Breast Reconstruction Surgery

o see Dr Avery, you will need a referral from your GP or another specialist who knows you well. Some people seek a consultation after speaking with family or friends, or following their own research into plastic surgery.

The initial consultation is an opportunity to discuss your personal reasons for considering surgery, your expectations, and any questions or concerns you may have. Dr Avery will take time to understand your health history and circumstances so that the information you receive is specific to you.

When you arrive at Avery, you will be welcomed by our Care Team and asked to complete a medical history form if this has not already been done. You are welcome to bring a supportive family member or friend with you to your consultation, should you wish, to help you collect and retain al of the information you need to make an informed decision about surgery.

As part of the consultation, Dr Avery will carry out an examination of the area of concern and provide information about whether surgery may be suitable for you. This discussion will include what the procedure involves, the possible risks and complications, and any limitations that may apply in your situation. The aim is to provide you with clear information about what surgery may or may not achieve, and whether it is an appropriate option for you.

Your consultation will also include discussion of the estimated costs associated with surgery.

After your appointment, our Care Team is available to answer any further questions, including those relating to fees and practical next steps.

At Avery, our focus is to provide you with accurate and personalised information to support your decision-making process before, during, and after surgery.

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

• 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
• If abdominal fat is being used (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 common practice for any surgeon to outline in detail every possible side effect or rare complication. However, it is important that you are informed of the more common risks and the less common but potentially very significant complications, so you can carefully weigh the potential benefits, risks, and limitations of surgery. It is usually possible to provide a more comprehensive list of potential risks and complications related to surgery, so that any risks particularly relevant to an individual can be identified and discussed further.

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.
• 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 variation
• 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 following breast reconstruction varies depending on the surgical technique and any additional procedures performed. Some people may require an overnight stay, while others may remain in hospital for several days. Transport home after discharge should be arranged, and having support available in the first days after surgery is often helpful.

Bruising, swelling, and discomfort are expected after surgery. The return to normal physical activity is gradual and can take several weeks to months. Strenuous activity is generally limited in the first 6 weeks. Supportive garments may be advised for a period of time to assist with comfort and swelling.

Pain management plans are tailored to each individual and are arranged before discharge, with adjustments made if required during the recovery period.

All surgery results in scarring. The location and appearance of scars after breast reconstruction depend on the surgical approach, any additional procedures, and individual healing responses. Scars usually change in appearance over time, though the degree and timing of these changes differ between people.

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 breast reconstruction surgery varies widely. It may range from a few hours to much longer, depending on the surgical technique used, whether one or both breasts are being reconstructed, and whether additional procedures are performed at the same time.

The most appropriate approach to breast reconstruction varies between individuals. Factors that may influence surgical planning include body shape, previous operations, overall health, treatment requirements, and personal preferences.

During a consultation with Dr Avery, the different reconstructive options, along with their potential risks, benefits, and limitations, are discussed in relation to your individual circumstances.

The risk of breast cancer recurrence is influenced by factors such as the stage and type of the cancer and any additional treatments you receive. These issues are best discussed with the doctors managing your breast cancer care. Current evidence indicates that breast reconstruction itself is not associated with an increased risk of cancer recurrence, and routine follow-up with your oncology team remains important for ongoing monitoring.

The decision about whether chemotherapy is required, and its timing, is made by your oncology team. If chemotherapy is recommended after breast reconstruction surgery, it is generally started once the surgical area has healed sufficiently. If complications such as delayed wound healing or infection occur, the start of chemotherapy may be adjusted by your treating doctors.

Radiation therapy can influence wound healing and may have an impact on reconstructed breast tissue or implants. For this reason, the timing and type of reconstruction is considered carefully if radiation is required, either before or after surgery.

Some research suggests that radiation may be associated with higher rates of complications when implants are used alone. In certain cases, reconstruction that uses the patient’s own tissue, or a combination of tissue and implant, may be discussed as an option. The most suitable approach depends on individual circumstances and is considered in consultation with your oncology and surgical teams.

Breast conservation surgery, also known as lumpectomy, usually involves removal of the portion of breast tissue where the cancer is located, and it is commonly followed by radiation therapy. Removal of breast tissue may change the shape or contour of the breast, which in some cases becomes more apparent after radiation treatment.

Reconstructive approaches can sometimes be used to address contour changes. The suitability of these options depends on individual factors and is discussed as part of your overall cancer and surgical treatment planning.

When a breast implant is placed in the body, the body naturally forms a layer of scar tissue around it. This is called the implant capsule. The thickness and characteristics of the capsule vary between people and over time, and may be influenced by factors such as the type of implant and its placement (above or below the chest muscle).

In some cases, changes in the capsule may lead to discomfort or a change in breast appearance. A capsulectomy is the surgical removal of part or all of this capsule. It may be performed at the time of implant removal or replacement. When the entire capsule is removed, this is called a total or complete capsulectomy. If the capsule and implant are removed together in one piece, this is referred to as en bloc removal.

It is not always possible or necessary to remove the entire capsule, as this depends on factors such as its thickness or attachment to surrounding structures. Capsulectomy procedures are usually performed under general anaesthetic, and the length of surgery can vary (often between 1–3 hours). Some patients go home the same day, while others may stay in hospital overnight, depending on the extent of surgery and their recovery.

Some degree of discomfort and limited movement are expected after surgery. The extent varies between individuals and depends on the type and extent of the procedure. Pain management is usually planned before discharge and may involve medications, dressings, and supportive garments. These measures are adjusted if required during recovery.

Patients are often advised to limit excessive movement of the operated area in the first weeks after surgery. The timing of returning to normal activities depends on individual healing and should be guided by follow-up reviews with the surgical team. If pain increases or recovery does not progress as expected, further assessment may be required.

Please allow 2 hours for your time with Avery. This will include meeting with Dr Avery and the Avery care team.

Breast reconstruction 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.