The goal of breast reconstruction is to recreate one or both breasts lost to cancer. Many breast cancer survivors find that reconstructing the breasts boosts their confidence as well as helps them feel normal in clothing and lead a normal lifestyle.

A/Prof Damian Marucci is a Sydney breast reconstruction surgeon serving patients seeking breast reconstruction in Miranda, Kogarah and all surrounding areas. He answers some of the top breast reconstruction questions here.

How natural does a reconstructed breast look?

There are many factors that affect how good a breast reconstruction looks, many of which (unfortunately) are out of your plastic surgeon’s hands. There are three primary components to consider:

1. Breast skin – Ideally, the best looking results occur after a skin-sparing mastectomy, when the reconstruction is performed at the same time as the mastectomy. Dr. Marucci can still deliver great results if the reconstruction is “delayed” — i.e., you’ve had your mastectomy sometime in the past— however, new skin will be needed. The skin can either be created from the existing chest wall through tissue expansion or recruited into the area in the case of a flap. Radiotherapy will cause discoloration and scarring of your chest wall skin, which makes the whole process trickier than in patients who don’t have radiotherapy.
2. Breast mound – There are three ways to create a mound for the reconstructed breast: an implant, a flap of tissue from another part of the body (usually the back or abdomen) or an implant under a flap.
3. The nipple-areolar complex – The nipple-areolar complex can be reconstructed by folding the skin on the breast mound, sometimes with a skin graft, and later having it tattooed. Alternately, you can get adhesive (stick-on) nipples, which look very realistic.

Symmetry is the main goal of breast reconstruction. It is often easier to achieve good symmetry when both breasts are reconstructed in the same way at the same time. Matching a completely natural breast is not impossible — there will always be scars and slight differences — but it is a noble goal we all strive for.

Do the breast reconstruction tissue expanders cause pain as they expand?

A tissue expander is like an empty container placed underneath the skin and muscle of your chest. It is “expanded” (inflated with fluid) normally every week or so in your Sydney breast reconstruction surgeon’s office by passing a needle through the skin and straight into a special part of the expander (called the “port”), which is designed so the fluid doesn’t leak out once the needle is removed.

Obviously, the needle going through the skin can be painful. The sensation of tissue expansion itself (what you feel as you surgeon is injecting the fluid) varies from patient to patient. Your plastic surgeon should inject the fluid slowly. You will begin to feel the increasing fullness and tissue stretching. When it starts to feel uncomfortable in any way, let your surgeon know. They will stop adding fluid, document how much fluid went in, remove the needle and schedule another appointment for more expansion in a week or so. Once the desired volume has been achieved, your surgeon can start planning surgery to replace the expander with a breast implant.

If you are in too much discomfort after the expansion, let your surgeon know, as they can easily remove some of the fluid from the expander and then try again in a few weeks time. Obviously the more fluid added the expander at each visit, the faster it will be to get to your desired volume.

How long do the tissue expanders stay in for?

Some fluid is put into the expander at the time of initial surgery and then Dr. Marucci usually commences tissue expansion in the office a few weeks later once the wounds have settled down.

Dr. Marucci fills the expander slowly and ask the patient to tell him when things are feeling a little tight — then he stops. He performs expansions fortnightly until the desired volume is reached — and then he likes to over-expand by 10 to 20 percent so that there are no issues with wound closure when the breast implant is placed.

He generally waits a few weeks after the completion of over-expansion prior to the exchange procedure

What is the recovery time after breast reconstruction surgery?

It depends on what type of reconstruction you have and how “recovered” you mean by “recovery time.”

For implant-based reconstruction, it is normally a few days in the hospital, then home with a drain. If the implant-based reconstruction is “two-staged,” it means an expander was placed at an initial procedure, and then swapped for a proper implant in a second procedure. In that scenario, you need to take it easy for a few weeks and you can’t shower until the drains are removed. Dr. Marucci recommends no swimming or exercise for 3 to 4 weeks, although you should be driving after a week or so.

When Sydney breast reconstruction surgeons use your own tissue without an implant, they are usually using tissue from the lower abdomen. This is known as either a “TRAM” or a “DIEP” flap reconstruction. For a TRAM or DIEP flap breast reconstruction, recovery involves a week in hospital, followed by not lifting anything heavier than 2 grocery bags for 4 weeks. Dr. Marucci advises no exercise or swimming for at least 4 weeks. Driving after this type of surgery is different for everyone, but he recommends no driving for 2 to 3 weeks for most.

If you are having a hybrid reconstruction using an implant with your latissimus dorsi muscle from the back, most patients are in hospital for 5 to 7 days, and again, Dr. Marucci advises no showering until the drains are removed. He recommends no exercise for a month, but most patients are driving after a week or two.

 Is it possible to have breast reconstruction after lumpectomy and radiotherapy?

Increasingly, the goal of breast surgeons is to preserve as much breast tissue as possible by only removing the cancer (lumpectomy) and then treating the remaining breast tissue with radiotherapy. This has been shown to have the same cancer control rate as having a mastectomy.

Sometimes the cosmetic results from this “breast conservation” surgery are excellent — but sometimes they are not. Lumpectomy reconstruction after radiotherapy in Dr. Marucci’s practice generally involves replacing the portion of the breast which has been removed with a “flap” of tissue from the back (i.e., a latissimus dorsi flap). If a large amount of skin has been removed and the position of the nipple has been affected by the lumpectomy, skin from the back will be included in the flap and used to replace the skin that was removed during the cancer treatment.

Some patients want their breasts to be larger in addition to reconstructing the lumpectomy defect. The latissimus dorsi flap can be used to cover a breast implant or tissue expander, while the un-operated breast undergoes a standard breast augmentation.

A newer technique is to reconstruct the lumpectomy defect is with fat grafting, which involves performing liposuction elsewhere, separating out and then re-injecting the fat into the breast to fill the hole. However, Dr. Marucci doesn’t think the jury is in on the safety of this technique in patients who have previously had breast cancer (although he knows some of his colleagues will disagree!).

How long after mastectomy surgery do I need to wait before undergoing a TRAM or DIEP flap breast reconstruction?

In the appropriate patient, breast reconstruction using tissues from the abdomen can be performed at any time after mastectomy. It is ideal to have a reconstruction at the time of mastectomy, although Dr. Marucci tends not to use a “tummy flap” if there is a high chance that the patient will need radiotherapy. If a patient will require radiotherapy, he waits at least 6 months after radiotherapy has finished before doing a breast reconstruction.

Otherwise an abdominal flap can be performed at any time after mastectomy. Dr. Marucci sees some patients who had their mastectomy 10 or more years ago and who now present for reconstruction

Schedule a Breast Reconstruction Consultation

If you are interested in learning more about your options for breast reconstruction, Sydney plastic surgeon Damian Marucci welcomes you to contact him. Call or email our Kogarah or Miranda offices to schedule an informational consultation today.

Download Implant Based Breast Reconstruction Information Sheet