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Summary of Breast Reconstruction

  • COST:

    OHIP Covered

  • SURGERY LENGTH:

    1- 6 hours

  • ANESTHESIA:
    General Anesthetic

Breast Reconstruction After Cancer

You don’t have to ‘just survive’ Breast Cancer to get your body back.

Breast Reconstruction re-creates a breast shape, to help you restore your mind and body after your battle with cancer. It is an important component of breast cancer care, leading to improved self-esteem and body image, which then actually translate to better survival. We offer patients implant-based breast reconstruction, pedicled flap reconstruction, and even new reconstructive surgeries known as single stage implant reconstruction procedures.

Why a Breast Reconstruction Procedure?

Whether you have had a mastectomy, or have had a lumpectomy or a segmental mastectomy, reconstructive breast surgery can help you not only regain your shape, but your self-confidence as well. Breast reconstruction offers women:

  • A balanced chest appearance when wearing a swimsuit or bra
  • An opportunity to regain the shape of their breast
  • The ability to avoid using a form or other external prosthetic device that fits inside the bra

A Story Of Three Women Who Underwent Breast Reconstruction

Breast Reconstruction Awareness

Breast cancer is one of the most common cancers in women and affects about 11% of Canadian women. For women who require a mastectomy, a breast reconstruction helps to restore their body image, self-esteem and has been shown to improve survival rates. Breast cancer reconstruction helps to close the loop on breast cancer.

90% of mastectomy patients never get breast reconstruction after breast cancer because they either do not know that this is available to them or do not realize that this is a service that is OHIP covered.

Every year, the second Wednesday in October is BRA Day, an initiative to increase awareness of Breast Reconstruction options available to breast cancer patients. Our clinic has been participating in this effort since it was started in 2011 by Dr. Mitch Brown, a Toronto-based Plastic Surgeon.

Breast Reconstruction Awareness

Breast cancer reconstruction rebuilds a woman’s breast after mastectomy.
This can be performed at the time of the mastectomy or at a later time.

  • mastectomy
  • mastectomy

What is Reconstructive Surgery?

Breast cancer is the most common form of cancer for women. To treat this disease, there are many different routes a patient may take. Some patients may undergo only a lumpectomy (removal of the tumor alone), while others need to have the entire breast removed (mastectomy). There are also some patients who have a known family history or are known to have a BRCA gene mutation, and these women may choose to have their breasts removed (prophylactic mastectomy) to minimize their risk of developing breast cancer. After any of these surgeries, a breast reconstruction can take place. Breast reconstruction helps to restore body image, self-esteem and has even been shown to improve survival rates.

Reconstructive Surgery deals with reconstructing shape and function which may be abnormal due to inborn errors, injury, or disease. The aim of reconstructive surgery is to allow patients to look and function as normally as possible.

Dr. Jugenburg has sub-specialization in cancer reconstruction, and has trained at the world-renowned Memorial Sloan-Kettering Cancer Centre in Manhattan. Dr. Jugenburg is offering patients implant-based breast reconstruction, pedicled flap reconstruction, and new advances in reconstructive surgery such as single stage implant reconstruction procedures.

Breast cancer is one of the most common types of cancer that women get. There are various subtypes of breast cancer, and various forms of treatment. Some patients may undergo only a lumpectomy (removal of the tumor alone), while others need to have the entire breast removed (mastectomy). After this breast surgery reconstruction can be done. There are also those women who have a known family history or are known to have a BRCA gene mutation, and these women may choose to have their breasts removed (prophylactic mastectomy) to minimize their risk of developing breast cancer.

Reconstructive Surgery Following Mastectomy

For women who have had all or a portion of a breast removed due to cancer, an option they can consider is breast reconstruction surgery. Rebuilding and reshaping the look of the breast following surgery is common, and there are many new and improved surgical options available to women today.

Are You a Candidate
for Breast Reconstruction

Breast reconstruction can be done or started immediately at the time of the mastectomy (immediate reconstruction), or at a time after the mastectomy (delayed reconstruction). The delayed breast reconstruction is usually performed for women who will need radiation after the mastectomy, as radiation given after breast reconstruction can cause delayed healing and scarring.

There are other factors that can play into the decision to have reconstructive breast surgery, including:

  • Your health
  • The type and stage of your breast cancer
  • The amount of donor tissue you have available; women who are extremely thin may not have enough extra tissue to enable a flap graft
  • The type of surgery you are planning
  • The size of the implant or reconstructed breast

Some women prefer not to have to make the decision about reconstruction while dealing with the breast cancer diagnosis. If you find that you are in the same situation, it is probably best to wait until after the breast cancer surgery is completed to make decisions about reconstruction.

However, the more you know about the reconstruction options available to you before a mastectomy can help you approach your surgery with a more realistic outlook about the outcome. It is best to discuss your concerns with your surgeon at the time of your consultation.

Types of Breast Reconstruction Surgery

There are several different types of surgery used to reconstruct the breast. These include using a breast implant, and your own tissue flap using a section of your own skin, fat and even muscle taken from your stomach, back or other area of your body, or a combination of the two.

