INTRODUCTION

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. The creation of a new breast can dramatically improve a person’s self-image, self-confidence and quality of life. Although surgery can achieve a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.

Breast reconstruction involves surgical reconstructive procedures in an attempt to restore a breast to near normal shape, appearance and size following mastectomy. This surgical procedure can be performed either using patient’s own tissue (autologous tissue) or prosthetic materials or combination of both. Breast reconstruction typically involves several procedures performed in multiple stages. It can either be:

  • Immediate breast reconstruction – begins at the same time as mastectomy
  • Delayed breast reconstruction – commences after the mastectomy and recovers from any additional treatment of breast cancer such as radiotherapy or chemotherapy.
There are many methods of breast reconstruction. The most common methods are:

1. Tissue expander or breast implant

2. Flap reconstruction – using patient’s own tissue from distant site (commonly donor site from abdomen, or back) to reconstruct the new breast (recipient site)

Following breast reconstructive surgery, some of the common surgical procedures performed to further restore the breast to a near normal appearance are:
  • Nipple areola reconstruction
  • Breast reduction or augmentation surgery for the affected or contralateral breast
  • Scar revision surgery
  • Liposuction or fat grafting to improve the shape and contour of the breast
Following breast reconstructive surgery, some of the common surgical procedures performed to further restore the breast to a near normal appearance are:
  • Nipple areola reconstruction
  • Breast reduction or augmentation surgery for the affected or contralateral breast
  • Scar revision surgery
  • Liposuction or fat grafting to improve the shape and contour of the breast
CANDIDATES
  • Patients who are able to cope well with the diagnosis and treatment of breast cancer
  • Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
  • Individuals with a positive outlook and realistic expectations
PRE-OPERATIVE EVALUATIONS

Communication is vital in order to achieve the patient’s goals. During the initial consultation, patients will have the opportunity to discuss their goals and desirable results with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the expectations from the surgical procedures involved and their long term benefits.  Every patient is different, therefore a specific treatment regime is plan to suit an individual’s need. The preoperative evaluation for breast reconstruction includes:

  • Discussion about patients’ expectations and desired outcome
  • Medical conditions, drug allergies and previous medical or surgical treatment
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Discussion on options available in breast reconstruction, likely outcomes of breast reconstruction and any risks or potential complications
  • Discussion on course of treatment recommended by plastic surgeon, including procedures to achieve breast symmetry
  • Discussion on anaesthesia and its risks
  • Physical examination
  • Breast examination including detailed measurements of their size and shape, skin quality, placement of nipples and areolas
  • Photography for preoperative and postoperative evaluation.
PREPARATION
  • Get laboratory testing or a medical evaluation
  • Evaluation of general health status and any pre-existing health conditions or risk factors
  • Adjust medications if for certain medical conditions
  • Stop smoking and alcohol well in advance before the scheduled date for surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements before surgery
  • Special instructions will be given on the day before and after surgery
RISKS AND SAFETY

The decision to have breast reconstruction surgery is extremely personal. Patients have to consider if the benefits will achieve their goals and if the risks and potential complications are acceptable. Therefore, it is important for patients to understand that every surgical procedure has its own complications and down time. However, if a patient is assessed properly before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced.

Some of the common risks of breast reconstruction:
  • Infection
  • Bleeding
  • Poor wound healing
  • Wound breakdown
  • Skin discoloration
  • Swelling due to blood clot or fluid accumulation
  • Fluid accumulation
  • Unfavourable scarring (hypertrophy or keloidal scar)
  • Excessive firmness of the breast due to problems related to implants
  • Partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site
  • Injury to deeper structures such as nerves, blood vessels or muscles
  • Asymmetry
  • Possibility of revision surgery
  • Anaesthesia risks
POST-OPERATIVE EXPECTATIONS

After the surgery, temporary dressings or bandages are applied to the donor and recipient sites. Small tubes may be temporarily placed under the skin for 24-72 hours to remove any excess blood or fluid that may be collected after the surgery. During the first 5-7 days, there may be pain, discomfort, swelling, bruises and tightness around the operated sites. Once the tubes and temporary dressings are removed, patient is advised to wear sports bra (for 4-6 weeks) to minimize the swelling and support the new breast during the healing phase. It is advisable to avoid strenuous activities such as heavy weight lifting or strenuous exercise for the first 4-6 weeks after the surgery. However, light physical and social activities can resume from the 7-10 days after the surgery. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively. All the stitches will be removed 7-14 days after the surgery. The symptoms of discomfort, swelling and bruises around the breasts may disappear completely about 3-4 weeks after the surgery but the new breast may gradually take several months or a year to soften and feel more natural.

POST-OPERATIVE CARE
  • Regular application of antibiotic ointment and cleaning the operated areas for the first week after the surgery
  • Bed rest with arms elevated to reduce swelling
  • Avoid  excessive arm movement or weight lifting for the first 4-6 weeks after surgery
  • Arm movement should be limited for up to 2-3 weeks following the surgery
  • Wear sport bra (no underwire bra) for 4-6 weeks after the surgery
  • Regular use of scar gel and massage after the surgery to improve the scar and breast shape
– COPYRIGHT OF DR LEOW AIK MING