RECONSTRUCTIVE SURGERY
Breast reconstruction
The timing of breast reconstruction will depend on how early breast cancer is detected and treated. The breast surgeon, reconstructive plastic surgeon, oncologist, breast care nurse and various counsellors should discuss combining the mastectomy with breast reconstruction. If disease is too advanced then reconstruction can be delayed until a disease-free period has elapsed. Breast reconstruction after mastectomy neither prevents early detection of disease recurrence nor precludes the use of chemo or radiotherapy.
Informed patient choice is essential once the necessity for surgery has been established. Breast reconstruction should be offered as an option to all patients undergoing mastectomy, partial mastectomy or lumpectomy. The likely options are:
Implants: for small breasts, a silicone gel or saline implant may be the only suitable option, inserted via the mastectomy incision.
Tissue expansion: not suitable if radiotherapy to the chest wall either pre- or post-operatively has been given. More skin is produced by insertion of a balloon type device placed under the chest, which is then inflated over time until a good match with the healthy breast is achievable.
Latissimus Dorsi Flap and Implant: The muscle from the back with an amount of back skin can be used to replace the skin taken during a mastectomy. An implant is normally used with it to provide the bulk for the newly created breast. This obviously leaves a linear scar on the back of the patient where the skin and muscle have been taken.
TRAM flap: Depending upon individual patient circumstances, this procedure can be used to transfer skin and fat from the lower abdomen, leaving a "tummy tuck" type of scar, provided enough tissue is available for transfer. No implant is used. Various techniques can be used to make this option reliable.
Hospital stay varies with each technique and between patients and range from 3-7 days. A recovery period from between 6 weeks and 3 months should be expected.