Implants

There are a variety of breast implants that are available to be used for breast reconstruction. Saline filled implants as well as silicone implants can be used. The newest silicone (gel) implants with thicker cohesive gel, which are often called “gummy bear” implants are prefered because of their texture. There are also different types of implant surgery, including:

One-stage,

or immediate breast reconstruction is performed at the same time as the mastectomy. This may require extra support to hold the implant in place. Unlike traditional tissue expanders, there are new, single stage breast implants that can be left in place and expanded, without having to remove them during another surgery. This procedure uses Alloderm, a substance that acts as a muscle substitute to provide coverage over the implant.

Two-stage,

or delayed reconstruction is the most often used procedure. It involves an implanted tissue expander that helps stretch the skin and muscle, which is removed and replaced with an implant during a second surgery at a later time.

Tissue Flap Procedures

Women who have sufficient excess skin and fat can have breast reconstruction using their own tissues. These skin flaps are used to recreate the breast as it was before the cancer. There are several different types of flap procedures, including:

TRAM Flap Breast Reconstruction

The Transverse Rectus Abdominis Myocutaneous flap (TRAM), uses belly skin, fat and muscle to reconstruct the breast. This procedure is used in order to have visible breast symmetry when unclothed. However, using the rectus (six-pack muscle) does create additional risks, including, hernia, abdominal bulge and weakness. In addition, this procedure requires significant recovery time.

DIEP Flap Breast Reconstruction

This is a variation of the TRAM flap that eliminates using the rectus muscle. This is a skin transplant, and includes blood vessels. It requires microsurgery, and includes the risk of total flap failure.

Latissimus Flap Breast Reconstruction

This procedure uses the latissimus back muscle to reconstruct the breast. Because the back has less fat than the abdomen, the latissimus flap reconstruction usually requires a breast implant to achieve aesthetic results.

TUG Flap Breast Reconstruction

This is a newer alternative to the TRAM or DIEP flap surgery that utilizes fatty tissue and muscle from the bottom fold of the buttock that extends to the inner thigh. It requires microscopic surgery as it utilizes skin, muscle and blood vessels.

Gluteal Flap Breast Reconstruction

Using a flap from the gluteal area of the buttocks to reconstruct a breast is a complicated procedure and is considered the last resort for reconstructive surgery.

This is a patient who underwent a bilateral mastectomy. She was not aware of breast reconstruction options at that time. Only after the mastectomy she learned about her reconstruction options, and underwent delayed breast reconstruction using breast implants.

This patient underwent a mastectomy and immediate reconstruction. She is seen after bilateral breast reconstruction using implants. She also underwent a nipple reconstruction, and tattoo of the areola.

To see more before and after images of Breast Cancer Reconstruction

MORE BEFORE AND AFTER GALLERY

What to Expect Following
Breast Reconstruction

Breast reconstruction is a remarkable procedure to rebuild your breast following mastectomy. Results vary by individual and by procedure, but there are some things you should know about breast reconstruction:

  • A reconstructed breast will not have the same sensation as the original breast

  • You will always have visible incision lines on the breast, whether from reconstruction or from the mastectomy

  • Certain surgical techniques will leave incision lines at the donor site, usually located in less exposed areas like the back, abdomen or buttocks

  • If only one breast is involved, it can be reconstructed. But you may consider a breast lift, reduction or augmentation for the opposite breast in order to improve symmetry in size and position of both breasts.

When it comes to breast reconstruction, each patient has a unique set of circumstances and needs. A consultation with a surgeon will provide you with the opportunity to discuss your options, answers and questions you have and learn how breast reconstruction will help you go on living your life, and not just surviving cancer.

This patient had breast cancer on both sides, requiring both breasts to be removed. She underwent reconstruction of both breasts with implants, and nipple reconstruction 3 months later. She is now 8 months after her reconstruction.

Nipple Reconstruction
Nipple Reconstruction

Nipple Reconstruction

Once the breast has been recreated (the breast mound), women can choose to have the nipple and areola reconstructed as well. This usually takes place some time after the breast mound re-creation in order to allow the newly reconstructed breast to settle in before the nipple/areola are planned. The nipple is created by using the existing breast tissue and wrapping it together into a small ball of tissue. The areola is recreated by either using a skin graft, a tattoo, or both.

Breast Reconstruction Advocacy

Breast cancer is one of the most common cancers in women and affects about 11% of Canadian women. For women who require a mastectomy, a breast reconstruction helps to restore their body image, self-esteem and has been shown to improve survival rates. Breast cancer reconstruction helps to close the loop on breast cancer.

90% of mastectomy patients never get breast reconstruction after breast cancer because they either do not know that this is available to them or do not realize that this is a service that is OHIP covered. Our team at TCSI would like this number to decrease dramatically. Women shouldn’t just survive breast cancer. With breast reconstruction you can go on living, not just surviving.

Breast Reconstruction Advocacy

BRA DAY event at the Humber River Regional Hospital where our team spent a day educating patients about breast cancer reconstruction options. Increasing awareness is crucial as so many women go on without realizing that they have the option of breast reconstruction available to them.

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