Breast reconstruction is all about the timing for best results

Posted on 15 October 2020

For women who have undergone a partial or full mastectomy, the decision on whether to reconstruct as well as timing is a personal one. But it can also be influenced by factors regarding the treatment being received along with considerations for the best outcome.

In many situations, it is preferable to have the surgery done straight away. According to Dr Carla Norval, Plastic and Reconstructive Surgeon at Mediclinic Sandton, “Immediate reconstruction can be done under the same anaesthetic as the lumpectomy or mastectomy.”

If patients are having breast conservation (i.e. lumpectomy/ segmentectomy), they will require post-operative radiotherapy to decrease the rate of local recurrence (the breast cancer coming back in the same breast). In these cases, it is much better to reconstruct the defect at the same time, as it results in better aesthetic result.

She explains, “Trying to reconstruct a deformed breast after radiotherapy can be extremely challenging and leads to problems with wound healing. In this case we would do the reconstruction as part of the initial surgery.”

“In the case of a mastectomy, there are several advantages of doing immediate reconstruction if the patient is fit and well. If done correctly, by a plastic surgeon with a special interest in breast reconstruction, the result is definitely superior. More skin is preserved and often the nipple and areola skin can be saved.” Dr Norval continues, “I further believe that if the right type of reconstruction is chosen, there is a definite psychological advantage as the patient feels more normal rather than being lopsided or flat chested. Immediate reconstruction also results in fewer anaesthetics. Performing a delayed reconstruction can be more challenging as the skin that has been removed would need to be replaced with skin recruited or imported from another site of the body. The nipple and areola usually further need to be reconstructed.”

As part of a multi-disciplinary approach to treating breast cancer, the team of doctors at Mediclinic Sandton Breast Care will be involved in the decisions before surgery. Dr Norval explains her role, “I prefer seeing the patient before her surgery to discuss her options. This enables her to make an informed decision regarding her surgery and reconstruction.”

On the specifics of reconstruction, Dr Norval explains the process, “Breast reconstruction is performed using either the patient’s own tissue or expanders and implants. The advantage of using expanders followed by implants is that it avoids scarring elsewhere. Inserting an expander usually entails a two week recovery period. Expanders are inserted to stretch the overlying muscle and skin. Once a desired volume is obtained, the expander is exchanged  a permanent implant. The recovery period after exchange of expander for implant is again two weeks.”

Finally, on the point of a patient opting for reconstruction, “I have found that breast reconstruction provides the patient with the self-confidence they need to continue their lives looking normal.”

The multi-disciplinary team of specialists serving within the Breast Care Centre provide more information on the importance of regular screening.


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