Breast reconstruction surgery aims to achieve aesthetic breast proportions in patients who have failed to undergo normal breasts development or in patients who have had or are contemplating mastectomy surgery for breast cancer or its prevention.
The ideal features of the aesthetic female breast which can be surgically reconstructed include:
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The decision to undergo breast reconstruction is significant and adjustment to change in appearance needs be considered in addition to the process of post-operative recovery.
The aim of the consultation is to ascertain expectations and identify potential limitations to achieving those expectations such as skin quality, breast anatomy, scarring from previous surgery and the impact of adjuvant treatment such as chemotherapy and radiotherapy. During the consultation your surgeon will discuss the potential management of the other breast in order to consider the best options of achieving breast symmetry in your case.
Patients seeking breast reconstruction surgery have typically experienced or considered the limitations in clothing including swim wear due to disproportionate breast size, nipple areolar complex position and asymmetry. They are also self-conscious of the appearance of their breasts and have suffered a loss of self-esteem and confidence as a consequence.
Two or more consultations are often required prior to surgery to ensure a good understanding of procedure, the likely results and the period of recovery and downtime required.
It is important that the Surgeon is made aware of previous surgery and history of scarring, along with significant medical history including a tendency for easy bruising and excessive bleeding, deep venous clots involving the legs, all prescription and non prescription medication, allergies to anaesthetic agents, antibiotics and dressings, history of smoking and psychological or psychiatric issues. In addition, it is important that the surgeon is aware of adjuvant therapy including chemotherapy and radiotherapy. These issues are important as they have the potential to affect the surgery, anaesthesia, potential complications and recovery. A history of Raynaud’s disease or conditions affecting the peripheral circulation is also significant.
If necessary, further medical consultation may be necessary to minimize complications including consultation regarding blood thinning agents which may need to be either ceased or modified in preparation for surgery. Diagnostic tests including blood tests may also be necessary for the Surgeon to obtain a complete assessment of bleeding tendencies and to optimise fitness for general anaesthesia. Depending on the type of reconstruction considered, specialised CT scans may be necessary in addition to breast ultrasound studies and mammography.
If advised by the Surgeon, it may also be necessary to cease medication such as the Oral Contraceptive Pill. It is important to avoid Aspirin, Disprin and non-steroidal anti-inflammatory medication such as Nurofen in addition to herbal medications such as Garlic, Ginseng, Ginko, Arnica and Fish and Krill oils two weeks prior to and after surgery. It is essential that smoking cease six weeks prior to and after surgery to minimize the risk of surgical wound complications and anaesthesia. Nicotine containing products can also affect wound healing and should be ceased two weeks prior to and after surgery.
A further significant aim of consultation is to facilitate understanding of the potential risks of breast reconstruction surgery.
Risks which are infrequent but common to all operations include problem scarring which will depend on previous surgery and the type of reconstruction undertaken, wound complications including infection, wound breakdown, or haematoma (collection of blood) or seroma (collection of tissue fluid) in addition to the risk of further surgery to address such complications.
Risks specific to breast reconstruction surgery which can improve over eighteen months to two years include swelling, redness, numbness of the breast skin and loss of sensation of the nipple areolar complexes. Whilst less common, a very significant complication is necrosis of the nipple areolar complex. Specific risks which may require revisional surgery include asymmetry, contour irregularities and dog ear formation, which are contour irregularities at either end of the scar. Revisional surgery is necessary in approximately 5 per cent of patients who undergo breast reconstruction surgery.
It is only at the culmination of the consultation process, after having the opportunity to have questions addressed by the Surgeon, should consent to breast reconstruction surgery be given. The consent process will also include discussion regarding the costs of surgery and potential revisional surgery.
In Australia, surgeons are strongly discouraged from advertising a set price for a medical procedure. This is in line with the Guidelines for advertising of regulated health services by the Australian Medical Board. For this reason we do not include a cost per procedure on our website.
Once Mr Patrick Tansley or Dr Sugitha Seneviratne have met with you in an initial consultation, part of this consultation will be to discuss the cost of this procedure. We can provide approximate costs for out of pocket costs before your initial consultation including any applicable Medicare rebate. We are happy to provide these by phone 03 9088 5000 or via enquiry through our website.
There is a cost for an initial consultation at our Melbourne clinic, with the potential to receive a portion of this back via Medicare where eligible for rebate, provided you have a referral from your GP. You can call our Melbourne office on 03 9088 5000 to enquire about any out-of-pocket costs before your initial consultation as well.
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Breast reconstruction surgery is tailored to address the specific elements of the breast on an individual basis and include creation of the breast mound of appropriate volume, width and projection and reconstruction of the nipple areolar complex. In addition, a “symmetricising” procedure of the contralateral breast may be required to either reduce or lift the contralateral breast or to augment it as necessary.
The breast mound can be reconstructed using a breast implant, use of local muscles and soft tissues or by microsurgical techniques. The resulting scars resulting therefore vary and can include the breast, back or abdomen depending on the technique used. The most appropriate of these surgical techniques and access incisions will be discussed during your consultation. Similarly, the reconstruction of the nipple areolar complex which is typically undertaken at a subsequent operation and techniques used as “symmetricising” procedures of the contralateral breast will also be discussed during your consultation.
The operation is performed using a variety of specialised techniques under general anaesthetic in an accredited hospital. Patients are treated in hospital for antibiotic therapy and pain management for one to two nights following implant breast reconstruction, seven days following microsurgical breast reconstruction and as day surgery for nipple areolar complex reconstruction.
The internal wounds are repaired with dissolving stitches and water proof dressings applied which are suitable for patients to shower. A compressive garment or “boob tube” will be provided and is worn for approximately 3 weeks. You will then be provided with a brassiere which is worn until six weeks after surgery.
The post-operative recovery period is approximately two to three weeks in the case of implant reconstruction or six to eight weeks after microsurgical reconstruction. During this period the breasts can be swollen or bruised and swelling typically improves over six to eight weeks after surgery. Whilst most patients are able to return to work within two weeks of surgery after implant reconstruction and six to eight weeks after microsurgical reconstruction, overall improvement can be expected for a number of months. Advice will be provided with regard to scar maturation strategies and resumption of driving and physical exercise.
At NorthEast Plastic Surgery we hold patient privacy and discretion in the highest regard. For this reason, before and after photos are only available for viewing during a consultation with a surgeon. Photos are provided by previous clients who have consented to the private and discrete use, to assist others with their decision.
All patient appointments are coordinated via our Essendon practice