Many women who have had breast cancer choose to have breast reconstruction after a mastectomy or breast conserving surgery. Though breast reconstruction can be performed at the time of the mastectomy (“immediate” breast reconstruction), some women choose to delay the decision to focus on restoring their health, and have “delayed” breast reconstruction, months or even years after their mastectomy.
The timing of breast reconstruction surgery is a personal choice that usually marks the milestone where a woman leaves their illness in the past and moves into a new life phase of physical and emotional health.
The reasons for having breast reconstruction can include a wish to replace the weight of a missing or reduced breast, especially if there are body aches and pains associated with disproportion; to balance appearance, by providing symmetry under clothing; to move on from the daily use of a prosthesis, or to return general body image, confidence and personal self-esteem.
Having breast reconstruction as a result of breast cancer and mastectomy is classified as a medical procedure and it is available at selected public hospitals as well as through the private health care system.
Breast reconstruction is a specialist procedure to address a unique type of breast asymmetry. As part of breast reconstruction, surgery may be suggested for the opposite breast, such as a breast augmentation, mastopexy or breast reduction, so that an improved symmetrical result can be achieved. Breast reconstructive surgery and other cosmetic breast surgery is regularly performed by Pure Aesthetics’ specialist plastic surgeons. Each of these specialist surgeries can play a part in the reconstruction process and can be discussed in detail during consultation.
The aim of breast reconstruction is to provide women with a symmetrical and natural look when clothed. It is usually not possible to recreate the breast and nipple to look and feel exactly as it was before, however many reconstructions recreate a lovely breast and good contour with significant advantages of having breast reconstruction.
Specialist plastic surgeons are experts in the various options for breast reconstruction, which can involve using your own tissues, usually from the abdomen, using a breast implant, or occasionally a combination of both. The aim is to give you a long-term, soft and natural result.
The nature of breast reconstruction surgery depends on the individual woman’s physical requirements and the extent of the original surgery. Simple procedures will require an overnight stay, while more complex surgery may need up to 7 days of hospital care.
Reconstruction procedures are selected from the range of techniques and can also involve microsurgery. The operation may involve inserting breast implants, re-locating your own skin and muscle tissue, or a combination of both methods.
Breast reconstruction using implants
Pure Aesthetics’ breast reconstruction surgeons use cohesive gel silicone breast implants which have a lifespan of at least 10 to 15 years. They are available in a range of projections, or sizes, to provide a natural anatomical look in proportion with your body.
The breast implant is placed underneath the chest muscle. Occasionally your particular reconstruction may require use of animal tissue to safely cover the implant, your own tissue replaces this acellular tissue over time naturally. Your specialist plastic surgeon will explain and demonstrate your particular options at consultation, before preparing a comprehensive treatment plan spanning from surgery preparation to recovery.
At your consultation you will be shown before and after photographs photos of breast reconstructions of our patients with breast implants, to indicate your likely results and assist in making your decision.
Breast reconstruction using tissue transplant
Your Pure Aesthetics reconstructive surgeon might suggest that your own tissue is used in breast reconstruction. This is where a “tissue flap” of your skin, fat or muscle is used in the surgery to to form a new breast.
Known as ’tissue flap reconstruction’, the two methods are “free” and “pedicle” flaps. Unlike breast implants, a tissue reconstruction uses your own tissues, so the reconstructed breast will fluctuate in weight naturally, which can be important to some women prone to weight changes. The commonest area for this tissue flap to be taken from is the lower abdomen – the same tissue that is removed during a tummy tuck, so an advantage is a flatter abdomen at the same time. Although there are more scars than in an implant reconstruction, the results from a tissue reconstruction are usually softer, more natural and better longevity. These are significantly larger operations with a longer recovery time, however.
Your Pure Aesthetics plastic surgeon will outline the benefits and risks of tissue breast reconstruction at consultation, if the procedure is suitable for you.
Nipple reconstruction surgery
Having nipple reconstruction during breast surgery is the woman’s personal choice. The procedure is done by using tissue from the new breast or by taking a skin graft from elsewhere on the body. To match the appearance of the other breast, the reconstructed nipple may be tattooed, including the areola area, to assist in giving a natural appearance.
When should I have breast reconstruction?
In some cases a woman is given the option of having reconstruction during a mastectomy, which is known as immediate reconstruction. Delayed reconstruction is more common, however, and can be done months or even years after the initial breast surgery.
