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Breast Reconstruction

Breast Reconstruction


Breast Reconstruction

Breast reconstruction surgery is a procedure aimed at rebuilding a breast's shape and appearance following a mastectomy or lumpectomy. This surgical option offers a way to restore the natural contour of the breast, helping emotional well-being and adjustment after mastectomy. Here is some essential information about breast reconstruction surgery, including its reasons, options, risks, and aftercare:

Reasons for Breast Reconstruction Surgery:

  1. Restoration of Breast Appearance: Many women choose breast reconstruction surgery to regain a sense of normalcy and restore the appearance of their breasts after undergoing a mastectomy or lumpectomy.
  2. Improved Body Image: Breast reconstruction can have a positive impact on a woman's body image, helping her to feel more confident and comfortable with her physical appearance.
  3. Psychological Well-being: Restoring the breasts can significantly contribute to a woman's overall emotional well-being, as it helps reduce the psychological impact of breast cancer and the surgical removal of the breast tissue.

Your specialist plastic surgeon, will work collaboratively across a multi-disciplinary team of specialists and allied health professionals including breast surgeons, breast care nurses, psychiatrists, cancer support staff, geneticists, oncologists and radiologists, to manage the complexities of each individual situation. This procedure can make a real and positive difference to women's lives.

Options for Breast Reconstruction Surgery:

  1. Implant-Based Reconstruction: This technique involves a two stage approach using saline filled tissue expanders and finally permanent silicone breast implants to recreate the shape and size of the breast.
  2. Autologous Reconstruction: Also known as flap reconstruction, this procedure involves using a woman's own tissue, typically from the abdomen or back, to reconstruct the breast. Common techniques include the TRAM flap, DIEP flap, and latissimus dorsi flap.
  3. Hybrid Reconstruction: This approach combines the use of implants and autologous tissue to achieve optimal results based on individual patient needs.
  4. Nipple and Areola Reconstruction: After the initial reconstruction, a separate procedure can be performed to reconstruct the nipple and areola, creating a more natural appearance.

Timing of breast reconstruction: Delayed or Immediate

Your surgeon may discuss options of delayed or immediate breast reconstruction surgery with you.  Ultimately, the decision between delayed (after mastectomy surgery) and immediate (at the same time as mastectomy surgery) breast reconstruction depends on several factors, including individual preferences, medical considerations, cancer treatment plans, and discussions with the healthcare team. It is important to have open and comprehensive discussions with your specialist plastic surgeon to determine the most suitable approach for your unique circumstances.

Delayed Breast Reconstruction

Delayed breast reconstruction refers to the process of performing breast reconstruction surgery after a significant amount of time has passed since a mastectomy or lumpectomy. The delay can range from several months to years, allowing patients to recover physically and emotionally from the initial surgery and complete any necessary cancer treatments such as chemotherapy or radiation therapy.

Advantages of Delayed Breast Reconstruction:

  1. Time for Emotional Adjustment: Delaying reconstruction gives patients time to cope with the diagnosis, undergo cancer treatments, and adjust to life after breast surgery before considering reconstructive options.
  2. Flexibility in Treatment Planning: Delaying reconstruction allows patients to prioritize their cancer treatment and focus on optimizing their health before undergoing an additional surgical procedure.
  3. Accurate Evaluation: Delayed reconstruction allows for a more accurate assessment of the breast's condition, ensuring a comprehensive understanding of the patient's anatomy and optimizing the reconstruction outcome.
  4. Improved Safety: By allowing sufficient time for healing and potential resolution of any post-surgical complications, delayed reconstruction reduces the risk of complications associated with simultaneous procedures.

Considerations for Delayed Breast Reconstruction:

  1. Emotional Impact: Some women may find it challenging to live without a breast during the period between mastectomy and reconstruction. The decision to delay reconstruction should consider the emotional and psychological well-being of the patient.
  2. Potential Additional Surgeries: Delayed reconstruction often requires a separate surgical procedure, which may involve longer recovery time and additional scarring.
  3. Effects on Body Image: Living without a reconstructed breast for an extended period can impact a woman's body image and self-esteem. This aspect should be carefully considered in the decision-making process.

