Today there are a very wide range of options and different types of breast reconstruction available to breast cancer patients. Sometimes breast reconstruction can take place at the same time that the mastectomy or lumpectomy is performed, but it is generally also possible to have breast surgery at any time after the original procedure.
This is a short summary of the different options and how they work. Also see our page on Nipple Reconstruction.
Breast reconstruction surgery divides into two basic types: breast implant and tissue transfer. With breast implant, as with normal cosmetic surgery, an implant is inserted into the breast cavity. Tissue transfer on the other hand involves using skin, fat and muscle tissue from the patient's own body to perform the surgery. It is also possible to use both of these techniques together to achieve the desired outcome.
Breast Implant – Expander Implant Post Mastectomy Reconstruction
Post mastectomy reconstruction may be done immediately following a mastectomy, or as a delayed procedure. The timing of this procedure is individual and will be discussed with Dr Gault as not all patients are suitable for immediate reconstruction. The process of using an expander and implant for breast reconstruction involves a two-staged approach. The first stage involves placing a tissue expander (a temporary implant) under the pectoralis major muscle on the chest wall. The expander is used to create a soft pocket for placement of the permanent implant.
During the first stage of reconstruction when the expander it is positioned on the chest wall, the tissue expander will be partially filled with saline. Approximately 3 weeks after this surgery, expansion can be started. The expansion process performed by Dr Gault in his practice treatment rooms. The process of expansion takes place every 2 – 3 weeks until the desired size is achieved.
The expander has a filling port built into the implant. This port is located and accessed with a needle through the skin. Expansion takes approximately 10 minutes and the amount of fluid injected is limited by the tightness of the patient’s skin and by patient comfort. Typically, the volume for each expansion procedure is 100 ml of saline. Some heaviness/tightness may be felt following each expansion. This will subside after 24- 48 hours and is generally managed well with the use of paracetamol or ibuprofen.
Once the expansion stage is completed, the second stage of reconstruction can be performed. The tissue expander implant is removed and is replaced with the silicone implant creating a more refined breast shape and feel.
Tissue Transfer and Flap Reconstruction
Also called flap reconstruction', tissue transfer is generally performed using two different methods – so called 'attached flaps' and 'free flaps'. The difference between these two techniques is that, with attached flaps, muscle and fat from either the back or stomach area is moved within the body (a process called 'tunnelling') to the chest underneath the affected breast/s. The free flap technique involves removing muscle, fat and skin tissue from the stomach, reattaching it to a blood supply and using this tissue to reconstruct the breast/s.
Two common techniques in tissue transfer surgery are the so-called TRAM flap technique (TRAM stands for Transcutaneous Rectus Abdominus Myocutaneous – the stomach muscle tissue used for the reconstruction) where skin and fat as well as muscle tissue are moved to the affected chest area, and DIEP flap reconstruction (DIEP stands for Deep Inferior Epigastric Artery Perforator) which uses skin and fat but not muscle to reconstruct the breast. The DIEP technique generally has a slightly quicker recovery period than the TRAM technique.
The advantage of transfer techniques is that an implant is not required and that any changes in bodyweight will not impact the look of the breast/s. With the TRAM technique there is a small additional benefit of fat tissue being removed from the stomach – a sort of 'tummy tuck'.
The surgical procedure and recovery period is longer and there will be scars on the back or stomach. If stomach muscle tissue is used, there may also be a loss of strength in that area.
Latissimus Dorsi Flap
This is a muscle, fat and skin flap taken from the back. It is moved around to the breast to reconstruct the breast totally, or more commonly used in combination with an implant for breast reconstruction. It is most commonly used for reconstruction when a patient has had a mastectomy and radiotherapy.
Many factors need to be weighed to decide which is the most appropriate technique to use in each case and Dr John Gault can give advice and support in making this decision. Contact our Gold Coast surgery for more information.