Immediate Breast Reconstruction

What is Breast Reconstruction?

Breast reconstruction is a surgery performed to restore the normal shape, size, symmetry, and appearance of one or both breasts after mastectomy.  

What are the benefits of Breast Reconstruction? 

• Reduces the Psychological impact of Mastectomy
• Helps patients with their body-image, self-esteem, and confidence
• Improves quality of life
• Eliminate the need for the external prosthesis

What is Immediate Breast Reconstruction?

Breast reconstruction can be performed at different times, depending upon what works best for your case. Immediate breast reconstruction is a surgery that is performed at the same time as a mastectomy. This is an ideal time for reconstruction, and we aim to maximise the number of patients having this procedure but the decision to perform a reconstruction surgery immediately or at a later time may depend upon several factors, such as:

• Your medical condition
• Your lifestyle and preference

And if you are a breast cancer patient, the stage of the disease and additional treatment required to treat breast cancer.

Immediate breast reconstruction can be all performed by a well-trained Oncoplastic Surgeon or coordination between a Breast Cancer Surgeon and a Plastic Surgeon. During immediate reconstruction, the breast will be reconstructed by either using an implant or using the patient’s tissue soon after the breast is removed and at the same session. Almost all of this procedure is done simultaneously during one operation to provide the patient with a completely reconstructed breast. As an experienced Oncoplastic Surgeon Dr Meybodi performs mastectomy and prosthetic breast reconstruction. He works closely with a team of skilled plastic surgeons who perform tissue-based breast reconstruction.  

For my breast cancer treatment, I need chemotherapy and radiation can I still have immediate breast reconstruction? 

Yes. New evidence, including experience from our team, has shown that immediate reconstruction is feasible and safe for patients who undergo chemotherapy and even radiation post-mastectomy and reconstruction. In patients who undergo post-mastectomy radiotherapy, the overall result might not be as good as patients who do not need radiation. Taking new measures such as Lipofilling of radiated neo-breast can help to maintain an acceptable outcome. We should not let perfect to be the enemy of good!

Advantages and disadvantages of Immediate Breast Reconstruction

Advantages
• Better cosmetic results
• Preserve breast skin
• Preserve breast nipple in suitable candidates
• Minimal scarring
• Potentially fewer surgeries
• No notable delays in having other cancer treatments
• Oncologically safe
Disadvantages

• Longer and more complex surgery compared to simple mastectomy 
• Not feasible in certain situations like inflammatory breast cancer 
• Additional scarring other than mastectomy alone in case of tissue reconstruction 

Methods of Breast Reconstruction

The two main techniques of immediate breast reconstruction include:
• Implant-Based Reconstruction: Inserting a prosthesis which is filled with silicone gel or saline (saltwater) under the skin or muscle of the chest to create a new breast mound is the most commonly performed technique.

• Flap or Autologous Reconstruction: The patient’s own skin tissue is taken from another section of the body, such as the stomach, thigh, or buttocks and used to create a new breast mound.

Consultation before immediate Breast Reconstruction

In general, preparation for immediate breast reconstruction may involve the following:

On the day of consultation:

• A thorough history taking and examination by Dr Meybodi is performed to check for any physical, medical and social circumstance. Address issues that need to be addressed prior to the procedure.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and more imaging to help detect any abnormalities that could threaten the safety of the procedure.
• In prophylactic procedures, you will be referred to a clinical psychologist for assessment and advice.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• Inform us of any medications, vitamins, or supplements that you are taking.
• You will review before and after surgery pictures of patients who had immediate breast reconstruction
• You will have a 3D photo to measure your breast volume and shape
•  A written consent will be obtained from you after the procedure has been explained in detail, and you made your mind to proceed.

Preparation for the surgery:

• Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing and increase your chances of areolar or nipple damage, tissue necrosis, and other complications.
• Maintain a moderated level of physical activity to enhance your physical and mental fitness in preparation for your surgery.
• You can find out more about how you prepare yourself and your home environment before surgery here.

On the day of surgery:

• You may be instructed to shower with an antibacterial soap in the morning of your surgery.
• You should not consume any solids and liquids 8 and 4 hours prior to surgery.
• Please bring all your images to the operating theater.

Procedure Involved in Implant-based Immediate Breast Reconstruction

Mastectomy and immediate breast reconstruction are usually performed under general anaesthesia in a hospital setting. The surgery may take a couple of hours or more based on the method of breast reconstruction. In general, Dr Meybodi will undertake the following steps:

• Use a marker to draw guidelines on the breast to mark the breast boundaries
• Make a surgical cut accordingly and more commonly on the inframammary fold
• Carry out mastectomy and lymph node related procedure
• Develop a pocket under the skin or chest wall muscle to insert an implant (prosthesis)
• A breast prosthesis is carefully inserted in the pocket to form a new breast mound
• The prosthesis is then supported with a mesh, which acts as an internal bra to hold the device in place
• A drainage tube may be placed under each arm to drain excess fluid or blood
• Close the incisions with sutures and apply a waterproof dressing

Post-Procedure Care and Recovery after Prosthetic Breast Reconstruction

Most people can go home in one or two days after surgery if no complications are noted. In general, postoperative care instructions and recovery involve the following:

• You may notice sensitivity, tenderness, swelling, and bruises over the reconstructed breast. Pain and anti-inflammatory medications are provided as needed.
• The drains are usually removed in about a week or two from the surgery. You will be instructed how to look after your drain. You can watch this video from MyHealth.Alberta.ca as a guide.
• You will be able to have a shower from the first day after surgery. A waterproof dressing will protect your surgical scar.
• You may experience constipation post-surgery try to add fiber to your diet and drink enough water. You can use simple laxatives to help your bowel motion. 
• You are recommended to wear a supportive bra after 2 days post-procedure.
• Refrain from using anything too cold or too hot on your reconstructed breast skin as your breasts will lack normal sensation.
• You will be able to resume normal activities within a couple of weeks but may have certain activity restrictions. You can find out about exercises after breast reconstruction surgery here.
• A periodic follow-up will be scheduled to monitor your overall progress.
• In follow up appointments’ Dr Farid will perform ultrasound to check the health of your reconstructed breast. 
• When tissue expander used for reconstruction, more Saline will be injected to the device to achieve the appropriate size

Risks and Complications of Immediate Breast Reconstruction

Immediate breast reconstruction is a relatively safe procedure; however, as with any breast reconstruction surgery, some risks and complications may occur, such as:

· Bleeding
· Poor healing of surgical cuts
· Infection at the surgery site and around the prosthesis
· Anaesthetic risks
· Blood clots
· Necrosis or tissue death
· Uneven breasts
· Accumulation of fluids around the prosthesis
· Loss of sensation in the breasts or nipples
· Need for revision surgery

What happens if I develop implant infection? 

With all the advances, implant reconstruction, including proper case selection, reduced operating time, meticulous tissue handling and enhanced recovery protocols, the chance of implant infection has decreased significantly. Unfortunately, the possibility of implant complication and in particular Infection, also known as peri prosthetic Infection is not zero. Implant infection can be managed conservatively with antibiotic an ultrasound-guided aspiration of fluid collecting around the implant. With severe infections, the treatment is a bit more complicated. In the past treatment of severe Infection was implant removal, which can cause significant morbidity for the patient. Dr Farid, with the team in Westmead Breast Cancer Institute, has been in the frontline of developing a new technique for salvaging infected breast implants with a high success rate. You can find out more about this technique here.

Useful Links:

Understanding Breast Reconstruction