Breast reconstruction is a complex area of reconstructive surgery that is a vital part of the treatment of patients who are unfortunate enough to suffer from breast cancer. Treatment of your cancer is of course paramount but this can be co-ordinated with reconstructive surgery where appropriate. A great deal of advice and guidance should be sought from your treating breast surgeon and oncologist.
Many cases of breast cancer are now treated with wide local excision or a partial mastectomy with or without radiotherapy. Plastic surgery techniques such as breast reduction and mastopexy can be modified to include excision of diseased tissue to create a more aesthetically pleasing breast than might otherwise be achieved. This rapidly evolving area of reconstructive surgery is known as Onco-Plastic breast surgery and requires close liaison between your breast surgeon and the plastic surgeon to achieve an optimum result.
As an independent practitioner this is not an area where I can profess any great involvement and the reconstructive surgery that I offer is for those patients who have had or who are having a mastectomy. Liaising with your breast surgeon, in the correct circumstances, we can reconstruct your breast at the time of mastectomy which will often allow your breast surgeon to minimise the amount of skin that is removed at mastectomy using a skin sparing mastectomy. In some cases the nipple can also be preserved which is a decision for your treating breast surgeon.
If you are having or have had a mastectomy there are three main reconstructive options available to restore volume and shape to your breasts. All methods of breast reconstruction need to replace lost volume and restore skin and the three main ways of doing this are as follows:
- The use of an implantable and expandable device. The volume of the device restores volume and by expanding the device, the skin of the breast is stretched to replace missing skin.
- New tissue can be brought in from elsewhere in the body. A good source of tissue is from the back using a flap known as a Latissimus dorsi flap. This procedure often requires an implant to restore volume.
- In suitable cases tissue can be taken from the lower abdomen to replace missing skin and restore volume. This technique which is known as a TRAM flap or DIEP flap has the huge advantage that the breast is reconstructed with all your own tissue, but it is a complex operation. This type of procedure is considered by many, including myself, to be the gold standard of breast reconstruction.
To compliment and complete breast reconstruction a nipple needs to be provided. This can be an artificial nipple or a reconstructed nipple.
An artificial nipple is made of silicone using a cast of the opposite nipple to form a mould. The silicone impression can be coloured extremely well to match the natural nipple. The artificial nipple is then attached with tissue glue which can last up to three weeks between applications.
An artificial nipple creates a nipple with the best colour match and shape but does require “maintenance”.