Nipple & Breast Reconstruction

Recent advances in breast reconstruction have addressed many of the issues associated with fears of disfigurement from women who have had a mastectomy or lumpectomy. Today there are more options and sophisticated procedures that been developed allowing for reconstructed breasts to be very natural looking with a softness and shape that is comparable to a natural breast.

Breast reconstruction can be done immediately following a mastectomy while the patient is still under general anaesthesia for immediate restoration of volume and shape of their breast or it can be done in at a later time if radiation is planned for afterwards. The benefit of immediate reconstruction is that it allows for a skin-sparing mastectomy in those who are suitable candidates. This surgery remans available however for patients that have already had a lumpectomy or mastectomy, or are not happy with the results of previous reconstructive surgery.

A breast reconstruction is usually a sequence of operations that involve two or occasionally three stages. The first operation is usually the longest and most complicated part of the reconstruction. Secondary procedures can involve implant exchanges, nipple reconstruction and possible surgery on the opposite breast to achieve symmetry.

Following are the types of reconstructive surgeries a patient can consider:

• Breast expanders/implants
• A combination of implants with muscle or soft tissue flaps
• Muscle or soft tissue flaps alone
• Muscle or soft tissue flaps transferred using microsurgical techniques

One of the most recent developments in breast reconstruction is the use of perforator (soft tissue) flaps which is an alternative approach to implant reconstruction and involves the creation of a skin flap using tissue taken from other parts of the body. DIEP/SIEA flaps involve procedures using tissue from the abdomen while SGAP (and related IGAP) flaps utilize tissue from the buttocks region to create the new breast. The same basic surgical concept is utilized for each procedure.

Preparation

Before undergoing breast and nipple repair consideration and preparation are vital. Those who are considering the procedure should clearly outline their targets and openly discuss this with their consultant.

Those who are considering the procedure should be aware of the risks and complications that can arise as well as the practical changes that are needed prior to surgery. Those who are considering undergoing either procedure should be aware that they may be unable to breast feed and may also lose nipple sensitivity. In preparation for surgery itself patients should not smoke or be exposed to passive smoking for a period of two weeks. Prior to surgery patients are also required to stop taking medication which alters blood viscosity including aspirin, birth control and hormone correction.

Preparing for surgery will greatly help a patient maximize results and improve the healing process.

• Eat healthy and drink plenty of water daily, both before and after surgery (allow for any pre-surgery restrictions).
• Do not smoke for two weeks prior or two weeks after the surgery.
• Arrange for sufficient home support to assist during recovery.
• Do not take aspirin or any products which contain aspirin or other blood-thinners for two weeks prior to your surgery.
• Notify the doctor's office if taking any vitamins or herbal supplements as some may need to be temporarily discontinued prior to surgery.
• Report any other ongoing health problems to the doctor's office.

After Surgery
Patients can expect to be released from the hospital in two to five days and are likely to feel tired and sore for a week or two after reconstruction however discomfort can be minimized by prescribed pain medication. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation but these are usually removed within the first week or two after surgery and most stitches are removed within a week to 10 days.

It may take up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, recovery time may be less.

Reconstruction cannot restore normal sensation to the breast but eventually some feeling may return and over time most scars will fade substantially.

Risks and Complications

• Patients may suffer scarring
• In a number of cases patients have also reported a significant decrease in sensitivity

By nature all medical procedures carry an element of risk. While the majority of patients do not experience any complication during our nipple and breast reconstructive procedures, before embarking on any medical procedure, it is advisable to consult fully with the McLean Academy so that our qualified staff can suitably discuss any risk or concerns that your procedure may pose.