Breast Reconstruction

Is a surgical procedure that rebuilds breast & restores shape to your breast after a mastectomy. It aims recreating the breast to match the remaining natural breast as closely as possible. It can be done at the same time as mastectomy (immediate reconstruction) OR at a later date (delayed reconstruction). This choice is made by patient in consultation with their surgeon prior to mastectomy.

 

Risk-reducing mastectomy

Some women are at high risk of getting breast cancer due to many family members affected. You can choose to have close surveillance using scans or mammograms with the intention of detecting a cancer at an early stage or, alternatively, opt for risk-reducing double mastectomy in order to minimise any risk. In this situation immediate reconstruction will almost always be possible and any one of the reconstructive techniques described above might be appropriate.

 

Breast Reconstruction and Recovery

Many women find that breast reconstruction offers many psychological benefits including improved quality of life, body image, confidence and self-esteem, and a restored sense of wholeness and femininity. However, the personal impact of the surgery varies from one woman to another and it isn’t a complete remedy for the distress associated with breast cancer and mastectomy.

Usually reconstruction surgery meets woman’s expectations. On some occasions, reconstructive surgery does not meet a woman’s expectations. This can lead to feelings of regret, anger and disappointment, and frustration at any need for further surgery.

Once you have decided to proceed with surgery you will have a preadmission assessment and clinical photographs. After surgery you will have some dressings and drains which remove excess fluid from the wounds. Everything possible will be done to make the process as comfortable and painless as possible.

Once you go home from hospital you will feel tired initially. After the first week you should be starting to look after yourself and begin to resume normal activities. A week after the operation you will be seen again in a clinic to check how you are doing and make sure all your wounds are healing well. You will then be seen a few months later to assess the outcome and decide if any adjustments are needed and when they should be carried out.

All operations result in scarring of some sort and the position and size of scars after breast reconstruction depends entirely on the technique used. In general, implant techniques give shorter scars confined only to the breast, whereas flap techniques give longer scars which will be on the breast and where the tissue has been taken from (back, tummy etc.). All scars can be expected to be lumpy at first and will go through a period of being pink, red and raised. They will usually then gradually become flat and pale. This process can take as long as two years to happen.

 

What complications?

The most frequent problem is delayed wound healing:

  • This risk is greatest in some of the larger flap operations where the incisions are longer.
  • If there is a wound problem it is usually minor, but more major wound healing problems can occur such as infection, skin loss, and wound separation, and may require re-operation.
  • Very occasionally, soon after the surgery, bleeding can occur which may necessitate a return to the operating theatre to stop it.
  • Sometimes patients can collect fluid beneath the operation site (a “seroma”), and this may need to be drained off in a clinic.


Other more general problems can include:

  • If an implant is used there are some specific complications that can happen such as deflation of the implant, infection, hardening around the implant, visible folds and ripples.


When can I drive?

You are usually able to drive after about 2-3 weeks. It varies from person to person depending upon how soon you feel pain free and able to do manoeuvres like emergency stop etc.


Do I need Reconstruction after Lumpectomy for Cancer?

Usually there is no need for reconstruction. Wide excision of the tumour sometimes leaved you with a dent. This is followed by radiotherapy which shrinks breast further by about 10%. This can make treated breast rather smaller, you may want the other breast adjusted to match or something done to the treated breast to restore shape and size. It is possible to add tissue to the treated breast using lipo-filling. I use different type of oncoplastic techniques to maintain shape and symmetry while removing cancer.

Pic: Latissimus dorsi flap: result and scar

Cosmetic Surgery: You can book an appointment to see photographs of Mr Kasana’s results and discuss your options.

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