Breast Reconstruction

What is Breast Reconstruction Surgery?

Breast Reconstruction is a surgical procedure aimed at getting a breast back into shape following a breast removal procedure (Mastectomy) or after a breast lump is removed (Lumpectomy).

This procedure can involve the use of an implant or transferred skin fat and muscle from another part of the body to create a replacement breast structure under the skin and breast muscle.
 
Following on from a successful reconstruction procedure it is possible to create a new nipple on the reconstructed breast and this is usually done as a separate operation once the reconstructed breast has completely healed.

Who will benefit from Breast Reconstruction surgery?

This procedure is performed within a broad age range for the following reasons:

• Women of all ages who are unhappy wearing an external artificial breast (prosthesis) following a Mastectomy
• Women of all ages who are unhappy with their general breast shape and/or size following a Lumpectomy.
• Women who wish to undergo further surgery after cancer surgery because they believe it will help them restore their self-confidence or feelings of femininity, attractiveness and sexuality.

How is a Breast Reconstruction procedure performed?

Breast Reconstruction Surgery can be performed in a number of different ways dependent on an individual's circumstances and the surgeon's specialist skills.  All of the described surgical methods will involve a general anaesthetic (you will be asleep throughout the procedure) and involve a short to medium stay in hospital of between 1 or 7 nights, dependent on the complexity of the procedure performed. 

These are the most commonly offered Breast Reconstruction procedures:

• Breast Implant Situated Under The Skin (Subcutaneous).
  In this type of reconstruction the breast tissue is removed but the skin and nipple is preserved. This method is usually only suitable for women with fairly small breasts and who have had a non invasive type of cancer; as some surgeons worry that in certain types of breast cancer, tiny areas of cancer cells may be left in the nipple and areola areas that may continue to develop. In this particular procedure a breast implant is placed underneath the skin to replace the lost breast tissue and the breast skin is sewn back in place in either the crease line beneath or on either side of the breast.  
   
• Breast Implant Situated Under The Muscle (Submuscular)
  The advantage of this method is that it is a simple procedure. It may not give a very good appearance compared to the other breast implant surgery, as the new breast will not have its normal droop and can look relatively high to the unaffected breast. However, this sort of reconstruction may be helpful if both breasts are being removed (bilateral mastectomy and reconstruction). Another disadvantage is that the implant can change shape slightly when you move, as the overlying muscle contracts.
   
• Breast Reconstruction With A Tissue Expander
  Breast reconstruction involving tissue expansion can produce very good results and avoid the need for the extensive surgery to transfer skin and tissue when insufficient breast tissue is left after radical surgery. However, this method will take much longer to create a breast, relative to other procedures as this method uses the natural elastic properties of a patient's own skin and muscle to stretch over a period of time. Two operations are carried out to achieve this type of reconstruction.
   
  In the first operation, an expandable implant (like an empty balloon) with a valve to allow filling, is placed under the chest muscle. This implant is then expanded over a few months by injecting sterile salt water into the implant through the valve, which is positioned just under the armpit skin.
  This implant is refilled on a weekly basis in order to gradually grow the size of the implant beneath the breast skin. This process is repeated until the size of the implant is slightly larger than the unaffected breast.
   
  The second operation is performed after several months and involves removing the inflatable silicone bag and replacing it with a permanent breast implant. The breast implant size will be selected to match the size of the unaffected breast.
   
• Breast Reconstruction Using Muscle And Skin Flaps
  This type of breast reconstruction uses areas of muscle and skin (known as flaps), which are usually taken from the back or abdomen. These areas are ideal because they contain very large muscles and provide enough skin and fat with a good blood supply to create the shape of a breast on the chest wall. This type of reconstruction can be used to create a new breast after mastectomy, or to replace large areas of the breast tissue that have been taken away during a lumpectomy. This type of surgery is usually more appropriate for patients who have had a lot of skin and muscle removed from their breast or where previous radiotherapy has made the skin unsuitable for tissue expansion. This is also a particularly useful method used when reconstructing a large shaped breast.
   
