Reconstructive Procedures
BREAST RECONSTRUCTION
BREAST RECONSTRUCTION
After a mastectomy (surgical removal of the breast), most patients contemplate breast reconstruction to restore shape and volume to their breasts. Breast reconstruction aims to re-create a natural appearing breast to restore the physical and emotional well-being of the patient.
Procedure
Following a mastectomy, breast reconstruction is often performed in stages. The initial surgery which is aimed at creating a new ‘breast mound’ can be performed immediately at the time of the mastectomy or delayed and performed later as a separate procedure. Techniques for breast reconstruction following mastectomy are divided into various groups:
Flap-based reconstruction:
Involves using the patient's own tissue, from another part of the body, as "donor" tissue to create a new breast. The plastic surgeon transfers skin, muscle or fat (or a combination) from a donor area (lower abdomen, buttocks or back) and moulds this tissue to create a new breast of the desired breast shape and size. This type of reconstruction may make use of either a:
- Pedicled flap:
A pedicled flap uses donor tissue that is locally available (close to the breast). The flap remains attached to its original site and blood supply by a ‘pedicle’ and is moved or rotated into the defect, where it is reshaped to form a breast. The donor site is sutured closed. - Free flap:
A free flap uses donor tissue that is further from the breast site and as such, the plastic surgeon must completely disconnect the flap tissue from its blood supply and the patient's donor area, in order to transfer it to the mastectomy defect. The free flap is then connected to blood vessels in the chest wall to re-establish blood flow to the flap. The flap is then moulded into a new breast. A DIEP flap is a commonly used free flap for breast reconstruction that uses lower tummy skin and fat to create a new breast. Apart from being a good breast reconstructive option in the right candidate, one advantage of this surgery is that it leaves the abdomen flatter than it was before.
Implant-based reconstruction:
This type of reconstruction uses a silicone breast implant to reconstruct the breast mound. It can be performed immediately at the time of mastectomy in cases where a skin-sparing mastectomy is feasible and where there will be sufficient coverage of the implant. Alternatively, it can be performed as a delayed procedure, but this generally requires the use of a tissue expander (inflatable ‘balloon-type’ silicone implant) that is regularly filled with saline to stretch the overlying skin and create a pocket for a breast implant. When there is an adequate pocket the expander is exchanged for a silicone implant.
Combined flap- and implant-based reconstruction:
This type of reconstruction involves using a flap to cover an implant-based reconstruction (or expander and implant). This may be necessary to provide additional protective tissue covering over the implant, and adds tissue bulk/ volume.
Breast Conserving Therapy (BCT):
In some instances, the oncologic surgeon will suggest a wide local excision/ lumpectomy to remove the cancer whilst preserving the rest of the uninvolved breast tissue - this is known as Breast Conserving Therapy (BCT). BCT usually requires that a plastic surgeon reconstructs the defect created by tumour removal by carefully rearranging the remaining breast tissue to create a reconstructed breast that is typically smaller than the patient's original breast size. The plastic surgeon will also perform a matching procedure on the opposite breast to create symmetrical looking breasts. Radiotherapy is required after Breast Conserving therapy to decrease the risk of breast cancer recurrence. BCT is usually only considered for smaller, early-stage, tumours.
Nipple Areola Complex Reconstruction: This is often performed in the final stages of breast reconstruction, after a suitable breast mound has been created. To reconstruct the nipple, the plastic surgeon creates small skin flaps, shapes and sutures them to form a nipple. The areola can be reconstructed through medical tattooing to create the darker area of skin around the nipple or alternatively a skin graft can be used.
Breast reconstruction takes one to six hours, depending on the technique.
General anaesthesia is administered during breast reconstruction surgery.
Breast reconstruction is an inpatient procedure.
Side effects include bleeding, hematoma, pain, swelling, infection and fatigue. Asymmetry or non-matching breasts, visible implant edges or rippling and poor scarring are potential aesthetic side effects. (Your surgeon will explain the potential side effects relevant to the reconstruction you are undergoing).
Risks include, infection, flat necrosis, flap loss, the formation of blood clots leading to deep vein thrombosis or pulmonary embolus. Implant based reconstructions are additionally at risk for implant loss, leakage or capsular contraction. (Your surgeon will explain the potential risks relevant to the reconstruction you are undergoing).
It will take a few weeks or months to heal completely after breast reconstructive surgery. Depending on the type of reconstruction performed and adjunctive treatments required, the surgeon will advise on what expect during recovery. Regular follow-up and future screening are indicated, as guided by the treating surgeon.
Healing occurs over several weeks after breast reconstructive surgery, and with time swelling reduces and scar lines improve. The patient should experience a return of her self-confidence and will be able to wear normal clothing. Most patients who undergo breast reconstruction are very happy with their reconstruction.
WHEN YOU CHOOSE A DOCTOR WHO IS A MEMBER OF APRASSA, YOU CAN BE ASSURED THAT YOUR SURGEON IS QUALIFIED IN ALL ASPECTS OF COSMETIC AND RECONSTRUCTIVE SURGERY.
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The Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa was formed in 1956. All our members are fully qualified Plastic surgeons that have been approved for APRASSA membership and will endeavour to provide you with excellent care throughout your plastic surgery journey.
