Obviously this is a massive topic so the following discussion is aimed at giving you general information and should be viewed as generic rather than specific to your circumstances.
The preface to these comments are to remember that your plastic surgeon will be bound by the over-riding priority of your holistic care and this prioritises your cancer treatment above all else. To be honest the great advances in breast reconstructive results which we have been able to achieve are as a result of modifying breast mastectomy incisions and techniques such that more and more tissue is preserved.
There is no doubt that the overwhelming decision you need to make about the ultimate breast aesthetics depends on whether you have an immediate reconstruction or not. The best results by far are achieved with an immediate reconstruction. The problem with a delayed reconstruction where the mastectomy is done first and the reconstruction done later is that the scarring is much worse and impacts the ability to achieve a good final result. In most cases the more skin and nipple areolar complex that is preserved the better cosmetic outcome.
The usual scenario involves a skin sparing mastectomy but taking the nipple areolar complex. This then entails a 3 stage reconstruction.
NB – Nipple sparing operations can also be done and in this case the last operation is not necessary.
- Skin sparing mastectomy and insertion of tissue expander
- Expander exchanged with definitive silicone implant
- Nipple reconstruction (and tattoo done as outpatient)
The process of tissue expansion is the same as the stretching of the abdominal skin in pregnancy. It is required in order to place less volume in the mastectomy pocket to allow the skin to rest which is required because it has had a surgical insult. When you wake on average you will be about half the size of what you previously were. Then once it the wound is healed the skin can be gradually inflated in the rooms with salty water. The tissue expander is essentially a spacer in order to stop the skin shrinking and preserve the shape of the breast. It will not look perfect to start with and is commonly too full at the top – this is normal. The expanders are not particularly comfortable and the expansion process often involves a stretching pain similar to if you have overworked a muscle. A one stage direct to implant reconstruction can be done in select cases but it comes with its own element of risk. (LINK to DTI in What’s new in plastic surgery)
The 2nd stage is done once all of the other breast cancer treatments are finalised. If this is not required such as in patients with pre-cancer DCIS then it is usually 3 months later. At this stage the final adjustments are made and a textured silicone teardrop shaped implant is inserted which will have a nicer shape and feel to it than the tissue expander.
The last stage is a nipple reconstruction and there are multiple techniques available to achieve this. The specific technique applicable to you will be discussed with you by your surgeon. The final stage is a tattoo for the colour of the nipple and areolar complex which is done by a cosmetic tattooist.
Also more info at http://www.vboc.com.au/