Oncoplastic and Reconstructive Breast Surgery

Breast reconstruction generally implies creation of a new breast after a mastectomy. However breast reconstruction also includes the reconstruction of large breast defects after cancer surgery using breast tissue alone (oncoplastic surgery).

In general terms, a complete breast reconstruction is either by artificial means (silicone implants) or from a tissue flap (transfer of tissue from the back or tummy). Sometimes a combination of the two is used. However not every woman is suitable for every option of breast reconstruction.

These operations will require a longer operation time, higher risk of complication and recovery time. In addition one will usually require two or more operations to achieve the desired results.

Aside from the type of reconstruction, one needs to consider immediate breast reconstruction (performed at the same time as mastectomy) versus a delayed reconstruction (performed after breast cancer treatment).

Aside from the psychological benefit of an immediate reconstruction, this allows for preservation of ones own skin which then looks more natural and has minimal scarring.

However for some women the cancer may not be suitable for an immediate reconstruction. Alternatively one may not be certain about the type of reconstruction and would prefer to keep the surgery as simple as possible. In that case reconstruction would be much better performed once all the breast cancer treatment is finished (delayed breast reconstruction).

Many women decide not to have a breast reconstruction and have a simple mastectomy and wear an external prosthesis in the bra. All women who require a mastectomy should have the option of breast reconstruction discussed.

Implant reconstruction:

This involves making a breast entirely with a silicone gel implant. The operation usually takes 2 hours and hospital stay is usually 3 – 5 days. The implant is generally placed under your pectoralis muscle (chest wall muscle) to reduce the risk of implant complication such as wound infection and breakdown.

Options for implant reconstruction include a single or two-staged process. A single stage implant reconstruction is the immediate placement of a permanent implant during the initial mastectomy. This operation however requires additional product to support the implant.

Some of these products are meshes and others are from donated human skin. A two-staged implant reconstruction involves the placement of a tissue expander, which allows for gradual stretching of your skin and pectoralis muscle to reach your desired breast size.

This is followed by a second operation where the tissue expander is removed and a definite silicone implant will be placed in the pocket.

Flap reconstruction technique:

Flap reconstruction involves the transfer of ones own muscle and skin from another part of the body to rebuild the breast shape. Some flap reconstruction (LD Flaps) can also be combined with an implant reconstruction to achieve the desired cosmetic result. The common types of flap reconstructions include:

Latissimus dorsi (LD) Flaps: This involves taking the muscle (latissimus dorsi muscle) from the back of the chest with some overlying skin and tissue and bringing it through to the front of the chest to rebuild the breast. It is often combined with a silicone implant to produce a reconstructed breast of the desired size. The operation usually takes 4-5 hours and hospital stay is usually 5 – 7 days.

DIEP Flaps: This involves taking some skin and fat from the abdomen (tummy) and transferring it the chest. This involves microsurgery and it requires a surgeon with microsurgery skills. The operation usually takes about 6-8 hours, although can take longer. Hospital stay is usually about a week.