  There are two reconstruction methods used involving flaps and these are known as "Tissue Flap" and "Free Flap" surgery, which are described as follows:
   
  i. Tissue Flap Reconstruction: This is a procedure in which skin, muscle and fat from the back or abdomen is tunneled through to the chest to create a new breast form. The skin, muscle and fat stay connected to the area of the body and blood supply from which it was taken.
   
  ii. Free Flap Reconstruction: This is a procedure in which skin and fat from the lower abdomen, or buttock, is grafted to the breast area. The skin and fat is completely removed from the original area and a new blood supply is created for the new breast tissue, using specialist microsurgery.

What is the recovery like?

Once a patient is fully recovered from the effects of anaesthetic they are normally quickly encouraged to be as mobile as possible to avoid complications such as Deep Vein Thrombosis. Following a progressive improvement of mobility and pain control, patients are normally discharged home around 1 - 7 days following surgery, dependent on the complexity of the reconstruction procedure undertaken.

Whilst Breast Reconstruction is a major procedure, the operated breast area is usually quite numb and relatively pain free following reconstruction surgery, although if flap surgery is involved, the donor flap site is often described as painful and will probably remain uncomfortable for some time. For this type of surgery, analgesic injections (pain killers) are usually given for the first few days following surgery and analgesic tablets are provided for any discomfort that may be experienced after that and following discharge.

After discharge patients are strongly advised to remain gently mobile at home, but to avoid any level of activity that would put undue strain on the new surgical wounds.  Patients are also advised to wear a soft, supportive bra, which does not have an under-wire and to keep their post-operative dressings clean and dry until they return to hospital for suture (stitch) removal around 10 - 12 days following surgery.

Patients will be advised to take a specific amount of recovery time away from work, dependent on the type of work they perform and the complexity of their reconstruction procedure. Patients are also requested to refrain from any strenuous upper body exercise for at least 8 weeks following surgery.

Are there any risks associated with Breast Reconstruction surgery?

All surgery involves an element of risk of developing complications. Risks such as bleeding, delayed healing, infection, implant rejection, encapsulation, asymmetry, alteration in sensitivity, the possibility of disappointment with results and scarring, will all be discussed openly at consultation, as well as our scrupulous efforts to manage and minimise these risks to their lowest possible potential.

Due to the additional healing and infection risks experienced with patients who smoke, smokers may be precluded from having surgery until they cease or substantially reduce their daily cigarette intake.

Although Breast Reconstruction is regularly performed without any complications, it is very important that all candidates are fully aware of both the benefits and risks of undertaking this type of complex reconstruction surgery.

All surgery, no mater how expertly or carefully it is performed, carries risks and the importance of a full evaluation and consultation to discuss your understanding and expectations in relation to these risks with an expert consultant surgeon in Breast Reconstruction, cannot be over emphasised.

How do I find out if I am a suitable candidate for Breast Reconstruction surgery?

Surgical Advisor will be delighted to help you find a leading expert surgeon in Breast Reconstruction surgery to consult with. Your surgeon will carry out a thorough evaluation of your condition and provide you with a comprehensive explanation of the most appropriate surgical solution.
 
Our Expert Consultant Surgeons are most carefully selected and recommended because they understand the importance of the decision you are making when contemplating complex Reconstruction Surgery and because of their Breast Reconstruction surgery expertise. Throughout your consultation you will therefore be encouraged to ask as many questions as you wish and to take your time in making a decision to proceed with any recommended treatment.

To ensure that patients are comfortable with any recommendations or advice given in their consultation, all patients are asked to go away after a consultation and think through all the information they have received. If for whatever reason you are still not sure about the best course of action and wish to have further dialogue with your surgeon, you will not be expected to pay for a second consultation appointment.

How do I make a consultation appointment?

For further advice on how to make an appointment with an expert Consultant Surgeon in Breast Reconstruction: 

Please call Surgical Advisor on: 0870 41 41 41 2
Or email us by clicking on: advice@surgicaladvisor.com