Common Questions about Breast Reconstruction

Delving into the realm of breast reconstruction, this article covers the most common questions our patients ask about breast reconstruction.

Broadly there are three main types of reconstruction options:

1. Implant-based reconstruction – this is either the insertion of implants or tissue expanders to produce a breast mound
2. Autologous breast reconstruction – this is using DIEP or muscle-sparing TRAM flaps to use your own tummy tissue to create one or both breasts.
3. Autologous and implant reconstruction – this mix and match approach is reserved for patients who have insufficient of their own tissue to create a complete breast reconstruction and also cannot have implants alone due to the risk of complications (such as in radiotherapy). These patients may be suitable for procedures such as latissimus dorsi muscle flap and an implant.

1. Can you sleep on your stomach after breast reconstruction?

This depends on whether own tissue or implants have been used for breast reconstruction.

After a DIEP flap – most of the wounds have healed within 2-3 weeks. It does take around 3 months for flaps to settle with respect to swelling and you are best to wait this time before sleeping on your chest.

After an implant reconstruction – just like any other implants these can move from the pressure of sleeping on your stomach. If these were inserted at the time of mastectomy, you will usually have drains in place. In general, we suggest waiting at least 3 months beyond the time of drain removal before you sleep on your stomach/chest. This is the same recovery times you have to wait before commencing upper body exercise after an implant breast reconstruction.

2. How long does breast reconstruction take?

The longest breast reconstruction operation is also the best which is the DIEP flap. DIEP stands for ‘deep inferior epigastric perforator’, which is the name for an artery that runs through the abdomen and where part of the body is taken to do the reconstruction.

The DIEP flap is the Rolls Royce of the Australian Society of Plastic Surgeon breast reconstructions. This is because it uses your own tissue, produces a breast that feels like your own, is permanent that cannot break/rupture/ripple, grows with you with respect to weight gain and weight loss, and also mimics the natural ptosis of breasts with time.

How long does a DIEP flap surgery take?

– For one-sided breast reconstruction with mastectomy – 6-8 hours

– For a bilateral breast reconstruction with mastectomy – 8 to 10 hours

– For one-sided reconstruction without mastectomy – 4-6 hours

– For bilateral breast reconstruction without mastectomy – 6 to 8 hours.

Implant-based breast reconstruction

– For one-sided breast reconstruction with mastectomy – 2 hours

– For a bilateral breast reconstruction with mastectomy – 4 hours

For one-sided reconstruction without mastectomy:

This will usually involve insertion of breast expanders which takes 1-1.5 hours, but there will be a second stage involving exchange to implants. The length of the second operation depends on if the opposite breast needs surgery in the form of a lift or reduction to match the reconstructed breast. Between the two operations, there are visits to the office to place saline in the expanders to fill the expanders.

For bilateral breast reconstruction without mastectomy – 2 to 3 hours. This will usually involve insertion of breast expanders and there will be a second stage involving exchange to implants which will also take around 2 hours. Between the two operations, there are visits to the office to place saline in the expanders to fill the expanders.

Latissimus dorsi breast reconstruction

– The side of reconstruction takes 4-6 hours with mastectomy and 2-4 hours without mastectomy.

3. How much is breast reconstruction surgery?

This surgery is offered as a private patient in a private hospital, and as a public patient in the public hospital. For patients without insurance, they can elect to be private patients in a public hospital to reduce their out of pocket costs.

Benefits of a private patient include:

• The convenience of selecting the time of surgery that suits you.
• Direct relationship with breast and plastic surgeon as they manage all your care.
• The procedure is entirely performed by the specialist surgeon of your choosing.
• The follow up is with the surgeon(s) that performed your surgery.

Downsides of a private patient include:

• Mainly the out of pocket cost.

Benefits of a public patient include:

• Cost-free if you are covered by Medicare.

Downsides of a public patient include:

• The inflexibility of time – public hospital lists are by number fewer and booked long in advance with urgent surgeries.
• If you need a mastectomy as well as reconstruction it can be difficult to coordinate the surgeons within the public hospital – and may mean a slight delay.
• Your surgery is performed by training plastic surgeons under the supervision of a specialist plastic surgeon.
• The standard of care is excellent but it is a personal preference if you wish only the senior surgeon to perform the key steps of surgery.
• The inpatient and follow up care is delivered by the registrars and the public hospital.