Immediate Breast Reconstruction:

Immediate breast reconstruction refers to performing breast reconstruction surgery at the same time as the mastectomy or lumpectomy procedure. It offers the advantage of waking up from the mastectomy surgery with a reconstructed breast or the promise of future reconstruction if additional treatments are needed.

Advantages of Immediate Breast Reconstruction:

  1. Psychological Benefits: Immediate reconstruction can positively impact a patient's psychological well-being, as waking up with a reconstructed breast can help maintain body image and reduce the emotional impact of losing a breast.
  2. Single Surgical Procedure: By combining the mastectomy and reconstruction into one surgery, immediate reconstruction reduces the number of surgeries and recovery periods required.
  3. Preservation of Breast Skin and Shape: Immediate reconstruction allows for the preservation of breast skin and contour, potentially leading to more natural-looking results.

Considerations for Immediate Breast Reconstruction:

  1. Treatment Considerations: Immediate reconstruction may not be suitable for every patient, as some may require additional cancer treatments such as radiation therapy. In such cases, delayed reconstruction may be a more appropriate option.
  2. Surgical Complexity: Combining mastectomy and reconstruction can be a more technically complex procedure, potentially increasing the risk of complications. This should be discussed with the surgeon to weigh the benefits and risks.
  3. Limited Time for Decision-Making: Immediate reconstruction requires making a decision about reconstruction before the mastectomy procedure. Some patients may prefer more time to consider their options and gather information.

What are the different types of Breast Reconstruction Surgery:

  1. Implant-Based Reconstruction: This technique involves the use of saline or silicone breast implants to recreate the shape and size of the breast.
  2. Autologous Reconstruction: Also known as flap reconstruction, this procedure involves using a woman's own tissue, typically from the abdomen or back, to reconstruct the breast. Common techniques include the TRAM flap, DIEP flap, and latissimus dorsi flap.
  3. Hybrid Reconstruction: This approach combines the use of implants and autologous tissue to achieve optimal results based on individual patient needs.
  4. Nipple and Areola Reconstruction: After the initial reconstruction, a separate procedure can be performed to reconstruct the nipple and areola, creating a more natural appearance.

What are the risks involved in breast reconstruction surgery?

General Risks of Surgery:

  1. Infection: Infection can occur at the surgical site, requiring antibiotics or additional medical interventions.
  2. Bleeding: There is a possibility of bleeding during or after surgery, which may necessitate a blood transfusion or surgical intervention.
  3. Adverse Reaction to Anesthesia: Although rare, some patients may experience adverse reactions to anesthesia, which can lead to complications.
  4. Scarring: Scarring is a natural part of the healing process. The extent of scarring varies depending on the surgical technique used.
  5. Adverse Reaction to Anesthesia: Although rare, some patients may experience adverse reactions to anesthesia, which can lead to complications.
  6. Blood Clots: Surgery increases the risk of blood clot formation, which can be dangerous if they travel to vital organs such as the lungs.

Risks Specific to Breast Reconstruction Surgery:

  1. Capsular Contracture: Implant-based reconstruction carries the risk of the body forming scar tissue around the implant, causing it to harden or become misshapen.
  2. Implant Malposition: Implants may shift or move from their intended position, requiring revision surgery.
  3. Implant Rupture or Leakage: There is a small risk of implant rupture or leakage, which may necessitate implant removal or replacement.
  4. Rippling or Wrinkling: In some cases, visible or palpable rippling or wrinkling may occur on the skin surface overlying the implant.
  5. Tissue Necrosis: In some cases, the transplanted tissue may not receive adequate blood supply, resulting in tissue death. This risk is more common with autologous reconstruction techniques.
  6. Implant Rupture or Leakage: There is a small risk of implant rupture or leakage, which may require additional surgery to address.
  7. Changes in Sensation: Breast reconstruction surgery can cause temporary or permanent changes in breast and nipple sensation.
  8. Flap Loss: In autologous reconstruction, there is a risk of partial or complete loss of the transplanted tissue due to insufficient blood supply (flap necrosis).
  9. Donor Site Complications: Harvesting tissue from the donor site (such as the abdomen or back) can lead to complications, including wound healing issues, infection, or abdominal muscle weakness (in case of TRAM or DIEP flaps).
  10. Seroma or Hematoma: Accumulation of fluid (seroma) or blood (hematoma) at the surgical site can occur, requiring drainage or further treatment.
  11. Delayed Healing: The healing process for breast reconstruction may take longer especially if adjuvant treatment such as chemotherapy or radiation is involved.
It is important to note that these risks can vary depending on individual patient factors, such as overall health, smoking status, and the specific surgical techniques used. Surgeons take precautions to minimize these risks and discuss them thoroughly with patients before the surgery. Preoperative evaluations, informed consent discussions, and close follow-up care help manage and mitigate these risks throughout the treatment process.


