Following the diagnosis of breast cancer and successful treatment of any form of breast cancer, it’s important to consider your options with regards to breast reconstruction. One of the most important things, whenever you have a diagnosis of breast cancer, is to ask the doctor who will be treating you what their planned treatment is, as well as your post-cancer options.
The cancer treatment plan can involve surgically removing a lump or removing more than just a lump from your breast; whether it’s removing skin, or nipple, or both, or the entire breast. Also, you should know whether there is any additional treatment other than surgery, to remove the cancer such as chemotherapy or radiotherapy. Once you have these answers, it guides your decision-making with regards to the post-cancer journey, which is the reconstruction of your breast.
To put it in very simple terms, as plastic surgeons we are trying to replace the ‘like-for-like’. For example, if you’ve just lost part of your breast we only have to consider replacing part of your breast whereas if you’ve lost skin, nipple, or all the breast tissue, we have to consider replacing everything. So, broadly speaking, when you’re seeking treatment for your breast cancer, always ask your breast surgeon what reconstructive options you have. Generally speaking, reconstruction falls into two categories: reconstruction of your breasts using your own body parts or reconstruction of your breast using a breast implant or a combination of those two things.
Your breast reconstruction options
Breast reconstruction options depend on what is missing in terms of breast cancer treatment. By that I mean if there is just a small part of your breast missing after a lumpectomy, then no reconstruction may be required. But when you’ve had a full mastectomy whereby you’ve had skin, all the breast tissue, and your nipple and areola (the flat part of the nipple) removed, then reconstruction is needed.
When it comes to breast reconstruction, we broadly categorise the options into those reconstructions that use one part of your body to reconstruct your breasts, and those that simply use a breast implant to reconstruct your breast; in some instances, we use combinations of both.
1. Silicone Implants
The simplest form of breast reconstruction is the use of silicone implants. Sometimes, if we are just replacing breast tissue, a silicone implant is enough but very often their needs to be other procedures done at the same time. For example, there might be a need to do a breast lift at the same time if there is excess skin. If there’s been a removal of skin we might need to take a paddle of skin and muscle from your back and swing this around as a piece of your own body, and use it to give padding over the implant.
Why some patients might be against implants
Some patients don’t really want to have a breast implant because a breast implant is a foreign object. With foreign objects, if there is, for example, an infection or a bleed around the implant that has been placed, it can cause some sort of complications. These complications are more likely in individuals that have undergone something like chemotherapy where the immune system has been compromised, or in radiotherapy when again the immune system and also blood supply to the area could be compromised.
Both chemotherapy and radiotherapy increase the risk of infection, bleeding as well as poor healing around the implant which can all lead to complications.
2. Fat Transfer
In addition to the implants, we can use your own body fat in a technique known as ‘Fat Transfer’. With this option, patients have liposuction and then that fat is processed in a special way and injected in and around the breast tissue and/or the implant if it’s been used, in order to give more volume to the breast. Once we have the breast tissue in the shape of the breast achieved, we often leave the patient to heal. Then there’s a second operation where we would perform reconstruction of the nipple and areola.
Remember the nipple is the protruding part of the breast, and the areola is the flat pigmented part of the breast. These two structures can be reconstructed using a skin overlying the breast implant either from the native skin of your breasts or from the skin that’s been transported in overlying muscle from your back, and then the areola – the pigmented dark part – can be reconstructed using medical tattooing. Actually, advances in medical tattooing have been great in recent years and I’ve actually found that you cannot really tell the difference between a tattooed areola and a natural areola.
3. Free Tissue Transfer
Another option for certain patients is to use reconstruction methods utilising just their own body parts. It’s probably the gold standard or Rolls-Royce of the best reconstruction you can have in terms of reduced complications because you don’t need an implant. During this technique, we perform a tummy tuck medically known as abdominoplasty, which involves skin, fat and sometimes a degree of muscle from your abdomen.
We disconnect on its blood supply, so it has artery and vein. And then where you’ve had your mastectomy, and skin and nipple and areola have been removed, we remove a small piece of rib. Behind that rib, there is an artery and a vein, and we perform specialised surgery called microsurgery which involves a microscope and sews together the artery to the artery, and the vein to the vein.
This is done in order to create a new blood supply to the tissue that we disconnected from your abdomen, and the technique is known as a flap or a free tissue transfer. The actual technical term is a DIEAP flap (Deep Inferior Epigastric Artery Perforator Flap) which describes the blood vessel that supplies the tissue that we remove. Once that tissue has got its new blood supply it can be moulded onto the chest and actually tailored to look very much like your existing breast. It can also be used in situations where both breasts have been removed. In this situation, it’s called a bilateral or both-sided reconstruction.
Just as I described with breast reconstruction using an implant, breast reconstruction is normally done in stages. So, once you have the breast volume and the shape achieved you then go on to do the secondary reconstruction elements such as the nipple and areola reconstruction. All of these reconstructions are very much dependent on your general health; what is missing and as to whether you can undergo such operations. This is because, for example, the DIEAP flap that I’m describing can take 6 to 8 hours to do. So, general health considerations do need to be considered and that’s why it’s very important when you first have your diagnosis of breast cancer that you consider your reconstructive options carefully.
Breast Reconstruction timeline
In the Middle East, unlike in England where I trained, often breast reconstruction is not offered immediately, which means that on the day that you have your breast cancer removed, we perform the reconstruction on the day. This has advantages including less psychological upset because when you go to the operating theatre you have the cancer dealt with, and you leave with your reconstruction on the same day.
Very often here in the region, patients are not informed of the options for reconstruction, so they have to heal without having a breast for a while and then have reconstruction on a different day in the future. Obviously the psychological and physical harm that this can do can be very damaging to your feelings of being a woman.
Generally speaking, the evidence when it comes to reconstruction is skewed towards having immediate reconstruction with something like a DIEAP flap. This technique works well if you’re young, fit, and healthy and you’ve got a diagnosis of breast cancer necessitating the removal of skin, breast tissue, and your nipples.
This is the reconstructive option of choice. But as I say, you must consult a breast surgeon that has contact with plastic surgeons who are capable of doing such complex surgery.
About Aesthetics by King’s College Hospital Dubai
Aesthetics by King’s College Hospital London Dubai consists of modern medical centres in Dubai Marina and Jumeirah, and the newly opened state-of-the-art 100-bed facility at Dubai Hills in Mohammed bin Rashid City. As part of King’s College Hospital (KCH), they offer patients local access to world-class treatments by leading Board-Certified Plastic Surgeons. Experts’ primary goals are patient safety combined with natural results and committed to being the best in the industry.