Mastectomy With Breast Reconstruction

Breast reconstruction is surgery to ‘recreate’ a breast using one's own body tissue or implant after mastectomy. It provides the breast shape, but has no natural feeling.

Immediate breast reconstruction is when reconstruction is done at the time of mastectomy.
- Skin-sparing mastectomy is where most of the skin of the breast will be preserved.
- Nipple-sparing mastectomy is considered for suitable cases, where the nipple may be preserved if tissue from the base of the nipple shows no cancer cells when tested at the time of surgery. However, if the final histology results show cancer cells behind the nipple, a simple surgery to remove the nipple will be recommended.
Delayed breast reconstruction may also be done at a later stage, separate from the initial breast surgery.

Types of Post-Mastectomy Reconstructions

i. Flap reconstructions

Skin, fat and sometimes muscle (a flap) from another part of your body may be used to make into a breast shape. This operation takes about 6 to 8 hours and requires a hospital stay of between 1 to 2 weeks. Several drains are used and removed after 1 to 2 weeks. Flaps may be from the following areas:

Back (latissimus dorsi)
Buttock
Thigh
Abdomen
- TRAM (transverse rectus abdominis myocutaneous) flap
- DIEP (deep inferior epigastric perforator) flap, taking skin and fat only

Additional procedures to improve the look of the breast after the initial surgery may include adding a nipple, surgery to the opposite breast to create a good match, or refining the shape of the recreated breast.

ii. Breast implants

Silicone implants may be used to create a new breast and the operation takes about 4 to 5 hours. There are usually 2 to 3 drains inserted and the hospital stay is 2 to 5 days.

A 1-stage procedure is when the permanent implant is inserted at the time of mastectomy.

A 2-stage procedure is when a temporary expander is placed at the time of mastectomy and gradually expanded to stretch the skin. The expander will be exchanged for a permanent implant at a later surgery.

The expander will be exchanged for a permanent implant at a later surgery.