Richard has a long history of involvement in breast cancer, both as a laboratory researcher into breast cancer biology some twenty years ago, and now active breast reconstructive surgeon, contributing to numerous anatomical and radiological studies investigating microsurgical breast reconstruction and long-time breast cancer survivor advocate.
In collaboration with our Breast Surgical Oncology and Medical Oncology colleagues, both in private and in two Melbourne public centres, Richard offers a full array of specialised options for reconstructive breast surgery. This includes:
- Alloplastic (implant-based) reconstruction, as both staged and ‘direct-to-implant’ techniques. This involves placement of a silicone breast implant in the mastectomy pocket to replace the lost size and shape of the breast. Depending on your individual case, Richard may offer this as a single-stage procedure during the same anaesthetic as the mastectomy, or offer a staged procedure, with initial insertion of a tissue expander device to hold space for later replacement with the definitive implant once other aspects of your cancer care have been addressed. Richard may also offer the use of an ‘internal bra’ layer of surgical material to provide added structure.
- Autologous reconstruction uses your own tissues to recreate the breast. Richard identifies tissue from elsewhere in your body, often the abdominal fat and skin (called a DIEP flap) or inner thigh tissue (called a gracilis myocutaneous flap), and transplants this tissue (known as a ‘free flap’) into the mastectomy pocket using highly specialised microsurgical techniques to reconstruct the breast shape.
Both of these options usually require more than one procedure for the final result. This may include adjustments in shape or volume of either your reconstructed breast or the unoperated breast in order to achieve the best symmetry. In addition, reconstruction of the nipple can also be undertaken.
What happens before surgery?
On the day of surgery, you will be checked in and all details confirmed. You’ll see the Anaesthetist and discuss your plan for pain relief. Richard will make some markings on the operative sites to guide during surgery, then pre-operative photographs before you go into theatre.
What happens during your surgery?
The anaesthetist will safely place you under general anaesthesia for the duration of your procedure. Depending on the surgical plan, you may need a urinary catheter and other surgical safety devices. These are often removed either at the end of the operation or the days immediately after as needed. The exact steps of the operation depend on whether you require an immediate or delayed reconstruction, using your own tissue or an implant to reconstruct the breast. As an estimate, immediate, implant-based reconstructions often take around three hours to complete, whilst autologous reconstructions can take five hours or longer.
What happens after surgery?
After completion of your breast reconstruction surgery, you will wake up in recovery and be closely assessed and observed by our skilled nursing staff. Once comfortable and awake, you will be moved to an inpatient ward to further rest and recover. Most patients have at least one surgical drain, and your reconstructed breast will be monitored for the duration of your stay. Richard encourages an active recovery, with mobilisation around the ward as soon as your able.
You will probably need a little help at home on discharge, so ask a friend or family member to assist you. As an indication, autologous reconstruction with a DIEP flap requires around one month off work and six weeks before you really start to feel like yourself again.
Possible complications:
The decision to undergo breast reconstruction surgery should only be made after considering if the potential benefits can achieve your aims, and whether the risks are acceptable to you. The possible risks/ complications of breast reduction include (but are not limited to):
- Cardiac problems, including heart attack or arrythmias.
- Venous thromboembolism (including deep vein thrombosis and pulmonary embolism, which may be fatal).
- Surgical site infection.
- Haematoma/ seroma requiring return to theatre.
- Failed free flap reconstruction (complete or partial)
- Urgent return to theatre to assess and attempt to resolve microvascular flap compromise.
- Wound breakdown, delayed healing or protruding sutures.
- Nipple/ areolar necrosis (partial/ total).
- Conspicuous scars, including hypertrophic, stretched or migrated scars.
- Possible need for revisional surgery. Richard will only consider revising your breast reconstruction if he believes:
- there is a definable structural issue with the breast position or shape,
- this issue is realistically able to be improved with surgery and
- the risk of revisional surgery causing a worse result are minimal.
- Dissatisfaction with the degree of breast reconstruction.
- Abdominal bulge or hernia, or umbilical necrosis (in the case of DIEP reconstruction).
- Breast asymmetry.
- Resorption or failure of fat grafting (if undertaken).