What is breast reconstruction?
Breast reconstruction is surgery to rebuild the breast mound after mastectomy. It can be done at the same time as the mastectomy (immediate reconstruction) or as a separate procedure later (delayed reconstruction). The aim is to restore the shape, size, and, where possible, the appearance of the breast.
Reconstruction does not restore normal sensation to the breast, and it does not affect the risk of breast cancer recurring. But for many patients, it significantly improves body image and emotional wellbeing after surgery.
Immediate vs delayed reconstruction
Immediate reconstruction is performed at the same time as the mastectomy. The patient wakes up with a breast mound already formed. This avoids a second general anaesthetic and is suitable for most patients who do not require post-mastectomy chest wall radiation.
Delayed reconstruction is done months or years after the mastectomy. It is preferable when post-mastectomy radiation is required, as radiation can affect the appearance and outcome of implant-based reconstruction. In these cases, it is safer to reconstruct after radiation is complete.
Implant-based reconstruction
- Sub-pectoral implant reconstruction: The implant is placed beneath the chest muscle (pectoralis major). This provides good soft tissue coverage over the implant and is a well-established technique.
- Pre-pectoral implant reconstruction: The implant is placed in front of the chest muscle. This avoids the need to divide the pectoral muscle, reduces post-operative pain, and allows a more natural movement of the reconstructed breast. It requires adequate skin thickness and is combined with an acellular dermal matrix (ADM) or mesh to support the implant.
- Tissue expander followed by implant: A temporary expander is placed first to stretch the skin, then replaced with a permanent implant. Used when skin needs to be gradually expanded before the final reconstruction.
Flap-based reconstruction
Flap-based reconstruction uses the patient's own tissue to rebuild the breast. This gives a more natural feel and appearance compared to implants, and the result tends to age more naturally with the body.
- Latissimus dorsi (LD) flap: Uses muscle and skin from the back to reconstruct the breast. Often combined with an implant to achieve the desired volume. The donor site is the back, leaving a scar.
- Chest wall perforator flaps: Uses tissue from the lateral chest wall, based on perforating blood vessels, to reconstruct the breast. Dr. Shruthi is one of very few surgeons in Hyderabad who performs this technique. It avoids the donor site morbidity of the LD flap and uses tissue that is close to the breast.
- Goldilocks mastectomy: Uses the lower breast skin and fat as a local flap at the time of mastectomy. Particularly suited for patients with larger breasts who want natural-tissue reconstruction without additional donor site surgery.
Reconstruction for BRCA-positive patients
BRCA-positive patients who choose prophylactic (risk-reducing) bilateral mastectomy are often excellent candidates for immediate implant-based reconstruction. Dr. Shruthi specialises in this combination, planning both the oncological and reconstructive aspects before the patient goes to theatre.
Nipple-sparing mastectomy is frequently used in this setting, giving the most natural appearance after reconstruction.
Recovery
Recovery depends on the type of reconstruction. Implant-based reconstruction generally allows patients to return to light activities in 2 to 4 weeks. Flap-based reconstruction involves more tissue work and requires 4 to 6 weeks before resuming normal activity. Dr. Shruthi provides a detailed post-operative plan at the pre-operative consultation.
What to discuss at consultation
- Your body type and existing breast size
- Whether you will need radiation (this affects the reconstruction approach)
- Your preference for implants versus own-tissue reconstruction
- Timing (immediate or delayed)
- Lifestyle and recovery expectations
- Nipple reconstruction options
Dr. Shruthi discusses reconstruction options at the pre-operative consultation, before mastectomy. Patients who understand what reconstruction is available, and who have had the chance to ask questions, report far better outcomes and satisfaction.