Breast Reconstruction | New Zealand Reconstructive Surgical Specialists

What is breast reconstruction surgery?

Breast reconstruction is a surgical procedure aimed at restoring one or both breasts. A partial or complete defect of the breast mound may be the result of deficient natural growth as the breast develops (congenital deformity). However, it is most commonly a consequence of cancer treatment. While breast reconstruction after cancer is not required to improve survival (and is thus optional), for many patients it addresses the inconveniences of an external breast prosthesis, improves stigmatising disfigurement of their chest, and helps provide closure to their cancer journey.

As normal breasts vary widely in size and shape between patients, it is imperative that surgical reconstruction is tailored to each individual. The exact technique, number of operations involved, and timing are all important considerations when planning your reconstructive journey with your surgeon. Regardless, there are limitations in what can be achieved in terms of symmetry, natural texture and breast sensation.

Timing and technique

The timing of reconstructive surgery is critical to the result. In congenital surgery, breast reconstruction is achieved once breast and patient growth are complete. This provides a stable platform upon which symmetry can be pursued. In the context of cancer, reconstruction can be performed either be performed at the same time as cancer treatment, or once cancer treatment is complete. There are pros and cons to both options, but it is critical that reconstruction should never penalise cancer survival.

There are two main techniques used to restore the breast mound, each with nuances that affect feasibility and the final result. These are known as “prosthetic” reconstruction and “autologous” reconstruction. A common theme is that multiple operations are normal, rather than a single step. This is due to the limitations of what surgical manipulation the body tissues will tolerate per operation. The choice between options will depend upon individual circumstances, with your surgeon providing guidance based on your specific needs and goals.

Prosthetic reconstruction

Prosthetic reconstruction uses an artificial implant to provide volume and shape. While the implants are usually silicone, they differ significantly from historical silicone implants courtesy of modern technology and understanding. They are the same implants used in cosmetic breast augmentation, and we recommend patients read about that surgery here.

Pros:

Implant surgery is a less technically demanding option. The operation is less invasive and has an easier recovery.

Cons:

Implants are not a lifetime device, and may need revision surgery to replace them in future to avoid risk of rupture.
In the presence of radiotherapy, implants have higher rates of complications. In a radiotherapy context, a surgeon will ordinarily not recommend an implant alone without additional surgery to protect the implant.
While a range of sizes are available, implants are not manufactured in a wide variety of shapes and they cannot be modified. This restricts the symmetry that can be achieved. If there is a significant difference in symmetry, your surgeon may recommend surgery to the other breast in order to match the reconstruction. This could be a breast reduction, breast lift, or another breast implant.

Autologous reconstruction

Autologous reconstruction uses a patient’s own body tissues to recreate the breast mound. The body “donates” spare skin, fat and/or muscle from elsewhere, which is used to construct the new breast on the chest wall. These are powerful techniques that potentially provide the most “like-for-like” reconstructions achievable. However, they are also more technically demanding, and necessitate large scars elsewhere on the body. The most common technique is to use lower abdominal fat and skin, known as a “DIEP free flap”. However, other donor sites include the back, hips, buttocks, and thighs.

Pros:

Autologous reconstruction is a versatile platform which can create a more natural shape than that achievable from a manufactured breast implant.
Your own body tissue does not wear out as an implant does, so an autologous reconstruction is a lifelong.
Being made of living tissue, autologous reconstructions are much more forgiving than implants of radiotherapy.

Cons:

Transferring body tissue is complex and technically challenging, relying upon successful manipulation of small blood vessels sometimes 1mm or smaller. Planning and consideration of individual anatomy is essential. Should the blood vessels be damaged, the operation may catastrophically fail.
There are two surgical sites rather than one. Combined with the technical complexity and long operative time, autologous reconstructions are much demanding of the patient in terms of invasiveness, recovery, and risk of major complications. For those who are self-funding their surgery, there are also financial implications.
There may be limits in how large a breast can be reconstructed, depending on the breast defect and how much donor tissue is available. This is compounded if both breasts require reconstruction. A donor site can only be used once, and cannot be re-used if previously expended.

Who is a good candidate for breast reconstruction surgery?

Breast reconstruction is a deeply personal decision, and it’s essential to undergo the procedure for oneself rather than external pressures or ideals. You may be a candidate for breast reconstruction if you are in good health and without any medical conditions or illnesses that may impair healing (including smoking or vaping). You need to have realistic goals and a good understanding of the limitations of reconstruction. You must also have a positive outlook, and the resilience to face any challenges or complications.

For those seeking reconstruction in a breast cancer context, it is vital to recognise that reconstruction cannot succeed unless the cancer treatment succeeds. When considering and planning any breast reconstruction, this higher priority must be borne in mind.

What questions should I ask my plastic surgeon about breast reconstruction surgery?

Are you vocationally registered with the Medical Council of New Zealand as a specialist plastic surgeon?
Are you a member of the New Zealand Association of Plastic Surgeons?
Will the procedure be conducted in a hospital or office-based setting, and is the facility accredited for this type of surgery?
What type of anaesthesia is needed for this procedure?
Based on my medical history and condition, is surgery the best option for me? If so, am I a suitable candidate for this surgery?
Which surgical technique do you recommend for my case, and why?
What are the realistic expectations for the outcome of this procedure in my case?
What steps or lifestyle changes are necessary for me to get the best result from my surgery?
What is the anticipated duration of recovery, and what assistance will I need during this period?
What potential risks and complications are associated with this procedure? How would you manage these should they arise?
How will my results change over time?
If I’m unhappy with the outcome, what recourse options are available?

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Disclaimer: This website is intended to provide you with general information only. This information is not a substitute for advice from your Specialist Plastic Surgeon and does not contain all the known facts about this procedure or every possible side effect of surgery. It is important that you speak to your surgeon before deciding to undergo surgery. If you are not sure about the benefits, risks and limitations of treatment, or anything else relating to your procedure, ask your surgeon to explain. Patient information provided as part of this website is evidence-based, and sourced from a range of reputable information providers including the American Society of Plastic Surgeons, Better Health Channel and Mi-tec medical publishing.