What you need to know about breast reconstruction after breast cancer
Breast reconstruction surgery can happen at the same time as your surgery or as a separate procedure. Deciding what will work best for you can be overwhelming, so it is important that you ask your surgeon as many questions as possible to understand your options and make an informed decision.
Depending on the size and shape of your desired breasts, they can be reconstructed with either implants or with autologous tissue (tissue from other parts of the body). In some cases, getting the required shape and size can involve a combination of the two methods.
Different types of breast reconstructions
Implants
Breast implant reconstruction is very different to having a breast augmentation (or boob job) as the body has had to undergo the removal of all the breast tissue beforehand. However, as there is only one site of surgery it’s a shorter operation time and only one area of the body has to recover. The implant can be placed above or below the muscle and both of these options have advantages and disadvantages that you will need to discuss with your surgeon.
There are several things to consider if you’re thinking about implants:
As opposed to different reconstruction options, some women report their new breasts do not feel as natural.
If the breast implant is for one breast and a woman’s weight fluctuates with the implant in, it may no longer match the other breast.
It can also be more difficult to match the new breast with the existing breast.
Although built to last longer than they used to be, breast implants are not for life. You can expect your implants to last 10-15 years. Around this time, you may need to look at replacements to avoid ruptures and other complications.
Autologous Tissue (Using your own tissue)
In an autologous tissue reconstruction, the breast is rebuilt with tissue taken from elsewhere in the body. This surgery can be done two ways, using either free flaps, or attached flaps.
Attached Flap
The attached flap method uses tissue with blood vessels still attached and moves them through the body to the breast area. It may include tissue from the back, known as a latissimus dorsi flap. As the blood vessels are still attached, the new blood vessels do not need to be reconnected.
Free Flap
The free flap method uses skin, fat, and muscle from either the buttock or abdomen. With this method, veins and blood vessels need to be attached to the blood supply of the chest wall.
You will need to speak with your surgeon about which option is best for you.
The main reason that women choose to undergo tissue flap reconstruction is that it tends to produce a more natural looking breast and it will lose and gain weight proportionally to the rest of a person’s body.
However, there are several things to consider with autologous tissue reconstruction:
The surgery for tissue flap reconstruction is longer than implants and has a longer recovery time.
It has been reported that some women experienced a loss of strength in their stomach muscles where their reconstruction took tissue from their abdomen.
In rare cases, the reconstructed flap may die and need to be taken out. This would require the patient to undergo further surgery.
Tissue Expanders
If you are having a delayed reconstruction or have other specific requirements, your surgeon may discuss the need for a tissue expander. Tissue expanders are small balloon devices that are placed between the chest muscle and skin. Over several weeks your surgeon will gradually inflate the expander to stretch the skin to make room for a breast implant after surgery.
Nipple Reconstruction
You may like to consider nipple reconstruction as part of your breast reconstruction. This step is optional. Some women choose to skip this step as they are happy with the appearance of their breast without a nipple.
For those who choose nipple reconstruction, the new nipple can either be made from tissue on the new breast or done using a skin graft taken from another part of the body.
Some women choose to have the new nipple tattooed to match the colour of the other breast’s areola. In some cases 3D tattooing can help us avoid the need for nipple reconstruction surgery, yet still achieve a natural looking nipple and areola. It is important to note, this new nipple will not have sensation like before.
Where to get a breast reconstruction
Breast reconstructions following breast cancer surgery are available in both the public and private health systems. They are considered a medical procedure rather than a cosmetic one.
Public
If you choose to get reconstruction surgery though the public system, you should keep in mind that while there will be no charge, not all hospitals are able to perform this surgery and waiting times for the procedure can vary. Talk to your breast surgeon or breast care nurse about your options sooner rather than later.
Private
If you choose to go through a private hospital keep in mind that even if you have a high level of private health insurance, you may still be out of pocket. Be sure to ask your surgeon for a quote and check what your health fund will cover.
Dr Heidi Peverill is a specialist breast surgeon practising at ORBE Surgeons. Dr Heidi is based in Brisbane but can be seen at Mater Private Clinic in South Brisbane, Mater Redlands and Gold Coast Private Hospital.