The Procedure and Surgical Techniques

Breast reconstruction surgery is specific to the individual. Your Specialist Plastic Surgeon will recommend a surgical approach that will safely restore your breast, without compromising the safe management of your breast cancer. There is a wide range of surgical approaches available for reconstructive surgery. Find comfort in knowing your surgeon is skilled in the latest breast reconstructive techniques, including:

Tissue expanders and/or breast implants

Tissue expanders are sometimes required to keep the breast envelope shape. Once placed, tissue expanders are filled over time with fluid injections, to allow extra room for reconstruction further down the track. Your surgeon will also discuss the options of breast implants to reproduce the shape of the breast.

Lipofilling

Lipofilling and fat grafting are options to use your own tissue to replace volume in the breast. This can be achieved by removing fat from the buttocks, abdomen or upper thigh. The fat is then separated, and the high fat concentrate is injected back into the breasts to produce shape and fullness.

Free Flap 

There are several different types of free flap that the Specialist Plastic Surgeons practicing at Adelaide Plastic Surgery use, two of which are the TRAM Flap and DIEP Flap. They all have the benefit of using microsurgery on blood vessels to move skin and soft tissue to the area that was removed in the mastectomy surgery stage. 

TRAM flap stands for Transverse Rectus Abdominis Muscle. In this procedure, an area of skin from your lower abdomen with the underlying fat and abdominal muscle is removed, and transferred to reconstruct your breast. This can be done as a free flap using microsurgery, or left attached to a cuff of blood vessels in what is called a Pedicled Flap. 

DIEP flap stands for Deep Inferior Epigastric Perforator. This transfers the same tissue as a TRAM flap except the abdominal muscle, which has the benefit of maximising muscle function in the abdomen.

Pedicled Flap 

In a Latissimus Dorsi Flap, muscle and skin located in your upper back is transferred to rebuild the breast. This type of flap is known as a Pedicled Flap, as the tissue is not disconnected from its blood supply. Because the area is close to the breast region, the skin colour is often a good match to the natural breast colour. This procedure is sometimes combined with a breast prosthesis. 

As mentioned above, a TRAM flap can also be performed as a Pedicled Flap.

Nipple and Areola Reconstruction

The surgeons work closely with many breast oncology surgeons and, where possible, they will always try to preserve the nipple so the appearance of the breast is changed as little as possible. In some cases this isn’t always appropriate. The surgeons will discuss reconstructing a nipple or tattooing to make the patient feel most comfortable.

Hospital Stay + Anaesthesia

For reasons of patient safety, breast reconstruction is always performed under a general anaesthetic with an anaesthetist present. Surgery can take place as a day procedure, but in some instances an overnight stay is required, especially if your surgery involves intricate flap reconstruction. 

Nipple and areola reconstruction can be performed safely under either general anaesthetic or local anaesthetic, and will usually not require an overnight stay.

Your plastic surgeon will discuss your options in your initial consultation and determine which is best for you. 

Your Consultation

In order to keep your consultation as smooth and efficient as possible, we ask that you please bring all relevant documentation with you on the day. This includes your referral letter, Medicare card, private health insurance details, any third party or return to work insurance information, and any relevant scans i.e. x-ray or ultrasounds. 

During your initial consultation with your Specialist Plastic Surgeon, you will have an extensive opportunity to discuss expectations and desired results. You will also have the opportunity to ask any questions you may have about the procedure.

You will then meet with one of our experienced breast care nurses, where you will have clinical images taken as a before and after reference for both yourself and your surgeon (please note that all our images are confidential and are stored securely online pursuant to the current Privacy Act). Your breast care nurse will also take your measurements and fit you for a post-operative bra. 

The final stage involves meeting with your surgeon’s personal assistant. You will be given an in-depth quote, including the surgeon, hospital and anaesthetist fees, along with some take home information on your procedure. 

There is a lot of information to take in after your first consultation. We encourage patients to go home and discuss their procedure with loved ones and come back for a second visit. We find patients almost always come back with additional questions they hadn’t previously thought of, and this second visit allows you to go into your surgery feeling confident and fully informed about your procedure. We recommend that you allow an hour for this consultation. Please keep this in mind when organising parking so that you don’t feel the need to rush.

Before Your Procedure

There are a number of things you can start to implement before your procedure, to encourage a smooth recovery and ensure you are as comfortable as possible post-surgery.

It is important that you:

• Exercise, as having good physical health will significantly help your recovery
• Are not currently pregnant or breastfeeding
• Provide a complete medical history to your specialist plastic surgeon, including all current medications, as some may need to be stopped prior to surgery
• Quit smoking
• Pre-arrange someone to transport you to and from your surgery, as well as stay with you 48 hours after returning home, due to the general anaesthesia required for surgery
• Ensure you follow pre-operative instructions, such as fasting times, or your procedure may have to be cancelled
• Have plenty of loose comfortable clothing that is easy to get in and out of post-surgery i.e. zip through jackets
• Prepare your recovery area! You’ll want to have everything you need to recover easily accessible and within arms reach. We suggest comfortable pillows, icepacks, prescribed medications, emergency contact details, a phone, as well as things to keep you entertained

Recovery

Recovery time varies with the individual and your time frame for recovery will depend on your individual surgery details, the nature of your employment and your overall level of health. Your surgeon will discuss this with you prior to surgery, and it is important to allow yourself the recommended recovery time. Vigorous activity and exercise should be avoided for the first six weeks, however gentle walking is encouraged after the first week.

On discharge, you will be given specific postoperative instructions to facilitate recovery, and a follow-up appointment will be made with your plastic surgeon. These instructions will cover everything you will need to know in order to make your recovery as smooth and comfortable as possible.  

After surgery it is common to have some bruising and swelling, as well as a feeling of tightness across your chest. This is perfectly normal, and typically resolves within the first two weeks, however can persist for up to a month. A tape dressing is applied across the incision lines, and remains until your first post-operative visit.  If you have had flap reconstructive surgery you will have a separate dressing on your donor site. Please keep in mind this type of surgery is complex and often requires a longer recovery period than other methods of reconstruction. Adequate pain relief will be provided to you by the hospital to keep you as comfortable as possible. 

You may be required to wear your bra day and night for up to six weeks from the day of your surgery. The bra helps control the bruising and swelling, gives you support and helps reduce your pain. Patients often purchase two post-operative bras, to allow one to be laundered while the other is worn. 

A plastic tube may be inserted into each breast to drain off any excess fluid. These will remain in place until the drainage is minimal, and are removed by a nurse usually a day or two after your surgery. Your sutures will be removed on day 10–14, unless your surgeon has used dissolvable sutures. Occasionally half your sutures are removed at this visit, and the other half are removed the following week.

We are dedicated to supporting you to make a swift, uncomplicated recovery. A 24/7 on-call medical assistance service is available for all post-operative patients. 

View our post-operation information here

Breast Implant Registry

The surgeons supported by Adelaide Plastic Surgery, are pleased to participate in the The Australian Breast Device Registry (ABDR).  The registry is designed to track patient health outcomes, monitor the long-term safety and performance of breast devices and benchmark the quality of surgery involving breast implants.
If you would like more information please click here.

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