The recovery process after breast reconstruction surgery can vary depending on the specific technique used, individual patient factors, and the extent of the procedure. Here are some general aspects to consider regarding the recovery expectations:

  1. Hospital Stay: The length of the hospital stay can range from several days to weeks, depending on the type of surgery and the individual's overall health.

  2. Pain and Discomfort: Some degree of pain, swelling, bruising, and discomfort is expected after surgery. Your surgeon will prescribe appropriate pain medications to manage these symptoms during the recovery period.

  3. Rest and Physical Activities: Resting and avoiding strenuous activities during the initial 4-6 weeks is crucial for proper healing. Patients are typically advised to limit arm movement and avoid heavy lifting for a 6 weeks.

  4. Dressings and Drains: Dressings or bandages are applied to the surgical incisions, and drains may be placed to remove excess fluid or blood from the surgical site. Your surgeon will provide instructions on how to care for these dressings and drains.

  5. Supportive Garments: Depending on the surgical technique, your surgeon may recommend wearing a surgical bra, compression garment, or supportive bra to help reduce swelling, provide support, and aid in the healing process.

  6. Follow-up Appointments: You will have scheduled follow-up appointments with your surgeon to monitor your healing progress, remove sutures or drains, and address any concerns or questions you may have.

  7. Return to Normal Activities: The timeline for returning to normal activities, including work, exercise, and daily routines, varies for each patient and depends on the specific surgical technique and individual recovery progress. Your surgeon will provide guidance on when it is safe to resume these activities.

  8. Emotional Support: The recovery process after breast reconstruction surgery can involve emotional and psychological adjustments. Seek support from loved ones, support groups, or mental health professionals to address any concerns or emotions that may arise during this period.

It's important to remember that every patient's recovery experience is unique. Your surgeon will provide specific instructions tailored to your situation, and it's crucial to follow their recommendations to promote optimal healing and achieve the desired results.

During the recovery process, it is essential to promptly report any concerning symptoms, such as severe pain, fever, excessive swelling, redness, or drainage from the surgical site, to your healthcare provider. Open communication with your surgical team is key to ensuring a smooth and successful recovery.

Patients should have detailed conversations with your specialist plastic surgeon to understand the specific risks associated with their chosen surgical approach and address any concerns or questions you may have.

Breast Reconstruction FAQs


Key Questions about Breast Reconstruction

Before Procedure

What is a mastectomy?

A mastectomy involves the removal of all the breast tissue and is performed by a Specialist Breast Surgeon. Your mastectomy may also involve the removal of lymph nodes under the armpit depending on the type of breast cancer you have and at the recommendation of your Breast Surgeon.

Do I get to keep my nipples?

This depends on your individual breast pathology that will be discussed with your Specialist Breast Surgeon who will provide you with advice on performing a nipple sparing procedure.

If I have breast cancer in only one breast, will I need a mastectomy of the other breast?

This depends on the type of breast cancer, your previous history, family history and potentially genetic testing. Your Breast Surgeon will be able to provide advice if a prophylactic mastectomy of the other breast is recommended.

What are my options for breast reconstruction?

