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Your Breast

Reconstruction

at a glance

Breast reconstruction is a procedure to replace lost skin and breast volume removed during cancer treatment for either breast-conserving procedure or mastectomy procedure. The breasts can be reconstructed using either the body's own tissues (autologous reconstruction) or prosthetic material (breast implant and tissue expander) or a combination of both. Your surgeon can also customize your surgery during your breast reconstruction, depending on your needs to replace breast volume, reconstruct your nipples, and restore breast symmetry.

Timing my reconstruction

Breast reconstruction can be undertaken at the time of mastectomy known as immediate reconstruction or at a later date, known as delayed reconstruction.

The decision to have immediate reconstruction or delayed reconstruction depends on
your individual treatment plan and personal preference.

Timing Advantages Disadvantages
Immediate
  • Immediate reconstruction can help overcome the loss felt after cancer.
  • You will have your newly reconstructed breast immediately once you awake from your surgery.
  • Fewer operations/ general anesthetic.
  • Following breast conservation surgery, the risk of fat necrosis and skin loss is reduced.
  • Reduced time to consider all reconstruction options.
  • If you are having radiotherapy, it may damage the reconstruction.
  • You may require further surgeries if having radiotherapy.
  • If you have surgical complications, it may delay chemotherapy, which should be ideally undertaken with 6 weeks of your cancer surgery.
  • Increased risk of capsular contracture following radiotherapy.
Delayed
  • More time to heal after surgery.
  • Your cancer treatment will be finished and will not affect your reconstruction.
  • You have mor time to consider your reconstruction options.
  • Reduces the risk of capsular contracture following radiotherapy.
  • Until the breast reconstruction procedure, you will have no breast tissue and may need to wear an external false breast.
  • You might have a larger scar on the reconstructed breast than after immediate reconstruction
  • May reduce the risk of capsular contracture and fat necrosis after radiotherapy or chemotherapy

Your Breast Reconstruction surgical options

The breast can be reconstructed in several ways, and it all depends on your personal preferences, current health status, and your individual anatomy.

These include:

  • Breast implants with or without tissue expander to replace all or some of your breast tissue.
  • Autologous Flap reconstruction: using your body's own tissue to reshape and recreate the breast.
  • A combination of a prosthesis and your body's own
  • Autologous fat grafting (AFG): harvesting the body's own fat to reconstruct the breast or correct minor defects.

Autologous Flap Reconstruction at a glance

Flap reconstruction uses the body's own tissues such as skin, fat, muscle, and blood vessels to create a flap to reconstruct the breast. The tissues are most commonly taken from an area from the back, thigh, buttocks, or abdomen and can be taken as a pedicle flap (the flap remains attached the original site and tunnelled under the skin to the breast) or a free flap (detached from the donar site and reattached to the breast).

There are five types of flap reconstruction:

  • Latissimus dorsa flap: using a flap of tissue from your back muscle to reconstruct the breast.
  • TRAM (Transverse Rectus Abdominis Myocutaneous) Flap: uses skin, tissue, and muscle from your abdomen to reconstruct the breast.
  • MSTRAM (Muscle Sparing Transverse Rectus Abdominis Myocutaneous) Flap: using just skin, tissue from your abdomen to reconstruct the breast.
  • DIEP (Deep inferior epigastric artery perforator) flap: takes a portion of the lower abdomen, including skin and fat (leaving behind the abdomen muscle), to reconstruct the breast. This can be performed to reconstruct both breasts or one breast alone known as a stacked DIEP flap.
  • SIEP (Superficial inferior epigastric artery perforator) flap: takes a portion of the lower abdomen, including skin and fat (leaving behind the abdomen muscle), to reconstruct the breast.
  • Superior gluteal artery perforator flap (SGAP) or inferior gluteal artery perforator flap (IGAP): takes skin and fat from the upper part and lower part of your buttock to reconstruct the breast. This can be performed to reconstruct both breasts or one breast alone known as a stacked GAP flap.
  • Transverse Myocutaneous Gracilis flap (TMG) or Transverse upper gracilis flap (TUG): takes skin, fat, and muscle from your upper and lower thigh.

