BREAST SURGERY & RECONSTRUCTIVE SURGERY

BREAST RECONSTRUCTION

Breast reconstructive surgery aims to restore the shape and size of the breast after breast cancer treatment. This may occur immediately after the cancer surgery or in a delayed fashion after the patient has recovered from the cancer treatment. Women turn to reconstructive surgery because they remain unsatisfied about the appearance of their breasts after a mastectomy or lumpectomy. Oncological and plastic surgeons work together to discuss reconstructive breast options with their patients. Benefits, risks, recovery and post-operative care are all discussed in depth at consultations.

A woman considers breast reconstruction for several reasons that include:

• The need to balance out her chest, especially when wearing a bikini or bra
• To fit in clothes easily.
• To restore breast shape and enhance her confidence.
• When a breast prosthesis doesn’t provide relief
• To improve her self-confidence.

There are three broad categories of breast reconstruction techniques:

• Reconstruction using breast implants (alloplastic techniques)
• Using the patient’s own tissue to reconstruct the breast (autologous techniques)
• Nipple and areola reconstruction after cancer treatment

PROCEDURE

Breast reconstruction with breast implants

Using implants to reconstruct the breast can occur directly after removing the tumour.  Sometimes both implants and flaps are used in combination to reconstruct the breast.

Different implants used to rebuild the breast are:

• Tissue expanders: These are special implants that are gradually filled with a sterile salt solution to obtain a desirable breast size, which is then exchanged for a silicone implant in a second stage surgery. This technique is usually applied when there is insufficient tissue to accommodate an implant.
• Silicone implants: Silicone implants may be used for breast reconstruction in selected cases.

For delayed reconstructive surgery, the plastic surgeon uses a tissue expander to stretch the remaining chest wall skin. The expander is an inflatable prosthetic device that is used to prepare the cavity to receive an implant at a later stage when the patient is ready for surgery.

Autologous reconstruction

Women who opt for autologous, also known as flap reconstruction, prefer to use their own tissue, which is taken other areas of the body such as the abdomen,  buttocks, or back, to rebuild the breasts. Dr Sooka transfers tissue on its blood supply to its new position in the chest. The tissue is then tailored to reconstruct a new breast.

Types of flap reconstruction using tissue from the abdomen are:

• DIEP flap: A DIEP flap transfers fat, skin and blood supply from the lower abdomen to the chest to reconstruct the breast. The flaps blood vessels are reconnected to blood vessels in the chest. This surgery is considered the gold standard for breast reconstruction around the world.

Nipple and areola reconstruction may be necessary following breast cancer surgery. New nipples are reconstructed from the remaining flap tissue.

RECOVERY

The recovery period following breast reconstruction depends on the type of reconstructive procedure women choose to undergo. Dr Sooka provides post-operative breast care instructions to his patients to speed up their recovery. Patients need to regularly clean and keep their incision areas dry. They also need to attend yearly mammograms to check the health of their new breasts.