For individuals who have lost one or both breasts to cancer or injury, breast reconstruction can be a rewarding procedure to re-create a natural breast appearance and restore a woman’s body image. Our practice understands the large physical and emotional toll that patients experience after mastectomy, lumpectomy, congenital deformity (birth defect), or traumatic injury. Dr Rory Dower and our compassionate team are dedicated to supporting each patient on their individual journey, and offer breast reconstruction to restore as close to a normal breast size, shape, volume, symmetry, and appearance as possible.
Why Choose Dr Dower for Breast Reconstruction?
Breast reconstruction is a uniquely complex medical procedure that is often performed in multiple stages. In order to properly reconstruct the breast size and shape, specialized training in breast reconstruction surgery is often necessary to achieve the best aesthetic result. As such, it is pivotal to seek the expertise of a qualified plastic surgeon who possesses a deeper understanding of the procedure. If you are considering breast reconstruction after mastectomy, or to revise a previous breast reconstruction surgery, the importance of allowing yourself the most proficient care possible cannot be overstated.
Our reconstructive and aesthetic plastic surgeon has dedicated much of his surgical training to learning the safest and most effective techniques in breast reconstruction to provide an optimal cosmetic outcome. Dr Dower received specialized training in breast reconstruction during a 12-month fellowship at St. Thomas’ hospital in London, where he was a microvascular fellow performing DIEP (deep inferior epigastric perforators) and other flap techniques widely used in breast reconstruction. Additionally, he completed an observership at the acclaimed Memorial Sloane Kettering Cancer Centre in New York—one of the most favored implant breast reconstruction units in the world. Dr Dower understands how physically and emotionally overwhelming this process can be for breast reconstruction patients, especially following a unilateral or bilateral mastectomy. He is committed to providing the most advanced care possible, and makes himself fully available for any questions or concerns a patient may have. Dr Dower’s top priority is making you feel comfortable, well-informed, and confident about the breast reconstruction procedure.
Thank you Dr Dower, for exceeding all my expectations. I really appreciate the way you spoke to me throughout my procedure, it really consoled me. I feel very grateful to you, not only for your expertise, but also for your very kind and empathetic ways. It was a great comfort to me.
Candidates for Breast Reconstruction
Ideal candidates for breast reconstruction surgery understand that the procedure is an extremely personal decision and should not be performed under pressure from loved ones or other external influences. Prospective breast reconstruction patients should also:
- Understand the potential length of the process, especially if cancer treatment is necessary
- Be able to cope with their diagnosis and resulting treatment
- Have a positive outlook and realistic expectations for the look and feel of their new breast(s)
- Not have any other medical conditions or illnesses that may inhibit proper healing
About the Breast Reconstruction Procedure
Breast reconstruction is usually achieved in several stages. Depending on each patient, the surgery may be performed immediately following mastectomy, or delayed to a later time. Once the breast is ready for reconstruction, the surgery generally requires an in-patient stay for one or more nights. The type of surgical technique utilized, your overall health, and the timing of the procedure can all influence the number of overnight stays required. There are typically two main approaches to performing breast reconstruction, with adjunctive techniques utilized when necessary to optimize the outcome.
Techniques Used in Breast Reconstruction
- Implant-based: Implant-based reconstruction uses a tissue expander (when necessary) and a breast implant to re-create the breast mound for a natural breast appearance. Because mastectomy or radiation can leave inadequate tissue to support a breast implant, a tissue expander may be utilized to provide proper coverage for the implant. Additional fat grafting or tissue substitute techniques may also be necessary for additional support and coverage for a breast implant. Depending on each patient, a breast implant may be used in addition to flap techniques, or as an alternative.
- Flap techniques: A flap is a piece of tissue removed from a donor site to correct or improve the appearance of deformities. Flap techniques are employed in breast reconstruction to form or cover the breast mound using a woman’s own natural tissue. Dr Dower will determine the flap technique that will provide the most ideal outcome according to your unique needs. A TRAM flap can transfer muscle, fat, and skin from the lower abdomen to the chest in order to form the new breast. When muscle transfer is not necessary, he may utilize the DIEP or SIEA flap, which solely transfer skin and fat from the abdomen, resulting in an improved abdominal contour. If the tissue on the abdomen is insufficient, flaps may be taken from the buttocks or thighs.
Reconstruction of the nipple-areolar complexes takes place after the breast reconstruction. Minor outpatient procedures, such as tissue grafting, injections, or tattooing techniques, can typically restore the appearance of the nipples and areolas. If only one breast is being reconstructed, Dr Dower may recommend adjunctive cosmetic surgeries, such as a breast augmentation, breast reduction, or a breast lift, to achieve symmetry and balance between the natural breast and reconstructed breast.