Dr Cheng (Specialist Plastic Surgeon) will work together with your Breast Surgeon to reconstruct the breast after mastectomy. The more common method for breast reconstruction is the use of temporary tissue expanders. When you have your mastectomy, due to the removal of all the breast tissue, the skin is tight and needs to be gradually stretched to eventually accommodate a permanent breast implant. Tissue expanders can be placed in the same surgery as your mastectomy (immediate reconstruction), or at a later date (delayed reconstruction).

Other methods for breast reconstruction include; Latissimus Dorsi Flap, a Transverse Rectus Abdominus Muscle Flap (TRAM) and Deep Inferior Epigastric Perforators Flap (DIEP). At your consultation with Dr Cheng, you will be able to discuss all the possible reconstruction options available to your individual case. Dr Cheng will take into account your diagnosis, your medical history, your availability of abdominal tissue, if radiation treatment is required and your desired aesthetic outcome to achieve the best possible result.

When and where will I get to have my surgery?

If you are having an immediate reconstruction (mastectomy with either a tissue expander, latissimus dorsi flap, or TRAM) it will be performed at the Wesley Hospital and will require both your Specialist Breast Surgeon and Specialist Plastic Surgeon to be available for a combined procedure. As we don’t have permanent scheduled days for combined procedures, we appreciate your flexibility whilst your two surgeons and anaesthetist liaise together to organise a suitable time appropriate for your individual case.

How many surgeries will I need?

This depends on which type of reconstruction you will be having. Breast reconstruction with tissue expanders is usually performed as two stages. The first stage involves your mastectomy with the Breast Surgeon, and insertion of temporary tissue expanders by Dr Cheng. These expanders will be progressively filled to their volume capacity to stretch the skin to accommodate your future permanent implants. Tissue expanders can be exchanged with permanent breast implants after a minimum of 8 weeks after your last tissue expander fill.

What does a tissue expander fill involve?

Your first tissue expansion fill will likely be performed 4 - 5 weeks following your initial surgery. Your tissue expansion will be performed in our clinic rooms by Dr Cheng or one of his nurses on a weekly - fortnightly basis until we reach the volume capacity of your expander or until you are happy with the size. Your individual circumstances may alter the progression of these fills.

Can I have tissue expander fills during chemotherapy?

You may be able to have tissue expander fills during your chemotherapy treatment, depending on the type of treatment and how you are feeling. We would usually perform the fill just before the commencement of each chemotherapy session, whilst you are feeling well. If you don't require radiation treatment in addition to chemotherapy, we will generally wait until you finish your chemotherapy to commence your tissue expansion. After your last chemotherapy session, Dr Cheng will wait approximately 6 months before exchanging your tissue expanders for permanent implants.

What if I have to have radiation?

Ideally, we would aim to complete your tissue expander fills prior to the commencement of radiation due to the effect radiation can have on the skin. Your exchange of tissue expanders for permanent implants normally occurs after a period of at least 6 months after you complete your radiation treatment.

If I need a hysterectomy, can I have this performed at the same time as my mastectomy?

No, unfortunately due to the complexity of both of these procedures it would compromise your recovery.

When can I exercise after surgery?

We would not recommend strenuous activity before 6 weeks post-operatively. You will likely be given exercises to assist with your range of motion by the physiotherapist during your hospital stay. You will be able to discuss your return to activity with your nurse and Dr Cheng at your post-operative appointments.

When can I go swimming after surgery?

Unfortunately, swimming increases the risk of infection in a newly healing wound. It is not recommended that you go swimming (either the pool or the beach) until your wound is completely healed. This is generally not before 6 weeks after your procedure.

Will I need a special bra after surgery?

After the first stage of your reconstruction with tissue expanders, you won’t require a special bra. You are able wear anything that is comfortable, or no bra at all. You may find a soft singlet/camisole comfortable. After your second stage of reconstruction with permanent implants, you will be fitted by our nurses for a supportive post-operative bra that you will wear full time for the first 6 weeks after your surgery. If you are having a TRAM procedure, you will be fitted for a bra at your first post-operative appointment.
If you are having only one breast operated on, you may need to visit a special Prosthetics and Lingerie Service offered through Choices. Your nurse will be able to provide you with these details.

During Procedure

After Procedure

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Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Are you a candidate for surgery?

Are you a candidate for surgery?