You will be provided with a quote for a tummy tuck surgery, indicating total and out of pocket expenses, after your consultation. If any complications occur, no further out of pocket costs are incurred, even if this means further surgery.  There is no cost associated with breast reconstruction as a public patient in the public hospital. The out of pocket cost of implant-based reconstruction in the private hospital varies, depending on single versus both side reconstruction, and if the opposite breast needs surgery (in the case of single-sided reconstruction).

4. Is breast reconstruction surgery painful?

In general the larger the surgery the more painful it is – however, we take extensive measures to ensure patients are comfortable and mobile on the first day post surgery.

DIEP flap reconstruction involves surgery on both the breast and the tummy. It is the tummy surgery that slows you down due to the tissue is taken, the long scar and the muscle tightening under the skin. You wake up with your back up, legs bent and need to walk hunched over to protect the scar tissue. We use an extensive amount of local anaesthetic during the surgery, use pain pumps, and the anaesthetist uses excellent pain relief during and after surgery. Most of our patients remark how little pain they had (compared to what they expected) and are out of bed the first postoperative day.

Implant reconstruction, on the other hand, is more straight forward as it only involves the chest – there is no second site that has been operated on, and it does not slow you down like a DIEP flap that involves surgery on the tummy. However patients often expect less pain than they experience as they think this is minor surgery – it is not. The mastectomy alone is uncomfortable and to place implants or expanders at the same time we need to divide a part of the pectoralis major muscle which is painful. We then use a hammock or a sling of tissue called ADM to hold the implant in the correct position – the stitches are placed to the underlying chest wall or ribs and this can also be painful. Again we use a lot of adequate pain relief to make sure you are comfortable postoperatively.

5. Should I have breast reconstruction after mastectomy?

This is an individual decision but we do recommend that you research it and read up about it. This is because while you may have survived breast cancer and left it in the past it is the aftermath with which you have to face life every day.

Women after mastectomy can be left like completely flat chested:

While this may be a cancer-free achievement this person has a constant reminder of the horrible disease she suffered.

Patients, therefore, seek reconstruction to restore their femininity and body image, restore their self-esteem and confidence, feel socially accepted, have some positivity at the end of a cancer journey and minimise stigma.

Breast reconstruction can achieve all these aims and produce an excellent appearance for patients in clothing and often out of clothing as well.

6. Does Medicare cover breast reconstruction?

Yes, Medicare and Health Funds partially cover the cost of breast reconstruction.

There are Medicare item numbers applicable to both own tissue and implant breast reconstruction.

With appropriate health cover, all private hospital fees will be covered by the health funds, and a rebate available for surgeon and anaesthetist fees. This does mean that there is an out of pocket cost associated with being a private patient in a private hospital however this is far less than the actual total cost of surgery, and it would have cost prohibitive without private health insurance to undertake this in a private hospital.

Patients covered by Medicare can also be public patients in a public hospital with no out of pocket costs.

Dr Shagun Aggarwal is a cosmetic and reconstructive Specialist Plastic Surgeon based on the North Shore, Sydney,  and at 2 prestigious public hospitals in Sydney – Prince of Wales and Royal Prince Alfred Hospitals. Dr Aggarwal is passionate about breast reconstruction and a sub-specialist in this field. In fact he pursued two international premier breast reconstruction fellowships overseas – the first at the University of Toronto, and the second in microsurgery at the University of Pennsylvania.

Currently, Dr Aggarwal performs breast reconstruction regularly at the Sydney Adventist Hospital, Chris O’Brien Lifehouse and he was specifically employed by the Royal Hospital for Women as a specialist breast reconstruction surgeon for the Prince of Wales Campus.

2024 Beauty Trends: Your Guide to Natural Results

In 2024 we’re noticing a change in individual goals. We’re seeing a shift towards anti-ageing treatments on a natural scale.

Beautiful skin is the key.

Our patients are wanting a youthful, volumized appearance whilst still looking like themselves.

We’re seeing a very heavy focus on collagen stimulating treatments and individuals

starting to think about managing the ageing process from a younger age.

It’s All About Collagen

Collagen is a key structural element within the skin that is responsible for strength, structure and firmness of the skin. With the ageing process, the skin loses collagen sources which causes sagging, loss of elasticity and an increase in visible lines and wrinkles. Bioremodellers and biostimulators and energy based devices have been found to increase collagen production within the skin. Our aim is naturally lifted and hydrated skin.

Biostimulators

Biostimulators work to produce natural volume to the skin, resulting in a more plump and youthful appearance to the skin. It’s a popular treatment for those who don’t want filler.

