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RECONSTRUCTIVE SURGERY

There are several ways to surgically reconstruct a breast. Some are relatively simple, and some are more complex. It is important that you are assessed by someone who understands all the options and can advise you about which options would suit you best. Here at 108 we can offer all forms of breast reconstruction and we will take to time to help you come to the right decision for you.

Reconstruction can be performed at the time of mastectomy (immediate reconstruction) or after you have completed your cancer treatment (delayed reconstruction). Some ladies choose no reconstruction.

Broadly speaking breast reconstruction can be divided into implant-based techniques and flap techniques (using your own tissues). Implant techniques are relatively simple and avoid the need for big surgery, additional scars and longer recovery. It can be difficult to achieve a natural looking breast, but reasonably good results can be achieved in clothing. Implants are more likely to require revision surgery in the future.

Flap techniques such as the DIEP flap can achieve a more natural looking and feeling breast. They do however require a longer surgery, additional scars and a longer recovery period. Flap reconstructions tend age naturally, and revision surgery is less likely in the future.

For many women, implant reconstruction produces satisfactory results and avoids the big surgery, additional scars and longer recovery period associated with flap reconstruction techniques. Implants tend to sit higher on the chest and for this reason are they are more suited to women with small to moderate sized breasts. It can be difficultly to achieve a natural looking breast, but in clothing reasonably good results can be achieved. A breast reduction or lift of the contralateral breast can improve symmetry if necessary. If you need bilateral breast reconstruction, implants are often a good option as a nice symmetrical reconstruction can be achieved.

Implant reconstruction can be performed at the time of mastectomy or as a delayed procedure using an expander implant. Implants can be placed under the pectoralis major muscle or under the breast skin. Often a biological mesh (ADM acellular dermal matrix) is used to cover the lower part of the implant.

Revision surgery is more common in implant reconstructions compared to flap techniques. Radiotherapy can have an effect on implant reconstructions resulting in tightness and loss of shape of shape over time. If an implant reconstruction deteriorated, it is still possible to convert to a flap breast reconstruction down the line.

The DIEP stands for Deep inferior epigastric perforator flap which refers to the blood vessels supplying the flap. DIEP flap breast reconstruction is a technique which uses the skin and fat from the lower abdomen to make a breast.  The DIEP flap breast reconstruction is the most popular flap reconstruction and is reliable form of reconstruction with low complication rates. It can produce a soft natural looking and feeling breast. In suitable patients, removing excess skin and fat can often be a bonus as it can flatten and improve the abdominal contour similar to a ”Tummy Tuck” or abdominoplasty procedure. It does however, result in a scar from hip to hip.

It can be performed at the time of mastectomy known as immediate reconstruction or as a delayed procedure after you have completed your cancer treatment. It is also a very useful technique if you previously had an implant reconstruction that has deteriorated or become tight and uncomfortable. In this situation, the implant is removed and replaced by your own tissues.

While it is bigger surgery and longer recovery in the short term, DIEP flap reconstruction has many advantages in the longer term. Once the reconstruction in complete, revision surgery is rarely required in the future.

Other flap options include taking tissue from the back (Lattisimus Dorsi Flap) or from the inner thighs (TUG Flap) or from the buttock area (SGAP flap). These flaps are less commonly performed and a generally reserved for ladies who are not suitable for a DIEP.

This is a useful technique to improve the shape and contour of the breast after a wide local excision. Liposuction is used to collect some fat tissue, this is then processed into fat for injection.  The processed fat is injected into the area of the breast needing improvement. This technique is also used to improve implant breast reconstructions by increasing the soft tissue cover over the implant. It is can also be used to improve flap breast reconstructions.

Nipple reconstruction aims to improve the appearance of a reconstructed breast by creating a nipple shape on the breast.

It won’t feel the same as a natural nipple but can improve the appearance of the breast and most patients are happy to have it done.

The most common technique involves raising small skin flaps on the reconstructed breast and folding them into a nipple shape. Once this has healed, it can then be tattooed to match the pigmentation of the other breast. Nipple reconstruction is limited, and they do tend to flatten over time.

Nipple sharing is another technique where part of the nipple from the opposite breast is transferred or grafted on to the reconstructed breast.

Sometimes a nipple reconstruction is not advised if the skin is very thin over an implant of if you had radiotherapy. In this case you can simply have tattooing which visually gives the semblance of a nipple.

Another option is a stick-on nipple prosthesis made from silicone to match the other breast.

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