There is not one reconstruction method that will be suitable for every patient. The best outcome will vary depending on your body habitus, your general health, the characteristics of the disease being treating, previous treatments you have had, future treatments you will have and your own preferences.
Dr Teh has experience in all the procedures listed below.
Breast Implants/Tissue expanders
Breast implants after mastectomy is very different from cosmetic breast augmentation. In the latter, the implant is placed under a thick layer of breast gland which serves to not only hide the implant but also shields the implant from the external environment. The surgery involved in a mastectomy is also far more extensive with much more disruption to the blood and nerve supply of the breast skin and consequently, how it heals.
As a result of this, post mastectomy breast implant surgery is characterised by a much lower aesthetic satisfaction and increased complications compared to a primary cosmetic breast augmentation. Furthermore, in a unilateral implant only reconstruction, symmetry with the normal side is very difficult to achieve as the tissue behaviour and the feel of both breasts are widely dissimilar. A chest wall that has or will be irradiated is also a less than ideal environment for an implant based reconstruction. Autologous reconstructions are generally preferred in this setting.
The most ideal candidate for an implant only reconstruction is someone who is relatively slim with not a lot breast droop(ptosis), and is in need of a bilateral prophylactic mastectomy where both skin and nipple can be spared. In instances where the breasts are quite droopy, Dr Teh may recommend for the breasts to be lifted first prior to the mastectomy. This allows for a ‘delay’ phenomenon which helps to reduce the risk of nipple and skin necrosis whilst achieving better aesthetic outcomes.
Implant only reconstructions is only really suitable when done in the immediate setting. In a delayed reconstruction, there isn’t enough skin available to create an aesthetic breast mound. Tissue expanders do not work well in this setting. Also widely marketed are the use of ‘internal bras’ (synthetic meshes used to drape and hold the implant) as well as ‘slings (acellular sheets of human or animal skin) to create anchorage and coverage of the breast implants. Although good as an anchor, they are foreign in nature and do not provide an adequate barrier to infection (unlike vascularised tissue like a lat dorsi flap). According to several studies, they may in fact increase the risk of swelling and infection. Dr Teh prefers to use these devices only in very selected patients.
Unless you want to be reconstructed to a larger size than your native breasts, Dr Teh prefers to perform a one stage reconstruction by placing permanent silicone implants at the time of your mastectomy. These are placed either above or below your pectoralis muscle depending on how much soft tissue cover is left after your mastectomy. Should you wish to be a larger size, then you may have to have a 2 stage procedure. A tissue expander is placed during the mastectomy operation, and the expander is then filled gradually over the course of a few weeks. A second operation is performed some months later, and the expander is exchanged for a silicone implant.
In the past, textured teardrop implants were commonly used for breast reconstruction. Due to the emerging recognition of anaplastic large cell lymphoma and its relation to macro textured implants, Dr Teh prefers to use only smooth or nano/micro textured implants now. Increasingly there is a move away from implant based solutions in breast reconstruction towards tissue only techniques for this reason.
Latissimus Dorsi Flap