Breast Reconstruction

Breast reconstruction following mastectomy enhances a woman’s physical and mental wellbeing. Dr Moko has a special interest in breast reconstruction.

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.

Although breast reconstruction can rebuild your breast, the results are highly variable:

  • A reconstructed breast will not have the same sensation and feel as the breast it replaces.
  • Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
  • Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

Depending on a number of factors, reconstruction can be undertaken at the same time as mastectomy (immediate reconstruction) or some time after (delayed reconstruction).

In general, reconstruction involves the use of expanders and implants, or transferring your own tissue to the chest to create a breast mound. Further procedures are required to create the nipple and areola.

Both methods usually take more than one operation, can take several months to reach completion, and both have advantages and disadvantages. Surgery to the other breast is often required to achieve symmetry.

The following information is a brief overview to a very complex subject.

Before Procedure

At the first consultation, Dr Moko will listen to your goals and concerns, and take a thorough medical history and physical examination. She will review your situation and factors surrounding your mastectomy, chemotherapy, radiation treatment, and general medical health. She will cover in detail the options available to you, including the risks and limitations, and choose the best option for you.

Photos will be taken for planning and comparative purposes.

Procedure

Reconstruction with expander/implant

A tissue expander is placed under the skin and muscle at the site of the new breast. You stay in hospital overnight.

You attend Dr Moko’s rooms weekly for saline to be injected into the expander’s port. The expander is slowly filled over time, stretching the tissue to create a space large enough to eventually accommodate an implant. This process can take up to 12 weeks. The discomfort you experience during this time is managed with oral pain relief.

Once the expander has reached the desired size, you have a second operation to exchange the expander for an implant. You can go home the same day. You gradually return to normal activities 1 week after both procedures, but you will need to limit heavy lifting and upper body movements for up to 6 weeks.

Reconstruction with your own tissue

When a block of tissue that carries its own blood supply is surgically transferred to another part of the body it is called a flap. The most common flaps used in breast reconstruction come from the back (latissimus dorsi flap), and the abdomen (TRAM flap, DIEP flap).

Latissimus dorsi flap

The skin, fat and muscle on the back is raised and tunneled to the chest to create a breast mound. This flap often requires combination with an implant.

TRAM and DIEP flaps

The TRAM flap (tranverse rectus abdominus myocutaneous) uses skin, fat and muscle from the lower abdomen and is similar to a ‘tummy tuck’ in terms of recovery.

Commonly the tissue is kept attached to the muscle and tunneled under the skin to the chest, where the new breast is made. The abdominal wound is closed similar to a tummy tuck, resulting in a flatter abdomen.

In certain situations, the flap is disconnected from its original blood supply ie cut free from the body. The free flap is then transferred to the chest and reconnected to new blood vessels using microsurgical techniques. The DIEP flap (deep inferior epigastric perforator) is a variant of the free TRAM flap that takes abdominal skin and fat without sacrificing muscle.

Breast reconstruction with flaps can take several hours of operating time and several days as an inpatient.

After Procedure

Recovery will depend on the type of procedure. Dr Moko will give you details on what to expect from your breast reconstruction.