Reconstructive surgery is a safe option for women who are looking to restore the shape of their breast following cancer treatment. Only 23 percent of women are aware of the range of treatment options for breast reconstruction available to them following their breast cancer treatment. At Adelaide Plastic Surgery, our specialist plastic surgeons are skilled in a wide range of surgical approaches. They also work closely alongside our Surgical Breast Oncologist A/Prof Beverley Fosh, offering patients a holistic approach to breast reconstruction surgery.
Breast reconstruction is a very personal procedure. Our specialist plastic surgeons will work with you to recommend the best surgical approach for you, dependent on your overall health, desires and safe management of your breast cancer. Often breast reconstruction will be performed in stages and will involve more than one operation in order to safely achieve the desired results. Breast reconstruction is also an option for women who have not been diagnosed with breast cancer, but have undergone double mastectomy surgery as a preventative measure.
It is possible to have breast reconstruction performed as a joint procedure at the time of your breast cancer surgery or mastectomy. This is known as immediate reconstruction. Depending on your individual circumstances, your surgeon may recommend immediate reconstruction as a safe and preferred method, providing you do not require additional treatments after surgery, such as radiation therapy.
Our specialist plastic surgeons are also able to perform reconstructive surgery at a later time, after safe management of your breast cancer is complete. This is known as delayed reconstruction, and can be performed any time following your breast cancer surgery. This approach allows for the completion of any radiation therapy, and gives your body time to heal and recover.
At Adelaide Plastic Surgery, Dr Nicholas Marshall and Dr Amy Jeeves all perform breast reconstructive surgery, and work closely alongside A/Prof Beverley Fosh, along with other breast oncology surgeons, to collaboratively manage patient’s oncological and reconstructive surgical needs. Dr Amy Jeeves and A/Prof Beverley Fosh also offer their patients the unique service of a combined consulting clinic every two weeks, as well as a joint theatre list once a month, specifically for patients who require mastectomy and immediate reconstruction.
With over 150 years of knowledge and experience collectively, our specialist plastic surgeons have the skills and expertise to approach each patient’s journey uniquely, catering to your individual needs. If you would like to explore your reconstructive surgical options, one of our specialist plastic surgeons would be pleased to discuss this in an initial consultation.
The Procedure and Surgical Techniques
Breast reconstruction surgery is specific to the individual. Your plastic surgeon will recommend a surgical approach that will safely restore your breast, without compromising the safe management of your breast cancer. There is a wide range of surgical approaches available for reconstructive surgery. Find comfort in knowing our surgeons are skilled in the latest breast reconstructive techniques, including:
Tissue expanders and/or breast implants
Tissue expanders are sometimes required to keep the breast envelope shape. Once placed, tissue expanders are filled over time with fluid injections, to allow extra room for reconstruction further down the track. Your surgeon will also discuss the options of breast implants to reproduce the shape of the breast.
Lipofilling and fat grafting are options to use your own tissue to replace volume in the breast. This can be achieved by removing fat from the buttocks, abdomen or upper thigh. The fat is then separated, and the high fat concentrate is injected back into the breasts to produce shape and fullness.
There are several different types of free flap that our plastic surgeons use, two of which are the TRAM Flap and DIEP Flap. They all have the benefit of using microsurgery on blood vessels to move skin and soft tissue to the area that was removed in the mastectomy surgery stage.
TRAM flap stands for Transverse Rectus Abdominis Muscle. In this procedure, an area of skin from your lower abdomen with the underlying fat and abdominal muscle is removed, and transferred to reconstruct your breast. This can be done as a free flap using microsurgery, or left attached to a cuff of blood vessels in what is called a Pedicled Flap.
DIEP flap stands for Deep Inferior Epigastric Perforator. This transfers the same tissue as a TRAM flap except the abdominal muscle, which has the benefit of maximising muscle function in the abdomen.
In a Latissimus Dorsi Flap, muscle and skin located in your upper back is transferred to rebuild the breast. This type of flap is known as a Pedicled Flap, as the tissue is not disconnected from its blood supply. Because the area is close to the breast region, the skin colour is often a good match to the natural breast colour. This procedure is sometimes combined with a breast prosthesis.
As mentioned above, a TRAM flap can also be performed as a Pedicled Flap.
Nipple and Areola Reconstruction
Our surgeons work closely with many breast oncology surgeons and, where possible, they will always try to preserve the nipple so the appearance of the breast is changed as little as possible. In some cases this isn’t always appropriate. Our surgeons will discuss reconstructing a nipple or tattooing to make the patient feel most comfortable.
Hospital Stay + Anaesthesia
For reasons of patient safety, breast reconstruction is always performed under a general anaesthetic with an anaesthetist present. Surgery can take place as a day procedure, but in some instances an overnight stay is required, especially if your surgery involves intricate flap reconstruction.
