Breast cancer is one of the most common and devastating cancers that we see in our society today. Fortunately awareness of breast cancer has increased dramatically and the ability to detect it and treat it has improved in parallel with the increased awareness. Consequently women suffering from breast cancer are being managed earlier and more successfully. Management of breast cancer almost invariably involves some form of surgery to remove the cancer from the breast. This quite commonly entails mastectomy (removal of the breast). This surgery, whilst lifesaving, can in itself leave a women feeling scarred both emotionally as well as physically. This is where reconstruction after mastectomy becomes a valuable asset. It provides women with an opportunity to overcome the disability they had to undergo to defeat their breast cancer. Dr. Newton sees a large number of patients who wish to consider breast reconstruction after mastectomy. He finds it one of the most rewarding sections of his cosmetic plastic surgery practice.
There are essentially two forms of breast reconstruction after mastectomy: reconstruction using prosthesis and reconstruction using part of the patient’s own tissue.
When a prosthesis is used it is usually an expandable breast implant which is placed into the soft tissues of the chest wall and once the healing process has progressed, it is expanded by injecting saline. Dr. Newton says that there was a time when it was routine for this prosthesis to be removed and replaced with a more definitive prosthesis but, with the modern prostheses, no replacement is required, allowing this to be a one stage and fairly brief operation.
When the patient’s own tissues are used, the most common tissue used is tissue from the lower abdomen. This can be swung up from the lower abdomen using some of the muscles of the abdomen to supply the blood or it can be removed completely and then have the blood supply reattached.
These operations provide the patient with what is referred to as a “breast mound,” or a bulk of tissue on the chest wall which mimics the shape of a breast. It will fill a bra and will fill out clothing. It will create a cleavage and thereby accommodates many women in their reconstruction needs.
The timing of reconstruction is variable. Some patients are suited to an immediate reconstruction whilst others require a delay. This is largely determined by the pathology findings and the anticipation of extra treatment, besides the surgery to remove the tumour. Dr. Newton also points out that the size and shape of the remaining breast may well influence both the timing of the operation and the type of reconstruction carried out. It is sometimes appropriate to operate on the other breast to provide a better result because the breasts are made more symmetrical.
Nipples can be reconstructed also for women who have undergone Mastectomy for breast cancer. This is done in a variety of ways, including skin and cartilage grafts and even tattooing for the areola. Nipple reconstruction generally involves the reconstruction of two components; the areola and the nipple itself. The nipple is usually done first and consists of using small local skin flaps. The areola is best done by means of Tattooing. There are tattooists who specialize in this technique. Dr. Newton would often delay this procedure to allow the original operation to settle and for gravity and time to have some affect on the postoperative appearance of the reconstructed breast. Recovery for a Nipple Reconstruction is quick. You will have to wear a foam “doughnut” over the nipple for a while to help preserve its projection. . The costs of a nipple reconstruction are also rebatable.
It can take a while to recover after breast reconstruction, especially if you have had a flap performed. If you have had an immediate reconstruction, remember that you are recovering fro 2 operations. Support garments will need to be worn and you will have to take it very easy for the first four or so weeks. Then you can start to build things up. If a tissue expander has been used, you will have to attend Dr Newton’s rooms at about 5 weeks after your operation to commence the expansion of your prosthesis. This involves injecting saline into the prosthesis on a weekly basis until it is appropriately filled.
Results will vary according to the amount of tissue left after the mastectomy. Sometimes more than one reconstructive procedure is needed to get the best result. After the breast mound has been made, additional procedures can be considered. These include Nipple Reconstruction and Fat Injection.
Every patient is individually assessed and Dr. Newton’s fee will reflect the type and complexity of the procedure required.
At your consultation with Dr. Newton you will discuss the costs with our office manager. The costs will be explained and you will receive a detailed written costing. If a rebate is applicable it will be clearly defined in your costing.
Breast reconstruction is a major procedure. The risks are the same as for any major operation. They also vary according to the type of reconstruction performed. You need to go through the risks with Dr. Newton as they apply to your individual case.