Breast reconstruction surgery
Choosing to undergo breast reconstruction surgery after a cancer diagnosis is a personal decision that can depend on your own individual circumstances and preferences. There are several options available to you, which will be explained at your consultation and are outlined below. It’s a good idea to read this information before you come to your appointment and make a note of any questions you’d like to ask.
What is breast reconstruction?
Breast cancer is sometimes treated with a mastectomy (surgical removal of the breast tissue). Breast reconstruction is the procedure that follows this operation and replaces the tissue removed by the mastectomy. This can be done at the same time as the mastectomy, known as immediate breast reconstruction, or it can take place at a later date, known as delayed breast reconstruction.
Whether you are able to have an immediate or delayed breast reconstruction is determined by the characteristics of your tumour, your general health and whether you have had or will have chemotherapy and more importantly radiotherapy which may in some cases may delay you reconstruction.
Types of reconstruction
Implant reconstruction
An implant reconstruction is a relatively quicker procedure that can be performed by a breast cancer surgeon at the same time as your mastectomy. An implant is used to replace the removed breast tissue and recreate the shape of the breast.
After this type of surgery, you may be able to go home on the same day or after an overnight stay. Unlike other types of breast reconstruction, this type of reconstruction does not require tissue to be taken from another part of your body (donor site) and therefore avoids additional scars beyond your breast.
However, implants do need to be replaced after several years and their disadvantages include:
- Infection which requires implant removal.
- Seroma — a build-up of fluid where tissue has been removed.
- Capsular contracture — where scar tissue can form around the implant causing it to change shape and make your breast feel hard and painful.
- A rare form of breast tumour called a breast implant associated anaplastic large cell lymphoma (BIA-ALCL).
- Leaking of your implant.
- Rupture.
- The implant may settle in an unfavourable position (malposition) within the breast pocket.
- You may see wrinkling of the skin over the implant.
- Implants may be readily palpable (easily felt).
- Some patients have reported a collection of symptoms such as fatigue, memory loss, rash, ‘brain fog’, and joint pain which have been brought together under the term ‘breast implant illness’ (BII).
Latissimus dorsi reconstruction
A latissimus dorsi breast reconstruction uses muscle, skin and fat from your upper back and in some cases an implant to recreate the breast. Mr Kalu often defines this option as a halfway house between the main reconstructive options. It provides an alternative to a free tissue flap reconstruction (detailed below) where patients cannot undergo this procedure due to previous abdominal surgery such as tummy tucks, appendicetomy or bowel surgery, or due to personal preference.
The risks associated with latissimus dorsi breast reconstruction include:
- Shoulder stiffness and discomfort.
- Seroma (build-up of fluid) in the donor (back) wound or breast.
- Implant replacement after several years.
- All the above complications associated with implant reconstruction.
Free tissue abdominal based flap reconstruction (DIEP, MS-TRAM, TRAM)
Free tissue flap reconstructions can either be:
- Transverse rectus abdominis muscle (TRAM) — where fat, skin and a portion of the rectus abdominis muscle is removed from the abdomen and moved to the chest.
- Muscle sparing (MS-TRAM) — where fat, skin and small part of the muscle is removed from the abdomen and moved to the chest.
- Deep inferior epigastric perforator (DIEP) — where fat and skin is removed from the stomach and moved to the chest.
This type of reconstruction is a more significant operative procedure where the blood vessels within the chest are joined to those within the flap. It is usually a completely autologous (composed of your own tissue) option which often gives you a tummy that is more aesthetically pleasing. You will need to stay in hospital for a few days after your surgery. The option may be associated with further secondary or revisional procedures which may include lipomodelling (liposuction of fat from one area to transfer to your breast reconstruction), a symmetrising reduction of your other breast in addition to a nipple reconstruction.
One of the main advantages of free abdominal based reconstructive procedures is that the breast behaves and feels more like your original breast. You can be discharged in the knowledge that you are unlikely to need any further surgery and therefore move forward with your life.
The risks from free tissue flap reconstruction include:
- Risks associated with the general anaesthetic including chest infection, deep vein thrombosis and pulmonary embolus.
- Risks from surgery include haematoma (collection of blood) or infection that may necessitate a return to theatre.
- Blockage of the anastomosis (join of chest and flap vessels) which may lead to the need for a further operation and flap failure.