Breast Reconstruction 101

Entering breast cancer awareness month, MediFin wanted to educate females about the options after a mastectomy/breast cancer. One of our preferred doctors, Plastic Surgeon Dr Nicolette Landman, kindly agreed to discuss some common questions she always receives from patients.

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If you had a breast removed, you have the option to have breast reconstruction surgery to restore symmetry to the shape of your chest, and improve your self-esteem and quality of life.

What are the most common types of Breast Reconstruction surgeries available, and who is best suited for which surgery?

Breast Reconstruction can either be done as Immediate Reconstruction (done at the same time as the mastectomy) or as Delayed Reconstruction (done after chemotherapy treatment and/or radiation, or even years after a mastectomy).
The three main categories: Autologous reconstruction, where the patient’s own tissue is used to recreate the breast; prosthetic (placement of a breast implant) reconstruction; or a combination of above using the patient’s own tissue and an implant placement.

The type of reconstruction a patient is best suited for remains very individual. Your Plastic and reconstructive surgeon will explain the different options applicable to you, as well as the pros and cons of each option after a consultation.

What is the difference between Prosthetic or Autologous options, and how will I know which is best for me?

This is best discussed between the patient and their reconstructive surgeon. Factors to consider include:

* The type of mastectomy or cancer the patient had.

* Whether the patient has had radiotherapy.

* The general health of the patient (whether they have other diseases or illnesses).

* The patient’s general build.

* The size and shape of the remaining breast.

The end goal is to have a safe procedure that offers the patient as much symmetry as possible when she is wearing clothes or underwear. And it’s quite amazing, the results that can be obtained these days. Sometimes, you can hardly tell the difference.

I have heard that there are options for giving the appearance of a nipple, such as tattooed areolas. Are these available as part of the surgery options in South Africa?

We usually build up the nipple using the patient’s own tissue. Colour changes can be made with medical tattooing or through a skin graft, which changes the colour of the surrounding skin. It is also possible to create the nipple and surrounding areola completely with tattooing. Medical tattoos can build up a really good 3D image. Some patients choose to stop before that, and are happy to have the reconstructed breast without the appearance of a nipple.

Are there any new advances in breast reconstruction surgery available in South Africa?

Breast reconstruction surgery is a highly innovative field. In the last 15 years there has been great advances with very refined results. The DIEP flap reconstruction is the most advance type of reconstruction.  With this reconstruction the skin and fat from the lower abdomen with its blood vessels, the deep inferior epigastric perforators, are transferred to the chest to reconstruct the breast without the sacrifice of any of the abdominal muscles.

When is breast reconstruction considered ‘cosmetic’, what are the average costs, and when is a medical aid unlikely to cover them?

After breast cancer, breast reconstruction falls under PMB (prescribed minimum benefit) legislation.  This means that medical aids should cover the surgery.  To improve quality of life the reconstruction aims at 2 symmetrical breasts.  In cases where the opposite breast requires a lift of a reduction some medical aids might not cover that, but they will cover the reconstruction.  Cost varies greatly between the different procedures.

In cases of risk-reducing surgery (for instance when the patient has a family history of breast cancer and she wants to have a mastectomy to limit her chances of getting the disease), some medical aids might not cover the surgery. This varies from medical aid, as well as the plan option.

Are there any specific risks or complications associated with each of the common breast reconstruction surgeries listed above?

As with any operation, there are risks and complications.  The potential complications, according to the chosen procedure, will be discussed by your surgeon. Pre-operative instructions and post-operative care go a long way in reducing many potential complications.

Are there any cases in which breast reconstruction is not advised?

When the patient’s general condition does not allow it as a safe option. Patients report high satisfaction levels with improved body image, as well as improved quality of life after breast reconstruction.

 

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Dr Nicolette Landman

Plastic and Reconstructive Surgeon

admin@drnicolettelandman.co.za

0126529546