A breast reconstruction operation is a procedure that recreates the appearance of a breast following a mastectomy. This can be performed using your own tissue, a breast implant, or a combination of the two. Breast reconstruction can usually be performed at the same time as the mastectomy or it can be done months or years later as a delayed procedure. Each option has benefits and drawbacks and the best choice for you can be discussed with Dr Perron during your personal consultation.
This type of reconstruction uses the abdominal skin, fat and sometimes muscle to recreate the breast shape. It is a longer procedure that requires microsurgery to attach the abdominal tissue to a new blood supply. This option can provide an excellent end result and a natural feel because your own tissue is used.
TRAM vs DIEP
The difference between a TRAM (Transverse Rectus Abdominus Myocutaneous) flap and a DIEP (Deep Inferior Epigastric Perforator) flap is related to whether or not the abdominal muscle (6-pack muscle) is preserved. The decision to use a TRAM or DIEP flap relates to the anatomical blood supply of the abdominal tissues. Everyone has a slightly different blood supply to their abdominal wall. As such, the choice to use a TRAM or DIEP relates to your specific anatomy.
A TRAM/DIEP flap reconstruction usually takes several hours and is performed under a general anaesthetic. The stay in hospital can be anywhere from five to 10 days, rarely longer. You will need to wear a post-operative garment for several weeks after the procedure to reduce the risk of abdominal complications.
Patients will require about three to four weeks to recover and feel more like themselves again. Resumption of heavy exercise/lifting should be avoided for at least three months to avoid complications.
Latissimus Dorsi Flap
This reconstruction method uses a combination of your own tissue and a breast implant to recreate the breast shape. This option is usually performed in two stages, a few months apart. The latissimus dorsi muscle with a small patch of skin is moved from the back to the chest and an expander is placed behind this muscle.
At our Brisbane clinic and with Dr Perron as your breast augmentation surgeon, this procedure usually takes a few hours and patients will need to spend a few days in hospital to recover. There will be a scar on the back where the muscle and skin were lifted and moved to the chest. A breast implant expander is placed behind this muscle and skin on the chest to recreate the breast shape. The expander is inflated over the course of several weeks using saline injections. A second procedure then removes the expander and it is replaced with a silicone implant.
Patients will require a few days to recover after every expander session. Additional recovery time is required once the implant is inserted. Resuming normal exercise and lifting or high reaching should be limited for the first six to eight weeks following surgery.
This procedure is usually done in two stages and involves a tissue expander and a silicone breast implant.
The first stage involves creating a pocket for the tissue expander – usually behind the pectorialis major (‘pec’) muscle. This expander is then inflated over several weeks using saline to expand the pocket as well as the overlying skin. The expansion phase varies between patients and depends on several factors. These factors include the total volume needed in the expander to achieve the desired stage and skin quality over the expander. The second operation replaces a fully inflated expander with a silicone implant. More frequently, plastic surgeons are using ADM’s (Acellular Dermal Matrices) to help protect the implants, and reconstruct the breast shape. The specifics of this new technology can be discussed with Dr Perron.
As with any cosmetic surgery procedure, there are risks involved. The most common complications are some minor bleeding, infection, wound healing problems and pain. If the operation involves the use of implants, complications can also include:
- Capsular contracture – A hard shell that forms around one or both of the implants
- Implant rupture/leakage – A weakening of the implant shell
- Asymmetry – Uneven breasts
- Haematoma – Blood clots within the breast tissue
- Implant malposition – Rotation or movement of the implant
If the operation involves a flap, complications can include the following:
- Loss of blood supply to the flap (partial or total)
- Fat necrosis
- Fluid collection in the breast, or the donor sitee
- Decreased abdominal strength
- Asymmetry in breast size
- Shoulder pain
Other details about breast reconstruction, specific concerns, or your suitability for this procedure can be discussed with Dr Perron.
Breast Reconstruction FAQs
Breast reconstruction costs in our Brisbane clinic tend to start from about $6,000, but since every patient’s needs are different, costs will be different too. Implants, as well as hospital and anaesthetist fees, will all be taken into account when calculating a cost. If you will be using public facilities, Medicare will cover your procedure. Even if you decide to use a private hospital, Medicare will still cover some of the costs.
If you are coping with your diagnosis and treatment and you don’t have any additional conditions that may impair healing, you could be a candidate for breast reconstruction surgery. It will also be essential for you to discuss your expectations with Dr Perron prior to surgery.
There will be some discomfort and swelling after surgery, regardless of the technique that was used. However, this can easily be managed with pain medication. Arm movement will be limited, which is why strenuous physical activity is discouraged. You will also need to spend some time in hospital after your surgery so that Dr Perron can make sure you’re progressing in your recovery. You will need to spend at least a week at home if you’ve decided to go ahead with implants and a compression garment will need to be worn during your recovery. Dr Perron will provide you with specific aftercare instructions following your procedure to help you have a smooth recovery.
Your final results can take up to three months to become noticeable as the swelling needs to subside and your implants need to settle. Dr Perron will give you a better idea of a timeline once he sees how you’re progressing during your recovery.