Breast Reconstruction

Breast cancer is sometimes treated with a mastectomy (surgical removal of the breast tissue). Breast reconstruction is the procedure that follows this operation and replaces the tissue removed by the mastectomy. This can be done at the same time as the mastectomy, known as immediate breast reconstruction, or it can take place at a later date, known as delayed breast reconstruction.

Whether you are able to have an immediate or delayed breast reconstruction is determined by the characteristics of your tumour, your general health and whether you have had or will have chemotherapy and more importantly radiotherapy which in some cases may delay your reconstruction.

An implant reconstruction is a relatively quicker procedure that can be performed by a breast cancer surgeon at the same time as your mastectomy. An implant is used to replace the removed breast tissue and recreate the shape of the breast.

After this type of surgery, you may be able to go home on the same day or after an overnight stay. Unlike other types of breast reconstruction, this type of reconstruction does not require tissue to be taken from another part of your body (donor site) and therefore avoids additional scars beyond your breast.

However, implants do need to be replaced after several years and their disadvantages include:

• Infection which requires implant removal.
• Seroma — a build-up of fluid where tissue has been removed.
• Capsular contracture — where scar tissue can form around the implant causing it to change shape and make your breast feel hard and painful.
• A rare form of breast tumour called a breast implant associated anaplastic large cell lymphoma (BIA-ALCL).
• Leaking of your implant.
• Rupture.
• The implant may settle in an unfavourable position (malposition) within the breast pocket.
• You may see wrinkling of the skin over the implant.
• Implants may be readily palpable (easily felt).
• Some patients have reported a collection of symptoms such as fatigue, memory loss, rash, ‘brain fog’, and joint pain which have been brought together under the term ‘breast implant illness’ (BII).

A latissimus dorsi breast reconstruction uses muscle, skin and fat from your upper back and in some cases an implant to recreate the breast. Mr Kalu often defines this option as a halfway house between the main reconstructive options. It provides an alternative to a free tissue flap reconstruction where patients cannot undergo this procedure due to previous abdominal surgery such as tummy tucks, appendectomy or bowel surgery, or due to personal preference.

The risks associated with latissimus dorsi breast reconstruction include:

• Shoulder stiffness and discomfort.
• Seroma (build-up of fluid) in the donor (back) wound or breast.
• Implant replacement after several years.
• All the above complications associated with implant reconstruction.

Free tissue flap reconstructions can either be:

• Transverse rectus abdominis muscle (TRAM) — where fat, skin and a portion of the rectus abdominis muscle is removed from the abdomen and moved to the chest.
• Muscle sparing (MS-TRAM) — where fat, skin and small part of the muscle is removed from the abdomen and moved to the chest.
• Deep inferior epigastric perforator (DIEP) — where fat and skin is removed from the stomach and moved to the chest.

This type of reconstruction is a more significant operative procedure where the blood vessels within the chest are joined to those within the flap. It is usually a completely autologous (composed of your own tissue) option which often gives you a tummy that is more aesthetically pleasing. 
You will need to stay in hospital for a few days after your surgery. The option may be associated with further secondary or revisional procedures which may include lipomodelling (liposuction of fat from one area to transfer to your breast reconstruction), a symmetrising reduction of your other breast in addition to a nipple reconstruction.
One of the main advantages of free abdominal based reconstructive procedures is that the breast behaves and feels more like your original breast. You can be discharged in the knowledge that you are unlikely to need any further surgery and therefore move forward with your life.

The risks from free tissue flap reconstruction include:

• Risks associated with the general anaesthetic including chest infection, deep vein thrombosis and pulmonary embolus.
• Risks from surgery include haematoma (collection of blood) or infection that may necessitate a return to theatre.
• Blockage of the anastomosis (join of chest and flap vessels) which may lead to the need for a further operation and flap failure.

Breast imaging, such an ultrasound, may be required before the surgery.

At the consultation, you will be shown the scar patterns to be expected. 

The exact surgery cost will be provided after the consultation as Mr Kalu will need to meet you first to assess your own individual needs. 
A breakdown of the costs (hospital, surgical and anaesthetic fees) will be included in your clinic letter. The cost of the procedure also includes your dressings appointment post surgery and your follow up appointment with Mr Kalu six to eight weeks later.

You may return to driving after six weeks but the legal test that you would need to satisfy is that you are able to be in control of the vehicle and perform an emergency stop. Further advice should be sought from your insurer as to when they are happy for you to begin driving.

The reconstructive journey may also require secondary revisional procedures which include lipomodelling, a symmetrising reduction of your other breast in addition to a nipple reconstruction. 

For an implant reconstruction, the implants will need to be replaced after several years.