Dedicated to the care of breast cancer and all breast conditions
Dr Sarah Rayne is no longer practising in
Johannesburg and this practice is closed.

These pages are for information only,
and current only until 2018
Breast Reconstruction  
Some of this page has been written by a colleague in reconstructive surgery, Dr Charles Serrurier

Breast reconstruction is an important part of any woman’s cancer treatment and can help to restore a feeling of normality. Reconstruction should possiblefor almost all women and discussion about reconstruction should happen at the same time as any discussion about surgery. Even in the government sector, reconstruction is offered and possible.

The timing of a patient’s reconstruction is dependent on many factors but can be immediate (at the time that the tumour or breast is removed) or delayed (after finishing all other treatments- either months or years after the first surgery).

Operations to reconstruct a breast can be divided by what is used to reconstruct the breast:
  • Your own tissue (Autologous reconstructions)
  • Silicone implants (Alloplastic reconstructions)
Some women may have a combination of both.

Reconstruction by moving your own tissue (Autologous reconstruction)
Using Silicone implants/prostheses (Alloplastic reconstruction)
Matching the breasts
Nipple reconstruction
Reconstruction by moving your own tissue (Autologous reconstruction)
These operations can be small and just within the breast, or large moving tissue from the tummy or back.Common operations are:

Wide Local Excision with local flap within the breast:The defect in the breast is reconstructed using the patient’s own breast tissue from the immediately surrounding area (parenchyma). It is often done in a manner similar to a breast reduction. All patients who undergo breast conserving surgery will have to undergo radiation therapy post operatively.

Latissimus dorsi flap (a ‘Lat’):The Latissimus dorsi muscle from the back of the shoulder of the patients can be used to fill small gaps in the breast or used to reconstruct an entire breast after a mastectomy. This is a great option if radiation is required.

Transverse rectus abdominusmyo-cutaneous flap (a ‘TRAM’): The fat from the lower tummy is used with some muscle underneath.This provides enough tissue to reconstruct after a mastectomy, but often happens at a second later operation (delayed). Another version of this using a smaller blood supply is the Deep Inferior Epigastric(DIEP) flap.

Other reconstructions: Some patients have significant extra tissue on the upper or lower buttocks and can be harvested and then transferred to reconstruct a breast. The tissue from the upper buttock is known as an Superior Gluteal Artery Perforator (SGAP) flap and the tissue from the lower buttock is an Inferior Gluteal Artery Perforator (IGAP) flap. The tissue from the inner thigh may also be used for breast reconstruction and is known as a Transverse Myo-cutaneous Gracilis (TMG) flap.
Using Silicone implants/prostheses (Alloplastic reconstruction)
Alloplastic reconstructions make use of breast prostheses (implants) similar to a cosmetic breast augmentation.These reconstructions are commonly performed because they are simple and give good results. In certain circumstances, the implant may be placed at the time of the mastectomy in a one-stage reconstruction where the skin of the breast is spared from surgery.

If skin cannot be spared a deflated implant (a tissue expander)is placed and gradually inflated over the course of the next couple of months to stretch the skin. When this is complete, the tissue expander is removed at a second operation and a permanent implant placed. This is described as a two-stage reconstruction. Implants do not suit patients who need radiation because of a high complication rate.
Matching the breasts
The other breast is also of concern during the reconstructive process. It is important to try and get the breasts matching in size and shape. Surgery can be carried out on the other breast to help this: this may include a breast reduction, a breast lift or even in certain circumstances a breast augmentation.
Nipple reconstruction
The final stage of breast reconstruction can involve reconstructing the nipple areolar complex (NAC) if it has been removed. This is often a separate operation later on using local tissue on the breast, and a skin graft from elsewhere (the tummy or thigh are common sites). Final tattooing of the area helps match the areola colour.
No surgery is without potential risks and complications; however breast reconstruction has a relatively low rate of complications. Autologous reconstructions are tend to have more difficulties early on but later on are generally extremely stable. Alloplastic reconstructions are more straightforward to begin with, but can result in long term complications related to the implants such when they then become hard due to capsule formation. This leads to distortion of the breast and may causing pain. Fortunately this is an uncommon finding but will require further surgery.

Breast reconstructive surgery is complex and multifactorial. There are many different operations and certain breast reconstructive surgeons have a preference for a particular type of reconstruction. A patient with breast cancer needs to be treated in a multidisciplinary unit where all types of reconstruction can be offered as certain patients will be better suited to certain types of reconstruction. The patient’s requests and cosmetic expectations need to be integrated into this complex process so ultimately the patient receives safe oncological surgery and ends up with a reconstruction that meets her expectations.