Biostimulators are ideal for those wanting natural skin tightening and to address volume loss.

It works by targeting collagen and elastin production and supporting facial structures. It achieves a more lifted appearance and tighter skin quality. Optimal results are achieved by completing 2-3 sessions every 6-8 weeks. Results last up to two years, however we recommend yearly maintenance.

At Home Collagen Stimulation

We recommend the power product, C-E Ferulic for maximal Collagen stimulation at home.

SkinCeuticals’ C E Ferulic is a high potency serum with a combination of powerful antioxidants to protect skin against atmospheric ageing. 15% pure vitamin C (L-ascorbic acid), 1% vitamin E (alpha tocopherol), and 0.5% ferulic acid work in combination to protect against environmental damage and premature signs of ageing caused by free radical damage from UV rays, infrared radiation (IRA), and ozone pollution (O3).

In addition to the benefits of these powerful antioxidants, C E Ferulic can help fight the signs of ageing by improving the appearance of fine lines and wrinkles, and skin laxity that comes with age, while brightening complexion for more radiant looking skin.

Sydney Breast Reconstruction – Implant or DIEP flap – North Shore Plastic Surgeon

Breast reconstruction is a procedure that is carried out to restore breast shape and replace breast tissue that is lost during a mastectomy or lumpectomy.

The aim is to achieve an excellent shape, volume and symmetry so that a patient feels feminine, regains their confidence, and as much as possible has less of a reminder of the cancer treatment they had to undergo. The goal is to create breasts that look symmetrical, close to the original appearance and shape, and as natural as possible.

Whether or not a breast reconstruction is performed depends on several factors: your personal decision, your physical condition and the treatment you have had for the breast cancer including previous radiation. It is important that you understand every option available for breast reconstruction.

Having the right information as a starting point for a full and frank discussion with your surgeon can help you in the journey to reconstruction.

It is important that you consider the risks and the benefits of each procedure, in order to reach a decision that is beneficial for your medical prognosis, your physical and mental health, and your personal circumstances.

While cost should not be your primary driver, different procedures have different costs. You should discuss in detail with your surgeon the different techniques and implants available, and their respective pros and cons, as well as the options that are covered by your health insurance.

The benefits of breast reconstruction

Different reasons may motivate you to decide for or against reconstruction. The benefits of a reconstructed breast may include:

• Increased self-confidence and self-esteem
• A way to cope with breast cancer
• An improved symmetry of your breast
• Avoiding the choice between external prostheses or a flat chest

Disadvantages of Breast Reconstruction

There are several disadvantages and problems that may occur with breast reconstruction that need to be taken into account before making a decision to go ahead:

• Not all breast reconstruction procedures are a total success, and the result might not look like you expected. Breast reconstruction for example is a lot more challenging post radiation.
• Additional corrective surgeries may be necessary and the revision rate is higher than in augmentation breast surgery
• Surgery will leave scars on your breast and, in case of autologous reconstruction, in any areas tissue was taken from to create your new breast
• A reconstructed breast may not feel the same as a natural breast (however own tissue reconstruction comes very close)
• In order to achieve symmetry between the reconstructed breast and the healthy one, reduction/lift or enlargement of the latter may be necessary

The length of time you’ll spend in a hospital after surgery depends on what kind of breast reconstruction you choose.

You have two broad options:

Implant Breast Reconstruction Sydney

Implant surgery typically takes place after a mastectomy is performed to remove the breast tumour and surrounding tissue. In a few patients the final implants may be able to be used at the time of mastectomy, whilst in others a temporary device called an expander is used which is then changed over to a permanent silicone prosthesis at a second surgery. Those who have implant surgery are usually discharged after 3 to 5 days, but there is usually a need for drains post mastectomy and reconstruction which may still be in place on discharge.

DIEP flap or Free Flap Reconstruction Sydney

A free flap reconstruction is a little bit more complex of an operation than the implant surgery is. With this procedure, the tissue is taken from other parts of your body, like the abdomen. Patients are usually discharged seven days after the procedure.

While free flap reconstruction surgeries may be more complex, they are nothing to be afraid of, especially at Mode Plastic Surgery. Dr Aggarwal specialise in this type of breast reconstruction and has performed numerous DIEP free flap reconstructions for our patients. These can provide patients with a look of having had a tummy tuck, and using the tissue in the abdomen to reconstruct a breast that looks (and feels!) very natural.