If you need ongoing treatment, such as radiotherapy or chemotherapy, immediate breast reconstruction may not be recommended. In general, the timing is a personal choice and depends on your feelings about your appearance, health and lifestyle as well as many other considerations, including your expectations and need for a more or less rapid recovery and return to normal activities.
What are the disadvantages of having breast reconstruction surgery?
If reconstruction is delayed, which may be unavoidable, your operation will require another hospital stay and a period of recovery. This can be a confronting reminder of the mastectomy procedure for some women, depending on their personal goals about body image and their readiness for change.
Also, there will be some scars from breast reconstruction, the extent of which will be explained by your surgeon. However our aim is always to minimise scarring during every procedure.
While appearance is improved and wearing fashionable clothes is easier after reconstruction, over time the new breast may start to look different. If a breast implant was used, it won’t alter in size or shape like the other does with normal body fluctuations. Eventually your implant will need to be replaced, but usually not for at least 10 to 15 years.
Public hospital patients may face a moderate waiting period for surgery, while private patients will incur extra costs associated with the surgery. The usual risks of any surgery, such as infection and other complications also apply to breast reconstruction.
How soon will I recover from breast reconstruction?
Recovery experiences and times vary enormously depending on the nature of the reconstruction and the individual’s health. Pain relief medication and drainage tubes are used to assist recovery.
If your own tissue was used during reconstruction there will be two areas of healing on the body during recovery, which may prolong your return to full health. A four to six-week break from normal activity is recommended after having breast implants. More time is needed, with no heavy lifting for six weeks, if you had tissue reconstruction.
Patients usually experience tightening of the abdomen skin after surgery, similar to after a tummy tuck. Your surgeon’s treatment plan will include ways to address any abdominal weakness during recovery and will be discussed during regular follow-up consultations.
Will there be scars after reconstructive breast surgery?
Yes, there will be permanent scarring after breast reconstruction. All scars fade over time, starting in the months after surgery. Their final appearance differs substantially for every patient, due to factors such as skin health and elasticity.
Your specialist plastic surgeon can only try to control the final appearance of scarring by minimising the size of incisions made during your operation. This expert skill is a common reason women choose a specialist plastic surgeon for breast reconstruction surgery. In some cases, follow-up cosmetic surgery can reduce the visibility of scarring.
You will be shown breast reconstruction before and after photographs of past patients to indicate the scarring you can expect at different stages in time after surgery.
Do I still have breast cancer checks after reconstruction?
Breast reconstruction does not end the need for breast cancer detection. Examination for changes is still required in the skin and tissue. Personal examination should continue on a monthly basis and your plastic surgeon can answer questions about breast checks during your reconstruction follow-up consultations. You should visit your GP or oncologist with any general concerns.
Is pregnancy and breastfeeding possible after breast reconstruction?
Your plans for starting a family should be discussed with your plastic surgeon during consultation, to prepare you for the body changes that may occur related to breast reconstruction. Future pregnancy can proceed as normal, depending on any other health implications. Breastfeeding is not possible after reconstruction, however women usually can breastfeed using a remaining natural breast, with specialist lactation advice taken in preparation, before or during pregnancy.
How much does it cost to have a breast reconstruction?
Your plastic surgeon will provide the full cost of breast reconstruction and follow-up care during your pre-surgery consultations. It is recommended that you confirm refund details with your private health insurer, if applicable.
Reconstruction after mastectomy is considered by Medicare to be a medical procedure, though there may be a lengthy waiting period for the operation. The surgery and hospital costs are covered under the public health system, as are nipple tattooing if done by a doctor. Medicine and transport costs may be rebated, depending on eligibility.
What is the alternative to having surgical breast reconstruction?
Many women wear a breast prosthesis after a mastectomy to retain their previous breast shape. Using an external device is an easy and non-invasive alternative to breast reconstruction, which is not always available during the original surgery.
Prostheses are shaped to create a natural looking full or partial breast mound made of silicone gel or other soft materials and are fitted into a special bra. They can be used for the long term and give a realistic appearance to the body under clothing, allowing most fashionable outfits to be worn with confidence.
A breast prosthesis is commonly worn for a period of time after recovery from mastectomy or other breast surgery. After an interval that varies among women for several reasons, many investigate the option of breast reconstruction surgery as a permanent alternative to using prosthesis.
At Pure Aesthetics, our plastic surgeons understand the highly personal nature of undertaking surgical changes to body image, particularly at the breast. When giving advice, we take special care to ensure women inquiring about breast reconstruction fully understand all medical and emotional implications of the procedure.