Recovery After a Breast Reconstruction
The exact nature of the recovery period varies for each individual, depending on the surgical technique used to reconstruct the breast. Implant-based reconstruction typically requires one or two days of in-hospital care, while flap reconstruction can necessitate five days of in-hospital care. After the operation, an elastic surgical garment or surgical bra may be worn in order to reduce swelling and support the newly constructed breast(s). Adhering to Dr Dower’s detailed post-operative instructions is essential to your healing period, as it is important to minimize the incisions’ exposure to excessive force, abrasion, or motion. Medications will be provided to aid in recovery, minimize discomfort, and prevent infection.
Results of a Breast Reconstruction
Breast reconstruction is designed to restore the appearance of the breast and help reduce the physical and emotional impact of mastectomy. Dr Dower can produce exceptional results, but it is important for patients to remember that a reconstructed breast will not feel like a natural breast. After surgery, patients generally report great satisfaction at the appearance of their breasts. Dr Dower makes every effort to meet your surgical goals in the safest means possible, and can use his comprehensive experience to exceed your cosmetic expectations.
If you would like to learn more about breast reconstruction performed by Dr Dower, or if you would like to speak to a friendly member of our team, please don’t hesitate to reach out to our practice today.
FAQs about Breast Reconstruction:
The truth be told, there is conflicting data about whether women are happier with or without breast reconstruction. The benefits of this type of surgery are really dependent on your individual circumstances and preferences. What’s important is that you are given all the options, so that you have made the decision, rather than not having had the chance to do so. Give yourself the opportunity to be informed, empowered, and to decide what will best suit you.
Putting each patient’s treatment plan together is a complex decision making process which is best done in a multidisciplinary team (with a breast cancer surgeon, an oncologist and a plastic surgeon). Breast reconstruction is not something that is kept for the end of cancer treatment. To the contrary, it is important to discuss your options for reconstruction before having your mastectomy/lumpectomy. You may be a candidate for immediate reconstruction at the time of initial surgery. The benefits of this are that you may need fewer reconstructive surgeries in the future and the results of the reconstruction may be better.
Both are challenging in different ways
Creating symmetry is more challenging with a single mastectomy - it can be difficult to make the opposite/remaining breast look similar to the reconstructed one. For this reason, we often incorporate what we call a symmetrization procedure, which involves a breast reduction or breast lift on the opposite side.
With a double mastectomy, it is easier to achieve symmetry, because the same reconstruction technique is done for both sides but is more challenging in that it is a longer surgery with slightly higher potential for complications.
These days, patients have various options when it comes to breast reconstruction after a mastectomy (double or single). While most patients typically choose to have some form of reconstruction, many choose to go flat. ‘Going flat’ or ‘living flat’ refers to the decision not to undergo reconstruction or to rather use a prosthesis or ‘breast form’ to help feel more confident and look more balanced without surgery.
According to reliable data from the US, the number of women choosing to have reconstruction, went from 24% in 2009 to 40% in 2014.
When it comes to surgical reconstruction, women can either opt for an implant reconstruction, or an autologous or ‘flap’ reconstruction.
An implant reconstruction involves inserting an implant that contains saline, a silicone gel, or a combination of the two underneath the pectoral chest muscle. The duration of the procedure and the recovery period is less than that of a flap reconstruction. Although this option involves shorter surgery than a flap reconstruction, it may require more than one procedure. Both saline and silicone implants have a limited lifespan. This means you’ll need to undergo more surgery, either to replace the implant or revise the reconstruction in the future. This option is often the best for slim women who have small breasts, as they rarely have enough extra tissue on their backs, bellies, thighs, or bottoms to form a good breast shape when undergoing flap reconstruction.
Autologous or ‘flap’ reconstruction
Autologous or ‘flap’ reconstruction uses tissue from another part of your body, such as your belly, thighs, or back. This means that there will be at least two areas of the body that are healing at the same time. This option is becoming more popular, especially for women looking for a natural alternative to implants. This form of reconstruction is typically a single procedure that lasts a lifetime, however, the duration of the surgery and the recovery time is longer than that of an implant reconstruction.
Regardless of your age or relationship status, it’s difficult to predict how you’ll feel after a mastectomy and very important to get as much care and support as possible. Since breasts are considered one of the hallmarks of becoming a woman, it’s perfectly normal to feel intense grief and anxiety after losing a breast. Breasts play a significant role in a woman’s sexuality, and you may have used your breasts to feed your babies. You’ll experience a plethora of emotions when faced with losing your breast.
Although motivation letters are often required, most medical aids will authorize surgery for breast reconstruction (unless there is a specific exclusion for breast reconstruction in the policy). Depending on the plan type and the rates charged by the specialists involved, there can be a shortfall for which the patient will be liable.
For women who don’t have medical aid or can’t afford breast reconstruction, they can request breast surgery at a government hospital that offers this type of service.
Whilst dealing with breast cancer is a long and incredibly difficult journey, I have been amazed at the courage and hope that many women have shown. Each story is different and I see women drawing strength in different ways. It’s a privilege for me to walk a part of this journey with them and I want to encourage breast cancer sufferers/survivors to keep caring for and supporting each other – you are a force to be reckoned with!