Breast Reconstruction Surgery
Breast reconstruction is a surgical procedure that is performed in order to restore the look and shape of one or both breasts after a lumpectomy or mastectomy of one or both breasts. The procedure is key to restoring a woman’s self-confidence as well as aiding her during their psychological and emotional recovery after breast cancer treatment.
Majority breast reconstruction surgery cases are as a result of partial or total mastectomy after the successful treatment of any form of breast cancer. Breast reconstruction options depend on what has been removed during the breast cancer treatment. If a small part of your breast has been removed, for instance during a lumpectomy, then no reconstruction may be required. But when you’ve had a full mastectomy whereby you’ve had skin, breast tissue, and nipple and areola (flat part of the nipple) removed, then a reconstruction is needed.
Additionally, before commencing on any breast reconstruction option, you should know is there is any additional treatment required, other than surgery, to treat the cancer cells or tumour such as chemotherapy or radiotherapy. Once this is established, the information will guide your decision-making during your post-cancer journey, which is either the immediate reconstruction of your breast, or delayed reconstruction.
Immediate Breast Reconstruction: This breast reconstruction technique takes place immediately after the breast cancer surgery (partial or full mastectomy).
Delayed Breast Reconstruction: Sometimes the mastectomy patient may not need to have the breast reconstruction surgery immediately after the mastectomy and would prefer to first heal both physically and psychologically.
Breast Reconstruction Options
When it comes to breast reconstruction, there are two options. One uses a part of your body to reconstruct your breasts, and the other simply uses a breast implant to reconstruct your breast; in some instances, a combination of both is applied.
The common breast reconstruction options include:
Free Tissue Transfer
Free tissue transfer breast reconstruction is considered the gold standard of breast reconstruction. This is because it has reduced complications, and most patients prefer this option. During the procedure, an tummy tuck or abdominoplasty procedure is used to harvest skin, fat and sometimes a degree of muscle from the abdomen.
This harvested tissue is carefully disconnected together with its blood supply, so it has artery and vein. After the mastectomy, and skin and nipple and areola have been removed, a small piece of the rib removed, behind which there is an artery and a vein. A specialised microsurgery procedure is performed, which involves a microscope, and the artery from the harvested tissue is attached to the artery, and the vein to the vein.
This procedure is done in order to create a new blood supply to the tissue that was harvested from the abdomen. The actual technical term is TRAM flap, which describes the blood vessel that supplies the tissue harvested from the abdomen. Once tissue has its new blood supply, it can be moulded onto the chest and actually tailored to look very much like any existing breast. It can also be used in situations where both breasts have been removed. In this situation, it’s called a bilateral or both-sided reconstruction.
Other alternative techniques include DIEP flap or SIEA flap, whereby only the skin and fat from the abdomen is transferred to reconstruct the breast. Other donor sites for harvesting the tissue include the thighs or the buttocks; in techniques known as TUG flap, SGAP flap, PAP flap.
Breast reconstruction with implants is considered the simplest form of breast reconstruction. In majority of the cases, silicone implants are preferred. In cases where the reconstructive surgeon is replacing breast tissue, a silicone implant is usually enough, but more often than not their needs to be other procedures done at the same time. For instance, if there has been a substantial loss of skin during the mastectomy, a paddle of skin and muscle might be harvested from the back and swung to the front where it is used it to give padding over the implant with the blood supply still intact. This technique is known as a latissimus dorsi flap.
In addition to breast implants, the patient’s own body fat may be used during a technique known as Autologous Fat Transfer (AFT). This option allows the patient to undergo a liposuction procedure to harvest the fat, then that fat is processed then injected in and around the breast tissue and/or the implant if it’s been used. This is done in order to give more volume to the breast as well as adding symmetry. Once the breast tissue has been conformed in the shape of the breast, the patient is left to heal. In some cases, a second procedure is performed to reconstruct the nipple and areola.
Reconstruction of the Nipple and Areola
The nipple, which is the protruding part of the breast, and the areola, which is the flat pigmented part of the breast, may also need reconstruction in cases where they have also been removed as part of the breast cancer treatment. These two breast structures can be reconstructed using skin which overlays on the breast implant. This can be done by either using the native skin of the breasts or from the skin that has been swung in overlying muscles from the back. In other cases, the areola – the pigmented dark part – can be reconstructed using medical tattooing or hyperpigmentation. The results of this can be quite impressive to the point where one cannot really tell the difference between a natural areola and a tattooed areola.
Precautions in Breast Reconstruction Surgery
Breast reconstruction is usually performed in stages. Once the breast volume and the desired shape has been achieved, the secondary reconstruction is started. This is where elements such as the nipple and areola reconstruction are done.
All the stages of breast reconstruction are dependent on the general health of the patient; what elements are missing and if the patient is eligible to undergo all these surgical procedures. This is because, for instance, the DIEAP flap option takes an average of 6 to 8 hours to complete, and this is before the second stage of reconstructing the areola and the nipple.
In short, general health considerations need to be considered, which makes it very important for you to consider your reconstructive options carefully, when you are diagnosed with breast cancer.
Get in Touch
Reconstructive surgery at Kings College Hospital Dubai focuses on the safety and care of every patient in a compassionate environment with state-of-the-art facilities. To book an online or in-person consultation and a detailed evaluation by one of our world class plastic and reconstructive surgeons in Dubai, get in touch using the contact details given, and our patient-care staff will book an appointment for you.