Breast Reconstruction Surgery

Breast reconstruction is offered to all women facing the prospect of mastectomy to surgically treat their breast cancer. These procedures are performed to restore the shape of the breast after mastectomy. Dr Kollias believes that breast reconstruction is an integral part of breast cancer surgery. Deciding to have breast reconstruction can be difficult during this stressful period in your life. Dr Kollias and his staff will provide all necessary options, information and support required through this decision-making process.

External Breast Prosthesis

Many women choose not to have a breast reconstruction following mastectomy. This is a very personal choice, but one that is associated with the least amount of surgery and least amount of risks and complications. In this circumstance, Dr Kollias has a professional bra fitter who assists women with choosing a suitable post-mastectomy bra with external soft and silicone prostheses that can be worn in the bra cup(s). In clothing, the breast appearance is normal. See photograph.

For more information about mastectomy bras and external breast prostheses, click here.

Breast Reconstruction

Breast reconstruction can be performed at the time of breast cancer surgery (immediate reconstruction) or after all your breast cancer treatments are completed (delayed reconstruction).

Dr Kollias offers a full range of reconstructive options. In this way, your breast cancer surgery and breast reconstruction can be performed by a single, experienced surgeon without the need to “tag team” between surgeons, operating theatre lists and added personal expense. 

Dr Kollias offers the following range of breast reconstructions-

Implant-based Reconstruction

This is the commonest form of breast reconstruction performed worldwide. The procedure is safe, effective, associated with few risks and is associated with a quicker recovery compared with flap-based procedures. In this operation, a silicone implant is used to reconstruct the breast. This can be done as a single-stage procedure (“direct to implant” breast reconstruction which usually requires the use of mesh) or a two-stage procedure. In the latter, a tissue expander (spacer) is placed under the pectoralis muscle and skin, and is injected with saline over a period of a few months. This allows the skin envelope and muscle to be stretched enough to then allow a second operation at which stage, a permanent silicone breast implant of suitable size and shape is inserted.

Autologous Flap/Tissue Reconstruction

This method of reconstruction uses your own body tissues (skin, fat and muscle) to help reconstruct your breast. The tissue may be taken from the back (Latissimus Dorsi flap) lower abdomen ((DIEP-Deep Inferior Epigastric Artery Perforator flap or TRAM – Transcutaneous Rectus Abdominus Muscle flap). Flap-based reconstructions are more complicated than implant-based reconstructions. However, they are more suited for women who have received radiotherapy after mastectomy procedures or where the final reconstruction requires a natural “droop” and feel to match the other normal breast. Dr Kollias has an extensive experience with the Latissimus Dorsi flap and pedicle TRAM flap methods. The DIEP flap requires use of an operating microscope to join the blood vessels of the flap to blood vessels beneath the breastbone. This often requires removal of one or two ribs. This operation is performed by a plastic surgeon with experience in microvascular surgery. Dr Kollias is happy to provide an opinion and refer you to a microvascular plastic surgeon if this is considered to be the preferred reconstruction option.

The differences between the various breast reconstruction options in terms of duration of surgery, hospital stay, recovery time and possible complications are summarised in the following table:

For more information about breast reconstruction surgery, click here.

Nipple reconstruction:

Nipple reconstruction is the final stage of the breast reconstruction process. The nipple (papilla) is reconstructed using a local skin flap on the reconstructed breast, without the need for a skin graft or having tissue taken from elsewhere. The procedure is usually performed as a day surgery procedure, often under local anaesthesia. Once the nipple reconstruction has settled (usually after 2-3 months), areola tattoo is usually performed by a dedicated breast tattooist to provide the final colour for the nipple/areola reconstruction. 

Lipofilling/fat grafting:

Fat grafting can be performed where the breast reconstruction has left a minor depression which impacts on the final cosmetic outcome. Fat can be harvested using liposuction (usually tummy, back, thighs) and transferred (injected) into the defect to restore the loss of volume and deformity from previous surgery. This is a relatively simple procedure that can be performed in the Day Surgery Unit.