Both reconstructive surgeries have their pros and cons, so it’s important to talk with your surgeon about which option is best for you.

Common Questions about Breast Reconstruction Surgery

1. When can I have sex?

You shouldn’t have sex for at least one or two weeks after surgery. You’ll want to give your body some time to recover. After that, you can have sex whenever you feel physically and emotionally ready. It’s normal to feel nervous, unsure, or self-conscious in the beginning.

2. Will breast reconstruction change my risk of cancer recurrence?

No. Studies have shown that breast reconstruction does not change the risk of breast cancer recurrence either in the breast or in other locations in the body. Breast reconstruction also does not delay a diagnosis of breast cancer recurrence or change its treatment.

There is always some risk that your cancer could return, though. It could come back in the same area as your original cancer (local recurrence), in the nearby lymph nodes (regional recurrence), or in farther-away areas (distant recurrence). The good news is there are many strategies that can reduce your risk of a breast cancer recurrence. A few of these include:

• hormone therapy
• chemotherapy
• radiation therapy
• targeted therapy
• maintaining a healthy weight
• exercising
• eating a healthy diet

Usually, your breast surgeon in conjunction with other members of the team such as medical or radiation oncologists will determine the best course of treatment for you. They will usually also ask you to see them long term for ongoing cancer surveillance.

3. How will I feel in six months? In a year? Five years?

Every woman’s breast reconstruction experience is unique. Right after surgery, you may have tenderness, numbness, and twinges of pain. These sensations usually come and go, and often decrease within the first few months after surgery. However, some may last months, even one year or longer. This is because the nerves are the slowest part of your body to heal.

As you continue to heal, you may feel scar tissue begin to form, which will feel hard. This is common and will most likely soften over the next several months. It takes at least one year, sometimes longer, for all your tissue to fully heal and your scars to fade. You may go through a period of emotional adjustment, too. If you have any concerns about your physical or emotional health during your recovery, Mode Plastic Surgery Team is here for you and has a variety of resources to help you.

4. When can I drive again?

Many women can drive two to three weeks after surgery. Depending on your reconstruction, you’ll probably be on a narcotic pain reliever for the first week after surgery. If you’ve had flap reconstruction, you may need this medicine for a few days more than if you’ve had tissue expanders or implants. Don’t drive while you take this type of medicine, which can make you drowsy. Also, don’t drive until:

• your drain(s) have been removed
• you have recovered your full range of motion
• you can comfortably turn the steering wheel

If you have questions about when it’s safe for you to drive, talk with your surgeon.

5. When will I feel less exhausted?

Fatigue is common after breast cancer surgery. After all, your body has been through a lot. Be patient with yourself as you recover, but also tell your doctor if you’re concerned about your fatigue. It may be normal, or it may be a sign of underlying factors, such as depression, insomnia, or anaemia.

6. When can I pick up my kids?

This depends on the type of reconstruction you’ve had. Regardless of surgery type, you shouldn’t lift anything heavier than five kilograms — including your kids — until your doctor says it’s safe. This is usually about six weeks for people who have tissue-transfer reconstruction and four to six weeks for people who have surgery with tissue expanders or implants. If you can, plan ahead for childcare for young kids.

7. When can I exercise?

You’ll need to avoid strenuous activities, such as jogging and tennis, until your doctor tells you it’s safe. Your physical therapist will give you written instructions on what exercises and movements you can do while your incisions are healing. Talk with your doctor or nurse before starting any exercises outside these prescribed moves. If you’re having discomfort, you may find it helpful to take some pain medication 30 minutes before starting exercise.

8. If I have restrictions that limit physical activity, can I obtain a letter to suspend my gym membership?

Yes. If you’ve had reconstruction, our office can provide you with this letter for the duration of your recovery or restriction period. If you have not had reconstruction, contact your breast surgeon’s office.

9. Who removes my drains?

If you’ve had any type of reconstruction, our plastic surgery nurse usually removes the drains when they meet the criteria to come out. You do not need to see your plastic surgeon for drain removal although they will usually regularly review you and be responsible for making the decision as to whether a drain is ready to come out.

10. Whose office should I follow up with to schedule my routine mammogram?

Your breast surgeon should schedule your routine mammograms.

11. When should I schedule a breast reconstruction surgery consultation to discuss next steps?

If you have any questions or are interested in booking in a consultation with a specialist plastic surgeon who specialises in breast reconstruction, get in touch with us today.