Autologous fat grafting (AFG) reconstruction

Although lipofilling (injection of the body's own fat) has been used for several years in breast reconstruction, the technique was mainly used to add additional volume on top of a breast implant, to autologous flap reconstruction, or to fix minor defects asymmetries or differences in the shape of the reconstructed breast. However, a reasonably new concept emerging within breast reconstruction is complete autologous fat grafting reconstruction (AFG). This procedure uses fat from other parts of the body, such as the abdomen, thighs, and buttocks to reconstruct the breast.

One method of fat grafting procedure is to use an external device known as the BRAVA system. This system uses an external bra-like device to expand the breast's skin and internal tissues to make room for fat to be injected to reconstruct the breast. whelming.

We understand that breast cancer is life-changing; it is a journey you or a loved one did not choose, can plan for or anticipate. We have created this simple guide to help you understand breast cancer a little more and help better prepare for the journey ahead.

Implant Based
Breast Reconstruction

Implant reconstruction uses a breast implant to reconstruct the breast.

The procedure can be performed in one stage or two stages using a breast implant besides materials such as a tissue expander or acellular dermal matrix (ADM).

One stage reconstruction

During a one-stage procedure (also known as direct- to- implant reconstruction), your surgeon performs places a breast implant simultaneously as your mastectomy procedure.

The breast implant can be placed either in front or behind your chest muscle (pectoralis major muscle). Placing the breast implant in front of the muscle (pre-pectoral) has been associated with less pain than placing the implant behind the muscle. Both implant placement techniques expose the breast implant either partially or entirely, therefore to avoid implant visibility, your surgeon may use leftover skin (dermal skin) from your mastectomy, a sheet of collagen (acellular dermal matrix or ADM),or the bodys own fat to partially or fully cover the breast implant.

Two-stage Reconstruction

During your mastectomy procedure, your surgeon places a balloon-like device known as a tissue expander. The tissue expander is placed under or over the chest muscle (pectoralis major), and the incision is closed.
Over the course of the following months, the placed tissue expander will be expanded using small increments of saline every couple of weeks to stretch the skin gradually. The saline is injected through a small valve under the skin with a needle. Once the expansion process is complete, a further surgical procedure is undertaken to remove the tissue expander and replace it with a permanent breast implant.

Breast Reconstruction Recovery

Depending on the type of reconstruction you choose, the recovery time can vary. For autologous flap reconstruction, the hospital admission
time is around one week, but overall recovery time can be up to several months to fully recover.
Breast implant-based reconstruction is a shorter hospital admission time of around 1-2 days and a shorter recovery time of approximately 4-6
weeks.
After your surgery, it is essential to continue to monitor your breasts regularly; this includes a regular self-breast examination on the skin
around your reconstructed breast, your natural breast, and the area in the armpit. In addition, it is important to continue to attend regular
mammography screening on your non-reconstructed breast.

For further information regarding breast reconstruction surgery, Visit the FAQ on breast reconstruction for a comprehensive overview.

Reference List

Breastcancer.org. (2012). Treatment and Side Effects. [online] Available at: https://www.breastcancer.org/treatment.
Cancerresearchuk.org. (2017). Treatment options for breast cancer | Cancer Research UK. [online] Available at: https://www.cancerresearchuk.org/about-cancer/breast-can-cer/treatment/treatment-decisions.
Farhadieh, R.D., Bulstrode, N. and Cugno, S. (2015). Plastic and reconstructive surgery : approach and techniques. Chichester, West Sussex ; Hoboken, Nj: John Wiley & Sons Inc.
Henk Giele and Cassell, O. (2016). Plastic and reconstructive surgery. Oxford: Oxford University Press.
Janis, J.E. (2018). Essentials of plastic surgery. Johanneshov: Mtm.
Nice.org.uk. (2009). Overview | Advanced breast cancer: diagnosis and treatment | Guidance | NICE. [online] Available at: https://www.nice.org.uk/guidance/CG81.
Roy, P.G. (2016). Modified Lower Pole Autologous Dermal Sling for Implant Reconstruction in Women Undergoing Immediate Breast Reconstruction after Mastectomy. International Journal of Breast Cancer, 2016, pp.1–7.