- What Is Breast Reconstruction?
- Who is a candidate?
- What are the potential risks?
- Smoking and Surgery
What Is Breast Reconstruction?
A breast reconstruction is a procedure designed to reproduce a breast after a mastectomy operation. It either involves the placement of an implant filled with either silicone or saline behind a layer of tissue taken from elsewhere on the body, or reconstructing the breast totally from fat and tissue donated by another area of the patient’s body (the abdomen is the preferred option – similar to a tummy tuck procedure). It is performed under general anaesthetic, in some cases at the same time as the mastectomy, but generally as a separate procedure requiring hospitalisation for 1 – 7 days.
Who Is A Candidate?
Women who have had, or are having, a mastectomy are possible candidates for a breast reconstruction. Dr Layt works with Breast Cancer Surgeons and General Surgeons and will evaluate each persons individual situation in order to recommend the best possible reconstruction to undertake. Breast Cancer is a complex situation and in certain cases, the reconstruction may be required to be undertaken after a period of time after the initial surgery and treatments. In other cases, a reconstruction may be suitable at the time of mastectomy. Dr Craig Layt will explain the various procedures to you and make a recommendation as to what is your best option. Pre and post operative considerations are quite different depending on the procedure.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified practitioner.
Breast Reconstruction Photos
These before and after photos are of patients that have had surgery performed by Dr Layt. These patients have consented to the photos being shown. These are actual photos and have not been altered or digitally enhanced. Every patient is an individual and therefore final surgical results will vary from patient to patient.
What are the potential risks?
Risks and Complications
Surgery is not an exact science. Incisions and scars are part of any surgery and the location and extent of the incisions will be discussed with you. Every effort is made by the surgeon to minimise scarring. Scars will fade over time, but they are permanent. They can also become hypertrophic or keloid. Scars vary from person to person and are related to each individual’s skin type, genetics and the ability of their skin to heal.
Every surgical procedure involves certain risks and complications (as per the ASPS brochure) including, but not limited to:
Asymmetry is evident physically in every person. No two sides of the body are ever exactly symmetrical in shape, position or size and the surgeon will make every effort to achieve as close to symmetry as possible but some asymmetry is normal.
Delayed Healing, Infection and Suture Reactions can all be possible healing issues and may require antibiotics or in some cases surgical exploration.
Bleeding, Haematoma or Seroma Collections may resolve themselves but, in some cases may require further surgery.
Loss of Sensation and Numbness may also be experienced. In most cases this will improve over time on its own. In some cases this can be permanent.
Bruising and Swelling may also be a short term effect from surgery and will usually settle in one to two weeks.
Allergies to dressings, medical lotions, sutures or other materials can occur with some patients. You will be advised to cease the use of the dressing, lotion or material that is causing the reaction. In some cases anti-inflammatory medication may be prescribed.
Breathing Difficulties may be due to a general anaesthetic or breathing tube during the operation which has caused some swelling, noisy breathing or discomfort.
Blood Clots can also occur in some surgeries and may require urgent treatment and hospitalisation.
Pain thresholds vary from patient to patient. This may lead to different pain management and/or different recovery times to resume normal activities.
Achieving excellent results with minimal risk is a joint effort. It is important to disclosed to the surgeon and clinic and understand the following:
Full disclosure of your medical history including: allergies, personal, physical and mental history, previous surgeries, current medications and co-morbidities (including but not limited to, smoking, vaping, diabetes, prescription and illegal drug addictions, blood or heart disease, obesity or anorexia).
Co-morbidities may impact on outcome and healing post surgery.
Smoking, vaping, or taking recreational drugs must be ceased in the 6 weeks prior to some operations and during the healing phase. Failure to do so may increase the risk of complications, decrease your healing ability and affect your surgical outcome.
You should not take aspirin based prescription drugs 14 days prior to surgery and during the healing phase of the operation unless advised otherwise by the surgeon.
As per the Australian Health Practitioner Regulation Agency (AHPRA), all non-rebatable (cosmetic) procedures require a validated screening of Body Dysmorphia to be undertaken.
If Dr Layt is concerned about your mental state or physical state prior to the procedure, he may request evaluation by a psychologist, psychiatrist, general practitioner or other specialist. This referral is to assess your suitability, increased risks during surgery or any underlying physical or psychological problems which may affect your recovery or mental health.
In some cases this may require surgery to be postponed or cancelled by the doctor in his primary role to consider your care and personal well-being.
Complications with Breast Implants
Pregnancy may cause breast enlargement, cause the breast tissue to stretch, and a degree of ‘drooping’ of the breast tissue. This may require the breast to be surgically lifted; however, some poor skin integrity may have a tendency to stretch and continue to ‘drop’.
Capsular Contracture (less than 1%) occurs when the scar surrounding the implant thickens and tightens around the implant. This can make it feel hard, look unnatural, feel uncomfortable and may occur months to years later. Should this occur, a capsulectomy and a remove and replacement of implant/s may be required in the future.
Implant Rupture can occur after injury or years of repetitive action in the same part of the implant. MRI is the gold standard to assess this as Ultrasound shows a false positive reporting for rupture in approximately 30% of cases. A ruptured or leaking implant will require surgery of removal and replacement of the implant.
Implant ‘Wrinkles’ and Palpability can also be noticed. All implants ripple to a degree. If there is reasonable tissue coverage this will not be noticeable. If there is little overlying breast tissue and fat this is more likely.
Anaplastic Large Cell Lymphoma (ALCL) is a rare tumour of lymphoid cells in the breast which has recently been found to have an increased incidence in patients with textured breast implants. ALCL relates to a patients genetics, a textured implant and bacteria being present. This may present as a unilateral swelling of a breast due to fluid accumulation. When detected early, this is treated by removing the fluid and the implant. Dr Layt has and continues to perform this procedure utilising the 14 point plan to minimise the risks of ALCL, capsular contracture and other complications relating to using an implant.
In summary, the risks of bleeding, haematomas, capsular contracture, ALCL, infection, asymmetry, scarring, seroma, pain, palpable implant, loss of cleavage, sensation, implant malposition, implant rupture/leakage and breast feeding are discussed through the ASPS and The Layt Clinic information on Breast Augmentation. Implants may be removed and replaced over time and they are not lifetime devices. Implants used are registered with the Therapeutic Goods of Australia (TGA) and patients will be sent Patient Information Leaflet (PIL) regarding the implants chosen.
All surgery carries risks and it is important to understand these.
Every patient is an individual and therefore final surgical results will vary from patient to patient. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified practitioner.
There is no such thing as ‘risk free’ surgery. The important thing is to understand any potential risks and minimise their occurrence. You will be fully briefed on pre and post-operative procedures to assist you with the best possible surgery experience, recovery phase and final outcome.
Smoking and Surgery
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified practitioner.