Breast Reconstruction

What you need to know about Breast Reconstruction

At Avenue Plastic Surgery, we offer an individualised approach to bilateral mastectomy and breast reconstruction. If you believe you are a suitable candidate for either procedure, it’s important you have as much information as possible at hand. At Avenue Plastic Surgery, we ensure all our current and prospective patients are as informed as possible before undertaking any of our procedures. Call us now to book a consultation with one of our experienced surgeons. Before you book, find out whether bilateral mastectomy or breast reconstruction is right for you by considering these important questions.

Have you been told that you are at high risk of developing breast cancer?
If you are a high risk for developing breast cancer, e.g. if you have a strong family history or have tested positive for one of the BRACA genes, then our aim is to provide you with both peace of mind and an excellent aesthetic result.

What are your options?
Women who face a high risk of developing breast cancer may consider having a prophylactic mastectomy, which is a preventative surgery that removes one or both breasts to reduce the risk of developing breast cancer. Although we are aware that many surgeons are currently performing “nipple sparing mastectomy” for at-risk women, we have personally seen DCIS (pre-invasive cancer) occur in nipple tissue after it was removed as part of a risk-reducing mastectomy.

What is the safest option for risk-reducing mastectomy? We have developed a procedure that we believe is the safest option for a risk-reducing mastectomy.  We perform a total glandular mastectomy with nipple removal and fat preservation. Our MRI studies have revealed that, in women with larger breasts, there is a significant amount of fat quite separate from the mammary gland. Using MRI guidance, we are able to perform a total glandular mastectomy (including the nipple), while preserving the fat and then using this fat to reconstruct the breast. This can be performed as a double or bilateral prophylactic mastectomy, whereby both breasts are removed.

Can the nipple be reconstructed?
Yes, excellent techniques are now available for nipple reconstruction, which can be performed once the reconstructed breast has healed. A nipple reconstruction involves a small incision being made at the site of the nipple, with the skin then being raised into a nipple shape to create the appearance of a natural nipple. The areola is then recreated by tattooing. The final result mimics the appearance of a natural nipple and areola.

How is this similar to a breast reduction?
In a breast reduction, we retain the central glandular part of the breast (including the nipple) and remove all the excess fatty tissue.  In a total glandular mastectomy with fat preservation, we remove the entire central glandular part of the breast and use the surrounding fat to reconstruct the breast. The operation becomes much like a breast reduction except that the entire breast gland has been removed.  In most cases, the appearance of the breast is actually improved following this procedure.

Can it be done as a Day Case?
Yes, definitely!

What if I have a small breast?
For women with smaller breasts requiring risk-reducing mastectomy, we are able to use our highly successful fat grafting procedure (with or without an implant) in order to produce a natural looking breast.

What if I have already had a mastectomy?
Fat grafting, with or without an implant, is also performed for women who have already had a mastectomy.

What is the benefit of this type of surgery?
Using these procedures, we are able to avoid the far riskier TRAM flap and DIEP flap operations for breast reconstruction. In many cases, this procedure also results in a more aesthetically pleasing breast than the original.

Which women are at high risk of breast cancer?

Women with a strong family history of breast cancer and women who have been diagnosed with a cancer pre-disposition gene such as BRACA1 or BRAC2 have a high lifetime risk of breast cancer. The risk of breast cancer by the age of 70 years is 65% for BRACA1 carriers and 45% for BRACA2 carriers.

The risk of ovarian cancer by the age of 70 years is 39% for BRACA1 carriers and 11% for BRACA2 carriers. Mutation carriers are at increased risk of breast cancer even in their 30s, but the risk of ovarian cancer does not increase above that of the general population until the age of 40 for BRACA1 carriers and 50 for BRACA2 carriers.

How can the risk be managed?

The decision on how to manage risk is personal and will depend on many factors including your age, family responsibilities, body image and your level of anxiety. Total glandular mastectomy with fat preservation or fat grafting (with or without an implant) can, in many instances, produce a more attractive breast than the original and can be a useful alternative to a lifetime of screening. For many women it is far preferable than other forms of mastectomy and reconstruction.

*Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.