Breast Reconstruction

What is breast reconstruction?

Breast reconstruction is a surgical procedure that restores the shape of your breast after mastectomy. It is a complex procedure performed by a plastic surgeon. You may need two or more operations to achieve a correctly positioned and natural-appearing breast. However, your breasts probably won't be completely symmetrical afterward.

How experienced in Dr. Mansoor in breast reconstruction? Am I in good hands?

Dr. Mansoor has performed hundreds of breast reconstruction surgeries and works closely with many breast cancer surgeons. He has extensive experience in all forms of breast reconstruction and will go through all the available options in two consultations, the first of which is of at least one hour duration.

Will reconstruction of my breasts influence the recurrence of breast cancer?

Breast reconstruction does not stimulate breast cancer recurrence nor reduce its detection.

What are the different methods of breast reconstruction?

Your surgeon may choose from one of the below methods to reconstruct your breasts:

• Prosthesis
• Alloplastic (implant)
• Autologous (your own tissue)
• Combination of implant and your own tissue on top

How do I know which method is better for me?

Exactly which method is chosen depends on:

• Your general health, smoking status, age, body mass index (body weight in relation to your height), availability of your own tissue to be transferred to the chest, and the condition of the skin on the chest/breast
• The type of cancer, how much skin is to be removed, and the likelihood of other treatments apart from surgery (hormone therapy, chemotherapy, radiotherapy)
• Your preference as the recovery from different procedures vary

How does prosthesis reconstruction work?

If you decide not to have a surgical reconstruction, you may choose to have a prosthesis which is a silicone mould resembling a breast, which is put inside the bra.

Click on the link to go to Breast Cancer Network Australia for more information: www.bcna.org.au

How is implant reconstruction performed?

Implant reconstruction usually requires two operations, although occasionally it is possible to do a one stage reconstruction.

First stage:

The first stage involves the insertion of a tissue expander, which is shaped similar to a breast. This is inserted under the pectoralis muscle and is partially inflated with saline during the operation. Subsequent inflations are done in the clinic starting two weeks after the operation until the desired volume is reached. After a minimum of three months, the expander is removed and a tear-drop shaped silicone implant in inserted.

Second stage:

Quite often, the other breast needs to be lifted to resemble the implant and this is done at the second stage. Occasionally, the nipple is reconstructed at this stage, however, I usually do this under local anaesthesia in the clinic.

Would need further procedures after the implant?

Although this is a smaller procedure and recovery is faster, most patients would need further procedures in the years to come. An implant is a manufactured product, which will eventually fail from wear and tear, just like a car tyre. Replacing the implant or fixing other complications is usually a small procedure.

How is autologous (your own tissue) reconstruction performed?

There are many locations where skin and fat could be removed with blood vessels and moved to the chest to make a breast. The common areas include the lower abdomen, inner thighs and buttocks.

The lower abdomen is the most common site because there is usually adequate amount of fat and skin and long, good-calibre vessels. Although the rectus abdominis muscle is traditionally removed with the blood vessels, I prefer to preserve the muscles and separate the blood vessels from it, a procedure called the DIEP flap (deep inferior epigastric artery perforator flap).

What is the prognosis of an autologous reconstruction?

These operations are longer and have a failure rate of 1-2%; however, once the reconstruction is complete, the breast generally feels and moves like a natural breast and further surgery is very unlikely.

Can I combine the implant and autologous reconstruction procedures to reap the benefits of both?

Latissimus dorsi (LD) flap is an example of a combined implant and autologous reconstruction approach. It is an old-fashioned way of reconstructing a breast; and involves, taking skin and muscle from the back, still attached to the blood vessel in the arm pit, and tunnelling it under the skin to the front. As the volume is usually not adequate, an implant is inserted under the flap.

Latissimus dorsi muscle is a muscle used by climbers, tennis players and golfers. It brings the arm down when it is raised. This is a good procedure when there are no other options. It has complications specific to the implant as well as complications related to taking your own tissue.

How is nipple reconstruction performed?

There are many ways to reconstruct a nipple. I usually perform this under local anaesthesia in my clinic and use the skin from the middle of the breast to make a nipple. The nipple and areola is tattooed after 3 months. Occasionally, I use a skin graft taken from the lower abdomen or the groin to make an areola if the skin over the breast is too tight.