Breast cancer sucks. Unfortunately, as the most common cancer in women today, one in 8 of us will be diagnosed with it by the time we turn 85. It was estimated that around 42 women were diagnosed with breast cancer each day in 2015. Many of these women as part of their treatment will have one or both of their breasts removed in a mastectomy. Whilst it might save their life, it will also change it quite significantly.
Having one or both of your breasts removed can change not only your psyche and identity as a woman, it can affect your confidence, self worth and your sex life. Not only that, it can mean your clothes don’t fit any more. Dr Damian Marucci, Cosmetic Plastic Reconstructive Surgeon based in Kogarah in Sydney says, “Breast reconstruction is a surgical process to restore the breast following a mastectomy. It can be performed in a number of ways: with breast implants, the patient’s own skin tissue, or a combination of the two procedures.”
Breast Implants After a Mastectomy
Breast Implants are the most popular choice for breast reconstruction. Dr Marucci says, “The implant is placed under the skin and muscle of the chest wall. They are permanent and only need to be changed if there is a problem. Increasingly implants can be placed at the time of mastectomy, meaning that the patient only needs to undergo one anaesthetic to treat both the cancer and to perform the reconstruction. In these cases, the breast implant is covered partially by the patient’s own muscle and partially by a biological collagen mesh. This “one and it’s done” approach, is particularly good for patients who are having both breasts removed at the same time.”
“Patients who have already had a mastectomy and request a reconstruction don’t have enough skin for an implant to be placed. In these cases, the skin of the chest wall needs to be stretched up beforehand – a process known as expansion. Tissue expanders are like empty breast implants which are slowly filled with fluid over a period of weeks to months. The expander is then exchanged for an implant under a second general anaesthetic.”
Implant based reconstruction is ideal for patients who haven’t had radiotherapy, cases where both breasts are being removed, patients who don’t want scars anywhere else on their body, patients who wanted to simplest and fastest procedure, and for those who don’t have enough of their own tissue elsewhere to make a breast.
Can you reconstruct a breast with a patient’s own tissues and not use an implant??
Dr Marucci tells us that the simple answer is “yes”! Some patients have extra skin and fat on their tummies, thighs, back or buttocks. Plastic surgeons can move these tissues onto the chest wall to fashion a breast that looks and feels natural – because it is. This is called an “autologous” reconstruction. The tissue that is moved is called a “flap”. It is easier to match the natural breast on the other side with natural tissue on the reconstructed side.
Breast reconstruction using a patient’s own tissue can involve two kinds of flaps. A ‘pedicled’ flap is where the tissue is swung onto the chest without interrupting the tissue’s attachment to the body. The best example of this is where skin, fat and muscle from the back is moved through the armpit onto the chest wall. The muscle that is carrying the skin and fat is the latissimus dorsi (the “lats” in gym-speak).
Another way of moving tissue onto the chest to reconstruct a breast is called a “free flap”. This is where the blood supply to an area of tissue (for example, the part of the abdomen normally thrown away in a tummy tuck) is carefully disconnected, and then reconnected to blood vessels on the chest. This involves microsurgery. Not only does the patient have one or both breasts reconstructed using their own tissue (that will lose and gain weight with them), they will also get a tummy tuck as part of the reconstruction.
Do you ever combine flaps and implants in breast reconstruction?
Dr Marucci explained that if a patient has had a mastectomy and radiotherapy (so they need some sort of flap reconstruction) but they don’t have enough spare tissue anywhere to make a whole breast, a reconstruction can be performed by using a combination of an implant covered by a flap. The most common combination is to using a latissimus dorsi flap from the back and put an implant underneath it on the chest wall.
Individual Needs Are Different
If you are considering a breast reconstruction after a mastectomy arrange a consultation with your plastic surgeon (or two plastic surgeons to compare) and they should discuss with you your individual needs and which option will be best for you.
Dr Marucci says, “The process for your procedure will depend on the method that is chosen by you and your surgeon to deliver the best results. Some procedures (such as those involving implants) only need a day or two in hospital, whereas free flap surgery may require a longer hospital stay. There are a lot of options and different techniques used in breast reconstruction. Often I will see a patient and their families many times before we decide, as a doctor-patient team, which technique we will use.”
Breast reconstruction can often be performed at the same time as a mastectomy, so if you are looking at having your breasts removed you may wish to look into whether or not you can do a reconstruction while you are there. This obviously eliminates the need for two surgeries, two stays in hospital, and can also help with the psychological issues of having your boobs removed. Dr Marucci says, “I feel privileged to be able to contribute to restoring confidence in these women who have already gone through so much.”
Regardless of the method by which you have a reconstruction, or even if you have a reconstruction at all, we think any woman with cancer, who might have had cancer, or indeed still has cancer is brave and beautiful and we support the Pink Ribbon foundation who do amazing work for research, prevention and support into breast cancer.
If you’d like more info on the lovely Dr Damian Marucci, or would like to arrange a confidential consultation to see how he might be able to help you with your breast reconstruction visit his website here or contact his clinic on 02 9588 6374.