Nipple and areola reconstruction can be performed safely under either general anaesthetic or local anaesthetic, and will usually not require an overnight stay.
Your plastic surgeon will discuss your options in your initial consultation and determine which is best for you.
In order to keep your consultation as smooth and efficient as possible, we ask that you please bring all relevant documentation with you on the day. This includes your referral letter, Medicare card, private health insurance details, any third party or return to work insurance information, and any relevant scans i.e. x-ray or ultrasounds.
During your initial consultation with one of our specialist plastic surgeons, you will have an extensive opportunity to discuss expectations and desired results. You will also have the opportunity to ask any questions you may have about the procedure.
You will then meet with one of our experienced breast care nurses, where you will have clinical images taken as a before and after reference for both yourself and your surgeon (please note that all our images are confidential and are stored securely online pursuant to the current Privacy Act). Your breast care nurse will also take your measurements and fit you for a post-operative bra.
The final stage involves meeting with your surgeon’s personal assistant. You will be given an in-depth quote, including the surgeon, hospital and anaesthetist fees, along with some take home information on your procedure.
There is a lot of information to take in after your first consultation. We encourage our patients to go home and discuss their procedure with loved ones and come back for a second visit. We find our patients almost always come back with additional questions they hadn’t previously thought of, and this second visit allows you to go into your surgery feeling confident and fully informed about your procedure. We recommend that you allow an hour for this consultation. Please keep this in mind when organising parking so that you don’t feel the need to rush.
Before Your Procedure
There are a number of things you can start to
implement before your procedure, to encourage a smooth recovery and ensure you
are as comfortable as possible post-surgery.
It is important that you:
- Exercise, as having good physical health will significantly help your recovery
- Are not currently pregnant or breastfeeding
- Provide a complete medical history to your specialist plastic surgeon, including all current medications, as some may need to be stopped prior to surgery
- Quit smoking
- Pre-arrange someone to transport you to and from your surgery, as well as stay with you 48 hours after returning home, due to the general anaesthesia required for surgery
- Ensure you follow pre-operative instructions, such as fasting times, or your procedure may have to be cancelled
- Have plenty of loose comfortable clothing that is easy to get in and out of post-surgery i.e. zip through jackets
- Prepare your recovery area! You’ll want to have everything you need to recover easily accessible and within arms reach. We suggest comfortable pillows, icepacks, prescribed medications, emergency contact details, a phone, as well as things to keep you entertained
Recovery time varies with the individual and your time frame for recovery will depend on your individual surgery details, the nature of your employment and your overall level of health. Your surgeon will discuss this with you prior to surgery, and it is important to allow yourself the recommended recovery time. Vigorous activity and exercise should be avoided for the first six weeks, however gentle walking is encouraged after the first week.
On discharge, you will be given specific postoperative instructions to facilitate recovery, and a follow-up appointment will be made with your plastic surgeon. These instructions will cover everything you will need to know in order to make your recovery as smooth and comfortable as possible.
After surgery it is common to have some bruising and swelling, as well as a feeling of tightness across your chest. This is perfectly normal, and typically resolves within the first two weeks, however can persist for up to a month. A tape dressing is applied across the incision lines, and remains until your first post-operative visit. If you have had flap reconstructive surgery you will have a separate dressing on your donor site. Please keep in mind this type of surgery is complex and often requires a longer recovery period than other methods of reconstruction. Adequate pain relief will be provided to you by the hospital to keep you as comfortable as possible.
You may be required to wear your bra day and night for up to six weeks from the day of your surgery. The bra helps control the bruising and swelling, gives you support and helps reduce your pain. Patients often purchase two post-operative bras, to allow one to be laundered while the other is worn.
A plastic tube may be inserted into each breast to drain off any excess fluid. These will remain in place until the drainage is minimal, and are removed by a nurse usually a day or two after your surgery. Your sutures will be removed on day 10–14, unless your surgeon has used dissolvable sutures. Occasionally half your sutures are removed at this visit, and the other half are removed the following week.
Our team is here to support you to make a swift, uncomplicated recovery. We offer a 24/7 on-call medical assistance service for all our post-operative patients.
Breast Implant Registry
Our surgeons are pleased to participate in the The Australian Breast Device Registry (ABDR). The registry is designed to track patient health outcomes, monitor the long-term safety and performance of breast devices and benchmark the quality of surgery involving breast implants.
If you would like more information please click here.
Ready to book an initial consultation?
If you are ready to book your initial consultation, please book online or call us to book with one of our helpful team members. We’ll be pleased to help you start your journey.
Not quite ready or have a question to ask?
Stay up to date
News – March 23, 2023
Will my surgery leave me with a scar?
Specialist Plastic Surgeon Dr Anthony Porter and Jo Herreen RN discuss everything you need to know about post surgical scarring in our latest blog post. Read it now