Breast Reconstruction Surgery

Your GP or another specialist that knows you well must make a referral to Dr Avery. The decision to have a consultation may be made after talking with family or friends or following your own research into plastic surgery and Dr Avery.

The purpose of your initial consultation with Dr Avery is to discuss your motivations for surgery and expectations from surgery. It is an opportunity to openly communicate what you want to change, alleviate or remove. We will discuss any concerns you may have about your potential surgery and its outcome. We will also collect information that is specific and tailored to you, to add to the knowledge you acquired through your research outside of the consultation process.

When you arrive at Avery, you will check in with our Care Team and complete a medical history form, if not already completed. We encourage you to bring a supportive family member or friend who can remain with you throughout the consultation if you like, and be a sounding board during your decision-making process following the consultation.

The consultation with Dr Avery will include an examination of the area of your body that you are concerned with and considering changing. Our aim will be to determine if plastic surgery can achieve what you hope it will, and if so, what specific plastic surgery procedures will address your concerns and meet your expectations in a realistic way.

Plastic surgery procedures can impact physical appearance and there may be a psychological response to the changes in your body after surgery. Besides the reasons for having plastic surgery, it is important to be fully aware of any potential limitations of the operation and how they apply to your unique situation. This includes the risks of having surgery and all of the possible complications that can occur after surgery, and what can be done if these occur.

We will discuss what the surgery involves, how it relates to you specifically given your uniqueness and current state of health, what the possible risks of the surgery are, and then decide if having the surgery is a safe and appropriate choice for you as an individual.

Your consultation will also include a discussion of the estimated financial implications of having this surgery or surgeries that were discussed with Dr Avery.

After your consultation, our Care Team will be there to talk through any further questions you have, including the cost of the surgery.

At Avery, our goal is to ensure you are equipped with the knowledge needed for you to feel empowered throughout the decision-making process, surgery and post-surgery.

Each breast reconstruction procedure is unique and can involve several different surgical techniques depending on the following factors:

• If the reconstruction is being performed with the mastectomy or at a later date
• If the operation involves both breasts
• If breast implants are an option
• If radiotherapy has been used in your cancer treatment
• The amount of skin and breast tissue remaining in both breasts
• Skin quality and elasticity
• The amount of excess abdominal fat (see below)
• Whether the lost breast volume can be replaced using skin and tissue from another part of the body (known as an autologous flap) which is usually taken from the lower abdomen (generally the excess skin and fat removed during an abdominoplasty surgery), or whether breast implants can be used in combination with a tissue flap reconstruction. Skin and tissue may also be taken from the back, buttocks, or other areas.

Reconstructing the breast using lower abdominal tissue or other forms of tissue transplant allows the reconstructed breast to fluctuate in weight naturally, yet these procedures may involve more scarring and longer recovery times compared to using breast implants.

The procedure for inserting a breast implant will depend on the amount of skin left on the breast post-mastectomy. If the skin across the breast is left flat and tight, a temporary tissue expander may need to be inserted to stretch the area over several weeks before the implant is put in place.

It may be possible to reconstruct a new nipple-areola complex using existing tissue, as it is often removed during a mastectomy. Cosmetic tattooing of a nipple and areola can be considered either on its own or after a reconstructed nipple has healed.

The length of a breast reconstruction surgery can last anywhere from 2–8 hours depending on the techniques being used, whether one or both breasts are being reconstructed, and whether other procedures such as a breast reduction, breast lift, nipple reshaping, or breast augmentation are being performed on the other breast.

As with all surgical procedures, breast reconstruction surgery does have risks, despite the highest standards of practice. It is not usual for any surgeon to outline every possible side effect or rare complication of a surgical procedure. However, it is important that you have enough information about the most common risks to fully weigh up the benefits, risks, and limitations of surgery.

The following possible complications are listed to inform and not to alarm you. There may be other complications that are not listed. Smoking, obesity, and other significant medical problems will cause greater risk of complications.

Some general risks and possible complications of surgery include, but are not limited to the following:

• Heavy bleeding from an operated site. This may require a blood transfusion.
• Infection that may require treatment with antibiotics or further surgery in some cases.
• Allergic reaction to sutures, dressings or antiseptic solutions.
• The formation of a large blood clot (haematoma) beneath an incision site may require further surgery.
• Complications such as heart attack, pulmonary embolism or stroke may be caused by a blood clot, which can be life threatening.
• Pain, bruising and swelling around the operated site(s).
• Slow healing, often related to smoking or diabetes.
• Short-term nausea following general anaesthesia and other risks related to anaesthesia.
• Tissue cannot heal without scarring and that how one scars is dependent on individual genetic characteristics. Dr Avery will do his best to minimise scarring but cannot control its ultimate appearance.
• Smoking or using nicotine products during the 3–4-week pre-operative and post-operative periods is prohibited as these could dramatically increase the chances of complications.
• All medications I am currently taking, including prescriptions, over the counter remedies, herbal therapies and supplements, aspirin, and any other recreational drug or alcohol use can affect the safety of my surgery.
• There can be no guarantees about the results of any surgery.

Some specific risks for breast reconstruction surgery include, but are not limited to the following:

• Bleeding / haematoma requiring surgery
• Infection, may result in loss of reconstruction
• Change in skin sensation
• Scarring
• Delayed healing and loss of skin or tissue
• Seroma requiring draining
• Calcification causing pain and firmness
• Disappointing or unsatisfactory result
• Capsular contracture (hardening)
• Eventual implant displacement
• Asymmetry
• Skin wrinkling and rippling
• Chest wall deformity
• Further surgery required
• Future removal/replacement of implants
• Further recovery time if further surgery is required
• Implants fail – break, leak requiring removal/replacement
• Pain and discomfort
• Allergic reactions to tape, suture material, topical preparations, medications
• DVT (deep vein thrombosis) – clot in legs or PE (pulmonary embolus) – clot in lungs

The Australasian Society of Aesthetic Plastic Surgeons (ASAPS)has further information about breast reconstruction surgery including the possible risks for this surgery.

