Key points to consider about breast reconstruction following a mastectomy
Breast reconstruction technique. Breast reconstruction is considered to be an integral part of breast cancer management, with the aim of restoring a breast to its natural form. Increasingly, women are becoming aware of the quality-of-life and psychosocial benefits of breast reconstruction. A study published in the Singapore Medical Journal in 2018 confirms this trend in Singapore, highlighting a fivefold increase in the number of women who have chosen to go for breast reconstruction over 2001 to 2010. In 2001, 8.1 per cent (or 10 out of 123) of women underwent breast surgery. This proportion went up to 44 per cent (or 44 out of 107) in 2010.
In Singapore, specialist centres take a multidisciplinary approach to the management of breast cancer to optimise surgical recovery and results. Breast cancer surgeons work closely with plastic surgeons in co-managing patients with breast cancer. If you have been diagnosed with breast cancer, you would very likely face a discussion with both specialists. The breast cancer surgeon’s primary focus is on removing the cancer while the plastic surgeon is in charge of breast reconstruction.
Here are some key points to consider, as well as what questions to pose to your plastic surgeon during your discussion.
1. Are you a good candidate for breast reconstruction?
Patients with multiple comorbidities may not be suitable candidates for breast reconstruction as they are considered to be at an increased risk for reconstructive surgical complications.
2. What type of breast reconstruction technique is best for you?
The two main techniques for breast reconstruction are:
- Implant reconstruction – Involves the insertion of a silicone implant which could be round- or teardrop-shaped. Implants generally have a lifespan of 10 to 15 years.
- Autologous or “flap” reconstruction – Involves harvesting tissue from the patient’s belly, thigh or back. This is a more technically challenging technique involving microsurgery, which not every plastic surgeon is qualified to perform. Autologous reconstruction may also involve the use of an implant. Breasts reconstructed using flaps last a lifetime.
Neither method is superior over the other. Your plastic surgeon should be able to review the pros and cons of each method and suggest which is more suitable for you. For example, If you need to undergo radiation therapy after surgery, your plastic surgeon would most likely recommend flap surgery over implant surgery.
You can choose whether you want your nipple reconstructed. Should you choose to do so, the reconstructed breasts will be most realistic and lifelike. The nipple will be reconstructed using your own tissue and tattooed for colour.
3. When to start thinking about reconstructive surgery
Immediate breast reconstruction produces better aesthetic outcomes than delayed reconstruction, so you might want to make your decisions early on if your breast cancer surgeon identifies you as a good candidate for it. In immediate reconstruction, the plastic surgeon will be in the operating theatre to reconstruct the breast as soon as it is removed by the breast cancer surgeon. The entire surgical procedure would take between six and eight hours, with implant reconstruction taking a shorter time than flap reconstruction. The flap reconstruction patient would be able to get out of bed and walk around on the third day after surgery, and the wound would take 10 to 14 days to heal.
In delayed reconstruction, a two-stage approach is used. The patient would return to the plastic surgeon at earliest, one year after the mastectomy, to have the wound expanded. The implant would then be inserted at a later stage.
However, if immediate reconstruction is not recommended, but the patient does wish to undergo reconstructive surgery, there is a newer staged approach known as delayed-immediate reconstruction. A tissue expander or breast implant is temporarily placed under the chest muscle and breast skin after the breast is removed, to preserve the shape of the breast. After radiation is complete and the tissues have healed (four to six months), the temporary inserts are removed and replaced with an implant or a flap from the donor site as discussed with the plastic surgeon.
This article has been fact-checked by Dr Timothy Shim, senior consultant plastic surgeon at The Clifford Surgery Clinic, Mount Elizabeth Novena Hospital and Clifford Centre