Breast Reconstruction Surgery
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Together with managing a new cancer diagnosis, the prospect of losing your breast(s) can be devastating. If one-sided surgery is planned, this may lead to an imbalanced proportions, as well as functional issues, such as neck, shoulder, and back concerns if the remaining breast is large. The change in chest appearance may lead to aesthetic dissatisfaction and loss of sense of self. The use of breast prostheses is a helpful alternative but can be cumbersome, especially in unique circumstances such as swimming or intimacy. Fortunately, Plastic Surgeons have developed breast reconstruction surgery techniques to help improve aesthetics and symmetry in women who require breast cancer surgery.
Breast reconstruction refers to a range of surgical techniques used to create a new breast mound after a mastectomy. This is done using specialized breast implants, your own tissue, or a combination of both. Implant Based | AlloPlastic Breast Reconstruction can be performed at the same time as your mastectomy. Dr. Ratanshi also offers Own Tissue | Autologous Breast Reconstruction. However, owing to limited operating room resources at this time, it is only offered in a delayed fashion at a later date after your mastectomy. Hybrid | Latissimus Dorsi Reconstruction is typically used for salvage circumstances in patients who are either not candidates or who have not had successful outcomes with either Implant-Based or Own-Tissue Reconstruction. Dependent on many factors, the overall process for our Surrey breast reconstruction surgery can require multiple surgical procedures and upwards of a year or more from your first surgery to final result.
Dr. Ratanshi is proud to offer Breast Reconstruction Surgery for women who require a mastectomy, or who have already undergone a mastectomy in the past. In women with larger breasts who require a lumpectomy and who are otherwise candidates for a Breast Reduction, Dr. Ratanshi may be able to reconstruct your lumpectomy defect with Oncoplastic Breast Reduction Surgery.
A mastectomy is a surgery procedure that removes the entire breast to treat breast cancer. It may be accompanied with a sampling of lymph nodes in your arm pit (sentinel lymph node biopsy) or removal of all of your lymph nodes (complete axillary lymph node dissection) for more aggressive cancer. This is performed by a General Surgeon who is specialized in Breast Cancer Surgery. Similar removing an avocado from its shell, or a kiwi fruit from its surrounding skin, a mastectomy removes the breast gland (with or without the nipple and areola) sparing the surrounding skin. Left alone, the skin will contract and adhere to the underlying pectoral muscle resulting in a flat chested appearance. The remaining skin is almost always permanently numb (i.e. without feeling) as the nerves supporting sensation are removed with the breast gland.
Women with smaller, less aggressive breast cancers that are a sufficient distance from the areola may be candidates for a lumpectomy. A lumpectomy is different than a mastectomy. A lumpectomy removes the cancer with a small safety margin of healthy tissue, leaving the majority of the breast intact. For this reason, it is sometimes referred to as Breast Conserving Surgery. Often, a lumpectomy is followed by radiation to reduce the risk of cancer recurrence at the surgical site.
Breast reconstruction has advanced substantially over the past 30 years. While excellent aesthetic result can be achieved in many patients, it is impossible to perfectly restore a natural breast. There are a range of strategies Plastic Surgeons use to help recreate a breast depending on a patient’s body characteristics and required cancer surgery. Most mastectomies involve removing the nipple, the surrounding areola and the underlying breast gland. Often, there is also a deficiency of some skin which must also be removed with your areola. Therefore, in order to create a new breast mound, three important components are needed – (1) sufficient skin to cover the entire surface of full breast mound, (2) an implant or your own tissue to replace the volume of breast tissue removed in your mastectomy, and (3) a shape and contour that resembles the natural aesthetics of a breast.
The most commonly used approach for breast reconstruction in Canada is Implant Based | Alloplastic Breast Reconstruction. Using this technique, your breast is reconstructed over two to three surgeries, each of which is a day surgery (i.e. you go home the same day). In your first surgery (ideally at the time of your mastectomy), a specialized inflatable device called a tissue expander is placed. During subsequent weekly office visits, the expander is serially inflated with sterile salt water. This helps slowly stretch your natural breast skin until there is enough skin to accommodate the volume of your final implant. Once you approach your goal volume/size, a second surgery is planned to replace the rigid expander with a softer, more supple implant. Some women may require touch up surgeries, such as fat grafting or nipple areolar reconstruction, which is addressed subsequently.
Women with sufficient abdominal tissue may also be candidates for Own-Tissue | Autologous Reconstruction. This is a more involved procedure that requires a two-to-three-day admission in hospital. Here, excess abdominal skin and fat below your belly button is removed and transplanted to the chest to recreate a breast mound. Like a transplant, it requires the connection of tiny blood vessels under a microscope to maintain circulation to the transferred tissue.
In patients undergoing one-sided cancer surgery, the reconstructed side may appear different than the remaining, cancer-free breast. Often, the reconstructed side can sit higher, and appear more full than the natural side, which could have descended with time.
Patients may require a balancing operation, such as a Breast Lift or a Breast Reduction to achieve better symmetry. During your consultation for your breast reconstruction Surrey plastic surgeon, Dr. Imran Ratanshi, will review this with you.
In patients with smaller breast volume with less natural breast descent, an oblique scar parallel to your bra line is typically used. In patients who have larger breast volume and more breast descent, an inverted T-scar may be required to help manage some of the excess skin present.
Breast Reconstruction Surgery to address a cancer deficit is a benefit of the British Columbia Medical Services Plan (MSP). Procedures to improve significant asymmetry, such as a single sided mastopexy or breast reduction after reconstruction of your cancer side are also benefit of MSP. Prior authorization, which includes submission of a photograph is often obtained from MSP before booking any secondary or revision surgery.
The purpose of breast reconstruction is to help restore pre-mastectomy appearance. For patients who may desire larger breast volume beyond their pre-mastectomy appearance, particularly if one-sided mastectomy is required, a private fee would be applicable for augmentation on the non-cancer containing side.
Many patients can achieve reasonable restoration of breast shape and contour with reconstruction. Some patients may desire additional cosmetic contouring to address bothersome areas of excess tissue. It is important to note that there is no breast gland tissue in the underarm (axillary) fat or in the upper outer quadrant of the chest wall.
These areas are left undisturbed following a mastectomy. Liposuction or excisional procedures to cosmetically address excess underarm (axillary) fat is not a benefit of MSP. Fees to address these areas start at $3000 + GST depending on the amount of tissue to be removed. Candidacy may be dependent on the need for radiation, as this can affect healing and your final result. Some patients who have undergone Own Tissue | Autologous Reconstruction may request additional abdominal liposuction or contouring. This can be done at the time of any other revision surgery. It is considered cosmetic and is not a benefit of MSP. Fees for abdominal liposuction start at $7500 + GST depending on the amount of tissue to be removed.
Dr. Ratanshi prioritizes patient safety and satisfaction above all. He is a double subspecialty-trained Plastic Surgeon and regularly performs aesthetic and reconstructive breast and body surgery as part of his practice. Dr. Ratanshi aims to utilize the latest evidence-based techniques and technology to deliver exceptional results. Dr. Ratanshi is committed to making your journey to enhanced beauty as comfortable and rewarding as possible.