The recovery period for breast reconstruction surgery will depend on the different techniques used during surgery. Some procedures may require an overnight stay following surgery, while others may require several nights in hospital. As with any surgery, you will need to organise somebody to drive you home, and it is recommended that you have another adult stay with you during the first night after leaving the hospital.

The full recovery period for a breast reconstruction can vary from a few weeks to a few months and some bruising, pain and swelling can be expected. Physical activity should be limited within the first 6 weeks.

Patients recovering from a breast reconstruction may be required to wear a compression garment for up to 6 weeks to provide support and reduce post-operative pain or swelling.

A customised pain relief program will be created for each patient and issued before leaving the hospital. If circumstances change at any stage during the recovery period, then the pain medication can be adjusted accordingly.

The shape and size of scars from a breast reconstruction will depend on the techniques used during surgery and any additional procedures performed. While they will not disappear, most scars will generally fade, some becoming minimally visible in a matter of months, depending on how well your skin copes with scarring. As with most scars from surgery, the final result may be seen at 12-18 months.

The financial aspects of your surgery are as important as the medical elements when planning for surgery. At Avery, the surgeries we offer fall into three different financial categories: Self-funded – aesthetic surgery; self-funded – plastic and reconstructive surgery; and health insured – plastic and reconstructive surgery.

To make sense of these three financial categories, we have created a detailed price guide to help you understand what may or may not be covered by your health insurer/Medicare and your out of pocket expenses.

To download this guide, please click here.

For more information or to book a consultation, please contact our team on 02 4002 4150.

The length of a breast reconstruction surgery can last anywhere from 2–8 hours depending on the techniques being used, whether one or both breasts are being reconstructed, and whether other procedures such as a breast reduction, breast lift, nipple reshaping, or breast augmentation are being performed on the other breast.

The best method for you depends on many factors, including your body shape, past surgeries, current health, treatment needs and personal preferences.

During your consultation with Dr Avery your reconstructive options will be discussed, including the risks, benefits and choices for each procedure.

The risk of breast cancer recurrence depends on the stage and nature of the cancer and any additional breast cancer treatments. Any risk of breast cancer recurrence is best discussed with the doctors treating your breast cancer. Reconstructive surgery has not shown to increase the risk of the cancer returning or make it harder to detect if cancer does return.

Your medical oncologist will help determine if and when chemotherapy may be a beneficial treatment option for your breast cancer. If chemotherapy is required after surgery you may need to wait until your surgical wounds from your mastectomy and reconstruction have healed and recovered before starting chemotherapy. If you have complications such as wound healing problems or infection, chemotherapy may be delayed.

You may want to delay breast reconstruction until you are finished with radiation therapy as radiation may influence the final result of your reconstruction. Radiotherapy may impact any wound healing and the final appearance of any reconstruction. If you require radiation or have had radiation, it is frequently recommended to use your own tissue or a combination of your tissue with an implant.

Implant-only reconstruction may not be recommended as radiation often results in an increased risk of implant complications such as infections, fluid build-up and severe capsular contracture (scar tissue around the implant causing hardening of the breast).

Breast conservation surgery usually involves removing a portion of breast tissue where the cancer is located, followed by radiation therapy. The removal of breast tissue can often leave an indentation or dimple on the breast. This dimple may not be seen until after radiation treatment. Reconstructive options can help improve the contour and appearance of the breast.

When a breast implant is placed inside the body, the body forms a layer of scar tissue around the implant, this layer is known as the implant capsule. How thick an implant capsule develops varies between people and varies over time. It can also be influenced by the properties of the implant and where the implant is placed (under or over the pectorals muscle in the chest). With time the capsule may cause symptoms such as pain or a change in appearance in the breast. These changes can occur with or without a problem with the implant itself such as an implant rupture. A capsulectomy refers to the surgical removal of this scar tissue layer. This can be performed during implant replacement or during implant removal. When the entire capsule is removed this is referred to as a total or complete capsulectomy. When it is removed all in one piece with the breast implant included, this is known as en bloc removal and is generally the goal when removing implants in women with symptoms suggestive of breast implant illness. At times, it may not be possible to remove the entire capsule due to factors such as its thickness or its attachment to other important structures.

Capsulectomy is generally performed with implant removal or implant replacement, the total operation taking between 1-3 hours. An overnight stay is over required.

Pain following surgery will vary depending on the extent of surgery. Pain immediately after surgery may be reduced by the use of local anaesthetic at the surgical site given during the surgery. The pain will also be managed with tablets or injections as required. Physical measures such as the dressings and supportive garments as well as limited movement and possibly ice packs will all help minimise any pain. Pain is usually well tolerated within a few days after surgery with all these measures. If your pain is increasing following surgery this is usually a sign that you may need a review to ensure your recovery is proceeding as expected.

Dressings and supportive garments will offer support to the wounds and the areas of your body that are still recovering. You will be also be advised to restrict excessive movement of the surgical area in the first two weeks after surgery. A good general rule throughout your recovery is if an increase in movement or activity does not increase any discomfort or swelling, then it is probably safe and this gradual progression back to ‘normal’ will be encouraged.

Please allow an hour for your time with Avery. This will include meeting with Dr Avery and the Avery care team.

Body contouring surgery is performed under a general anaesthetic given by a specialist anaesthetist in an accredited private hospital.

Dr Avery operates at the accredited Lingard Private Hospital. This is to ensure your operation takes place in an environment governed by the guiding principle of safety to ensure your surgical experience is the best it can be.