Breast reconstruction takes many varied forms but can be broadly divided into three main areas. Firstly, using your own tissue to make a breast (autologous reconstruction). Secondly, using predominantly an implant to make a breast (alloplastic reconstruction) and finally using a combination of both- a hybrid breast reconstruction.
The treatment of breast cancer is also rapidly developing – it is still mostly divided into situations where the breast was reconstructed at the same time as the mastectomy (immediate) or after cancer treatment was finished (delayed). There are some newer variations, such as the treatment of gene mutation positive patients (e.g. BRCA1 or 2) or reverse radiotherapy sequencing but the general process remains the same. i.e. treat the cancer first and then reconstruct the breast.
I am specifically known for performing autologous reconstructions and hybrid reconstructions. That is, using your own excess fat (mostly from the abdomen) to make you a new breast that will respond like a normal breast will.
If you have enough abdominal tissue then an autologous reconstruction using this tissue to make a breast will give you the best long term aesthetic result. There are two main types of reconstructions that use this abdominal tissue. One is called a TRAM flap and the other is called a DIEP flap. The main difference between the operations is that the TRAM flap also takes your abdominal core muscle at the same time and the DIEP leaves the muscle behind.
If you have suitable blood vessels and anatomy, the DIEP flap has obvious benefits as your rectus abdominus muscle is not unnecessarily wasted. There are some people who simply do not have favourable anatomy for a DIEP flap and might require the TRAM flap instead.
My preference is always towards muscle preservation with a DIEP flap.
Congenital and tuberous breast deformity correction can have a major impact on a patient’s quality of life. Every patient is unique, and I take great care and effort to understand your goals so that I can tailor the right right operation to you. These operations have a much higher revision rate than a simple augmentation and it is often best to prepare yourself for a staged approach rather than expecting a single operation fix.
Options for the Breast Reconstruction surgery.
Tuberous breast deformity is a recognised anatomical variation of the breast. It has three features that typify the complete condition that include:
– A short distance between the nipple and the crease under the breast.
– A typically larger areola, with the breast gland almost falling through the overlying skin looking puffy.
– The breast has usually less volume with wide spacing between the breasts.
There is degree of asymmetry between all breasts, but some patients have more than others. When that difference between your breasts is significant you may want to do something about it. Why? The reasons may range from self-confidence all the way to simple practical concerns of being able to buy bras without difficulty. The first question that needs to be answered is this: What is the goal? Once we establish then it is usually a carefully planned process that means we aim towards the smaller breast, the larger breast or aim to change both breasts.
Most patients having breast augmentation have some elements but for some people there can be precious little skin or breast on the chest wall. An implant alone is usually the starting point and this is often augmented by techniques such as fat grafting.
If you have nipple position issues you will often require two stages to achieve your goals. One stage involves placing the implant and the second involves moving the nipple. Common sense should prevail here. Small differences between the nipples are common place and not worth the additional scars usually.
The sternum and ribs can best be thought of as the foundation on which we build your new breasts. The main presentations tend to be a hollow chest deformity or the opposite phenomenon where the chest can appear excessively proud like the keel of a boat. Scoliosis and rib anomalies can also be present with both these conditions and will impact your final result and the approach to achieve your surgical goals.
Any skeletal or rib-based issue can be treated with cardiothoracic surgery, but this is usually reserved for the most extreme cases. Even then, surgery is rarely performed unless there are functional concerns at the same time. Careful choice of an appropriate implant with possible fat grafting can be extremely effective for this situation.
My plastic surgery clinic is conveniently located in East Sydney between Hyde Park and Potts Point – close to the exit of the Harbour Bridge, Harbour Tunnel, Eastern Distributer and the Cross City Tunnel. There is valet parking available as well as free parking on the ground floor (90 minutes).
Our revolutionary 3D Vectra technology allows you to see in real time the projected results of your treatment. Based on the 3D photos we capture of your body we can adjust and perfect the exact treatment plan for you based on your desired outcomes. No more looking at sample images or imagining your personal results.
Choosing the right procedure and surgeon is important. I believe that helping my clients make informed decisions is key to a great result so if you have a question or would like to know more about something specific, please let me know – Regards, Alex.