Breast reconstruction is a surgical procedure commonly performed after a mastectomy to offer patients psychological and aesthetic benefits when recovering from breast cancer. This procedure allows many women to fully return to the life they enjoyed before being diagnosed with breast cancer.
Uniquely, Maisam Fazel is one of the few surgeons in the UK who can offer a wide range breast reconstruction options immediately at the time of the breast cancer surgery. Mr Fazel can also perform delayed breast reconstructions for those patients who were not given the option of breast reconstruction at the time of their mastectomy, or for those who prefer to complete all their breast cancer treatment before embarking on breast reconstruction. As there are a number of different breast reconstruction options. Mr Fazel spends a long time understanding a patient’s oncological and aesthetic concerns in order to offer the most appropriate reconstructive options.
This is one of the most common types of breast reconstruction and involves placing a breast implant under the chest wall muscle to reproduce the shape of a breast.
The procedure is usually done in two stages: At the time of the mastectomy, a tissue expander is placed under the chest wall muscle. Once the patient has recovered from surgery, small amounts of saline are added to the tissue expander on a weekly basis until the tissue expander reaches the desired size. In a second operation (usually three to six months later), the tissue expander is removed and replaced with a silicone gel implant of the appropriate size. A two stage implant reconstruction is usually required when performing a delayed breast reconstruction.
Mr Fazel also frequently performs one stage implant reconstructions using special synthetic or biological materials to support the implant and to give the reconstructed breast a natural shape (ptosis). This allows the breast reconstruction to be performed in one operation producing the desired aesthetic result immediately.
Latissimus Dorsi Flaps
After tissue expanders and implants, latissimus dorsi (LD) muscle flaps are the next most common form of reconstruction. The LD flap has been used successfully since the 1970s. Composed of soft tissue, this type of flap often enhances an implant reconstruction to produce breasts that looks and feels more natural. During an LD flap reconstruction, a muscle flap is taken from the back and moved through a tunnel in the armpit to the front of the chest. The LD flap receives its blood supply from the thoracodorsal artery, which remains attached after surgery to ensure proper blood flow. The procedure usually takes two to three hours to perform, and patients remain in the hospital for three to five days.
It is often necessary to place a silicone gel implant underneath the LD flap to help create the volume in the reconstructed breast. This in turn allows better symmetry between the reconstructed and natural breasts. Alternatively, Maisam Fazel is amongst a handful of surgeons in the UK who now combine lipomodelling with an LD breast reconstruction. In this process, fat is taken from the patient in a similar way to liposuction and re-injected into the reconstructed breast to give it greater volume. In this way, the use of an implant can be avoided. Occasionally, the lipomodelling process may need to be repeated to produce the desired volume effect.
Since an LD reconstruction involves two different surgical sites, recovery can take a little longer than just an implant reconstruction. There will be scars in the breast area and the back. The back incision can be made horizontally and then efficiently concealed with a bra strap. Patients will likely need to rest at home for three to six weeks. It is especially important to avoid heavy lifting and strenuous activity during the healing process.
Transverse Rectus Abdominis Myocutaneous (TRAM) and Deep Inferior Epigastric Artery Perforator (DIEP) Flaps
During the transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) flap reconstructive procedures, an incision similar to that used in a tummy tuck is made in the abdomen to lift layers of skin, fat, muscle and blood vessels. The abdominal tissue is then separated from the body and reattached to blood vessels in the chest wall (as in a DIEP) or a tunnel is created under the skin into the chest wall to relocate the abdominal tissue to the breast area (TRAM). In both cases, the breast mound is then carefully reshaped with these tissues.
Breast reconstruction with a TRAM or DIEP flap often takes five to eight hours to perform and requires a hospital stay of five to eight days. Patients may experience abdominal pain and tightness for several weeks, and it may take a few months to return to full activity. However, TRAM and DIEP flap breast reconstructions are able to produce a breast that looks and feels natural, and provides the added benefit of a flatter abdomen from the tummy tuck procedure.