Plastic & Reconstructive Surgery

Breast Reconstruction

After surgery for breast cancer, many women will decide to have their breasts reconstructed. This is usually done by the plastic surgeons in St. James’s Hospital. It can be done immediately after the cancer surgery or some time later, after the woman has completed any necessary other treatment such as chemotherapy or radiotherapy.

The patient will meet with the plastic surgeon before surgery. Following an examination, the different suitable options will be discussed and explained in detail. Some operations to make a new breast are less involved than others, and a decision is reached between the surgeon and the patient as to which is best for the individual. Making a new breast may involve the use of breast implants or of some of the woman’s own tissue, or a combination of both..

Hereditary Breast Cancer

Some breast cancers can be hereditary, and so some women who are high risk following genetic testing may decide to have one or both breasts removed to prevent cancer in the future. Most of these women decide to have breast reconstruction done at the time of breast removal. The methods used for this type of reconstruction are the same as if they had their breasts removed for actual cancer.

Nipple Reconstruction

All women who have had a breast reconstruction can have a new nipple created. This is done once the breast reconstruction has settled into its final position, usually at about six months. The procedure involves making a new mound to copy the nipple and then tattooing the brown area around it.

It is important that the patient is as healthy as possible before having breast reconstruction because some of the operations are quite long and complicated.

What is Breast Reconstruction?

Breast reconstruction involves making a new breast for a patient after mastectomy for breast cancer using a breast implant or moving some tissue from another part of the woman’s body, or a combination of both of these.

Treatment

There are three types of breast reconstruction available in St. James’s Hospital:

  • Implant-Based Reconstruction:  This is suitable for women with a small opposite breast and with enough loose tissue in the area where the new breast is to be. If the skin is a bit tight, in some cases it can be stretched by means of a balloon type implant, called a tissue expander, over a couple of months. Once enough skin has been stretched, the tissue expander is removed and a permanent implant is inserted. This type of surgery is not generally suitable for people who have had radiotherapy.
  • Implant and Flap Surgery:  This is suitable for women who do not have enough skin on their chest wall and need more volume to match the opposite breast. Most commonly, the tissue is transferred from the back. The surgeon uses a muscle called the latissimus dorsi and some overlying fat and skin from the back and moves it to the front of the chest. An implant is inserted at the same time. This is a bigger operation than implant-only reconstruction and leaves scars on the back, but a nice-shaped breast can be achieved.
  • Flap Surgery:  Tissue can also be transferred from the lower abdomen (TRAM or DIEP flaps) to make a new breast. As enough volume can usually be obtained with this procedure, an implant is not necessary. In general, the tissue is transferred with the use of microsurgery. This is a longer and more complicated operation that the other two detailed above, but it has a number of advantages:
    • No implant is used, so once everything is healed no further surgery is needed. (In some cases with breast implants, another operation may be necessary years later).
    • Transfer of tissue from the abdomen can lead to an improved appearance, like a “tummy tuck”.

Team

Breast Reconstruction Surgeons

In general, the patient will meet one of the surgeons in the Plastic Surgery Outpatient Clinic or on the ward. Following their surgery, they will be cared for by the plastic surgeon and their team on the ward. Follow-up is in the plastic surgery clinic.

Clinic Times

Day

Consultant Name

Type

Time

Contact

Weekly

 

Seven clinics per week

 

 

 

 

Nine main operating theatre lists

 

 

 

 

Ten surgical day ward lists

 

 

 

 

Full melanoma Service including Sentinel node biopsy and lymph node dissections

 

 

 

 

Post Moh’s reconstructions

 

 

Support

The breast cancer nurses are available on a daily basis for support. Members of the plastic surgery team are available 24 hours a day if required at 01 4103000.