructed breast, all or part of it may be lost.
All implants (breast implants, artificial joints, pacemakers etc.) are foreign material and more likely to get infected. Patients will be discharged on antibiotics to prevent this. In the rare event of a serious infection affecting the implant itself, it will have to be removed, and replaced once the infection settles. The incidence of serious infection is about 2-4%.
Around all implants a fibrous capsules (scar tissue) is formed to keep it in place and protected. For reasons that are not totally understood, this capsule can sometimes become thicker and contract. In its severe form it causes discomfort or can even distorts the breast. The incidence of capsular contracture in breast reconstruction is about 15% where the capsule needs to be removed and the implant replaced.
Dr Safvat will go through these with you in details depending on technique used and your individual risk profile.
What You Need To Do Before The Operation
Smoking and being overweight have been shown to cause more complications after breast reconstruction. Dr Safvat will insist that Patients stop smoking at least 4 weeks before their surgery. As a general rule if the weight is stable the result of the Breast reconstructions are better and more predictable, as the reconstructed breast increase or decrease in size with patient’s general weight.