Breast Reconstruction

Whether a patient requires radiotherapy depends very specifically on many factors including the type of tumour, the size of the tumour, whether lymph nodes are involved in the axilla (armpit) and the presence or absence of hormone receptors on the tumour cells. The requirement for radiotherapy is always something very extensively discussed between the patient and the radiation oncologist.

In the primary breast reconstruction, basically radiotherapy has an adverse effect upon all types of reconstruction both with autologous flaps (your own tissue) or with prosthetic reconstructions. It is conventional wisdom now that if the woman is known to require radiotherapy postoperatively, then it is best to delay the reconstruction to the secondary stage after the radiotherapy is completed. This avoids the breast reconstruction being irradiated and the potential complications and suboptimal results that could eventuate under that circumstance.

In delayed or secondary reconstructions, for multitudes of reasons, prosthetically based reconstructions are generally not ideal and are to be avoided unless there is no other option available. Prosthetic reconstruction in the face of radiotherapy to the chest wall can result in an unsatisfactory complication rate and poor cosmetic results. Although nothing is an absolute, usually a better solution can be found for breast reconstruction under this circumstance.

In broad terms, breast reconstruction falls into three groups:

• Prosthetically-based involving either the use of a tissue expander or a silicone prosthesis.
• An autologous flap (your own tissue) which commonly today would take the form of the DIEP flap. This is the roll of fat and muscle in the lower abdomen in the region where tissue would normally be removed during an abdominoplasty (tummy tuck).
• A combination. This most commonly is a Latissimus dorsi flap which usually requires having a prosthesis placed as well to get adequate volume for the reconstruction. The Latissimus dorsi is a broad, flat muscle in the back and usually requires a paddle of skin to be taken to replace the skin that is missing following a mastectomy.

All these forms of reconstruction have their pros and cons which would be extensively discussed with you during a consultation.

Dr Perkins currently only performs prosthetically based or Latissimus dorsi based breast reconstruction.

Even with the highest standards of practice, all surgical procedures carry a level of risk and the potential for complications. In addition, every individual will have a different risk profile depending on their general health, age and the complexity of the procedure.

During the consultation Dr Perkins will explain the possible complications and risks of the specific procedure to provide the necessary information to enable patients to weigh up the benefits, risks and limitations of the surgery.  The following are some of the risks associated with this procedure:

• Specific risks of prosthetically based reconstruction include infection around the implant, capsular contracture, leakage of the implant’s contents, asymmetry, rupture of implant due to trauma.
• Specific risks of autologous flap based reconstruction include small areas of hardness (fat necrosis), fluid collection (seroma) at the flap site.

General risks involved in any surgery include post-operative infection, excessive bleeding, pain/discomfort, haematoma (blood collection), seroma (fluid collection), adverse reaction to anaesthetic, unsatisfactory scarring. Read more about general risks and complications of surgery.

There are Medicare item numbers which cover breast reconstruction. As such, if you are in a private health fund with appropriate cover, a proportion of the costs will be rebated by Medicare and the health fund.

An estimate of costs will be provided following the consultation with Dr Perkins.