Bringing the cosmetic to reconstructive surgery: breast reconstruction in mastectomy patients

More than 3,300 women are diagnosed with breast cancer in New Zealand each year, and one in nine will be diagnosed with breast cancer during their lifetime, according to Breast Cancer Foundation NZ.

In many cases, individuals undergoing a mastectomy may consider breast reconstruction as an option either during or after their surgery. Today, Bisson Plastic Surgery discuss the treatment and reconstruction options available to patients during this difficult time.

When can breast reconstruction be performed?

When deciding on the timing for breast reconstruction, your entire team of doctors will liaise regarding the appropriateness of various treatment approaches. Typically, the plastic surgeon and breast surgeon will lead any discussion focused on reconstruction but radiation, medical oncologist, and other specialists will be involved in the direction of breast cancer treatment.

Ideally, this will take place before you make a decision on reconstruction, so that any potential complications or limitations of the surgery can be addressed before setting your mind to a procedure. It also ensures that when you make a decision, you are basing it on the fullest range of accurate information and advice available from your carers.

The characteristics of the breast cancer and various patient factors impact on the ideal treatment recommendations and these in turn will indicate which time is most appropriate to undergo reconstruction should you choose to. There are three primary options available, depending on your individual situation:

• Immediate reconstruction – at the same time as mastectomy surgery.
• Delayed reconstruction – after mastectomy or lumpectomy surgery, including after radiation therapy or chemotherapy is completed.
• Delayed-immediate reconstruction – a staged approach, involving partial reconstructive surgery during mastectomy and additional reconstructive surgery after any further treatments.

As treatments such as radiation therapy and chemotherapy can affect the volume, colouration and appearance of breast reconstruction results, there may be a preference to reconstruct a breast after such treatments are completed. In addition, healing and recovery from reconstruction surgery can delay important such treatments to help cure breast cancer after mastectomy.

How common is breast reconstruction following a mastectomy?

The decision for breast reconstruction following a mastectomy is entirely dependent on the patient’s wishes, various surrounding health factors, and what is most appropriate for the individual. However, breast reconstruction is increasingly considered as a viable option following a mastectomy, largely due to the advances in surgical techniques and the skills of the surgeons performing the operation.

In a study by the Agency for Healthcare Research and Quality (AHRQ) in the United States, data showed a significant increase (62 per cent) in reconstruction following a mastectomy over a five year period between 2009 and 2014.  In New Zealand, the wealth of information provided on the available options – including their potential advantages and disadvantages – allows patients to make an informed decision that best suits their body and situation.

There are two primary types of breast reconstruction; autologous/autogenous reconstruction, where the operation is performed using the patient’s own tissue, and implant reconstruction. Autologous tissue can be obtained as a “flap” from a number of “donor” sites on the patient’s own body. Typically this spare tissue can come from the abdomen or the back, however, tissue from the back tends to be thinner and this option often needs supplementation with a breast implant to provide sufficient volume and a natural look. Which reconstructive option is best for you will depend on a number of factors, such as:

• Your overall health
• Whether you will require continuing radiation therapy following surgery
• The tissue available to be used in autologous/autogenous reconstruction
• Your expectation toward the desired cosmetic and aesthetic result
• Whether the surgery will impact your living or family arrangements
• The complexity of the procedure and the required recovery time

Your plastic surgeon will discuss the available options with you during your initial consultation, which will then allow you decide which option, if any, will best suit your expectations and desired outcome. As all bodies are unique, there can be a large or limited number of options available – this is why speaking to your plastic surgeon before deciding on reconstructive surgery is absolutely vital.

What are the goals of breast reconstruction?

Each woman is different and as such not everyone’s aims or expectations are equal. It is important that the plastic surgeon understand the patient’s goals and similarly that these are aligned to what is technically possible. Thankfully breast reconstruction is usually no longer about creating a mound that might give a bulge under clothing. There is an art to creating a breast and although a surgeon cannot give back exactly what nature provided, reconstruction hopes to give good shape and symmetry to the other breast in, and even out of, underwear. This may mean the “other” breast has to be adjusted to match the best reconstruction can achieve. This can be common in ladies with very large or sagging breasts where it is impractical or impossible to surgically create a match.

Different types of reconstruction techniques come with varying benefits when it comes to shape and feel, and these should be discussed comprehensively. In addition, using autologous tissue from another part of the body leaves extra scarring and potential weaknesses at the donor site and these need to be borne in mind when reaching a final decision.

What should I discuss with my plastic surgeon?

Whether you have a reconstruction option in mind, or simply want to meet with a plastic surgeon to discuss your potential options, it’s important to ask any question you feel are necessary to inform you to the fullest extent. Your plastic surgeon will ensure you fully understand the procedure and how it fits together with your desired outcome and health status, however initial questions to consider include:

• Am I a good candidate for breast reconstruction?
• What type of breast reconstruction is best for me?
• How many reconstruction procedures have you done?
• What are the risks of breast reconstruction?
• What is the best reconstruction timing for me?
• Will reconstruction interfere with chemotherapy?
• Will reconstruction interfere with radiation therapy?

Breast reconstruction surgery at Bisson Plastic Surgery

Bisson Plastic Surgery provides a comprehensive range of reconstruction for mastectomy patients and takes absolute care in ensuring the mental, emotional, and physical health of our patients is paramount.

To learn which options are available and are best suited to your situation, contact us today to schedule a consultation appointment.