Breast Reconstruction

Why perform breast reconstruction surgery?

For women who have asymmetric development of their breasts, abnormal development as a consequence of trauma or burns or who are about to or have experienced a mastectomy, breast reconstruction offers the opportunity to have their body image improved or restored.

This group of procedures involves recreating a breast as a consequence of surgery to treat breast cancer, congenital developmental abnormalities (e.g. Poland's Syndrome, asymmetry related to failure of breast tissue growth) and trauma or burns. It may involve more than one procedure with the initial operation designed to establish a breast shape and a second procedure to create a nipple and possibly to correct residual scars and shape.

Following mastectomy for breast malignancy, every woman should be given the option of a reconstructive procedure. This can be undertaken at the time of mastectomy (immediate reconstruction) or as a delayed procedure (at the completion of any extra treatment e.g. radiotherapy or chemotherapy). For some the need or desire to have immediate breast reconstruction may be discouraged if extra treatment is planned from the outset, however good safe results are still possible.

Reconstruction can also be considered for patients who are entertaining prophylactic bilateral mastectomy either because they have developed a secondary lesion and do not wish to risk another breast cancer or they have a strong probability of developing a breast tumour. This risk may be based upon their family history or specific testing for genes associated with breast disease.

There are advantages and disadvantages of both immediate and delayed approaches and these are focused largely on the perception that complications may be greater in those who have immediate reconstruction depending on the choice of technique adopted and may subsequently delay additional treatment. However in delayed reconstruction the aesthetic results may not be as good as with immediate reconstructive techniques.

This relates principally to effects of scarring on the tissue remaining after mastectomy. Careful consideration will be given to individual patients needs as to which approach is both the most appropriate to restore body image as well as the safest in regards to management of your breast disease.

Our surgeons with an interest in breast reconstruction are always willing to discuss immediate reconstructive options and work with your breast surgeon to co-ordinate and expedite appropriate treatment and reconstruction in a timely manner.

At APSA we have surgeons skilled in all available breast reconstructive techniques.

These include the use of tissue expanders and breast prostheses, use of sheets of tissue incorporating muscle skin and underlying fat (myocutaneous flaps) either as a pedicled flap where the flap's blood supply is retained intact (eg pedicled latissimus dorsi flap, pedicled TRAM flap) or as a free flap where the blood vessels supplying a piece of tissue are divided and then re-attached to blood vessels in the proximity of the breast/chest defect (e.g. Free TRAM flap, DIEP flap). The combination of prosthesis with a patient's own tissue can also be considered.

Important issues to consider in breast reconstruction for any woman will be whether there is a need to reconstruct both breasts, what risks or complications are acceptable to obtain the best result, whether silicone implants are an acceptable alternative to using one's own tissues alone, the expected impact upon one's lifestyle and also the amount of scarring that a person is prepared to accept.

Many of these issues are best addressed at a consultation with your surgeon.

Other Breast procedures