Dr. Darrell Perkins has helped many breast reconstruction patients from across New South Wales, including Sydney, Sutherland Shire, Kogarah, Caringbah, Miranda, and the South Coast. His experience, skill, and results are respected and renowned throughout the region.
Goal of Breast Reconstruction
The goal of breast reconstruction is to produce a breast mound that matches a natural breast in size, shape and position. This is so the patient can normalise their lifestyle with respect to the clothes they wear, the activities they undertake and their own self confidence. Women who have had the misfortune of living with a mastectomy know the difficulties in choosing clothes to hide an external prosthesis and the almost impossibility of getting swimwear that they feel confident to wear. Breast reconstruction frees the patient from these constraints and allows the patient to lead as near a normal lifestyle as possible.
Timing of Breast Reconstruction
Breast reconstruction in broad terms is done either as a primary procedure, which means it is done immediately at the same surgery as the mastectomy. Alternatively, for woman who have already had a mastectomy, the reconstruction is called “delayed” or “secondary reconstruction” and this is performed sometime after the mastectomy, usually after all adjuvant therapies have been completed and the patient has recovered from those therapies.
Breast Reconstruction and Recurrent Breast Cancer
In the past many myths have been spread about the inappropriateness of having a breast reconstruction performed immediately at the time of the mastectomy. The fear was that the breast reconstruction would mask any potential recurrences of the breast cancer and may affect implementation of adjuvant therapies, such as chemotherapy and radiotherapy, in a timely manner. These very specific points have been studied extensively and to summarise, it can be very confidently said that having immediate reconstruction has no adverse affect whatsoever on the risk of developing cancer into the future. It can also confidently be said that there is no affect on the ability to detect recurrences of breast cancer in the future even on the side of the breast reconstruction. Essentially the mastectomy flaps that are left behind are sitting on top of any form of breast reconstruction and are easily palpable and thus any recurrence, which would normally occur in the flaps, is easily palpable or detectable.
Studies have also very specifically looked at whether complications from immediate reconstruction in any way have affected the timely implementation of adjuvant radiotherapy and chemotherapy, i.e. has the complications from the surgery prevented the patient from having their radiotherapy and chemotherapy as planned? In summary, the studies have not shown this to be a significant factor at all, and the facts would appear to be that there is no oncological (cancer reason) for not having an immediate reconstruction.
Radiotherapy and Breast Reconstruction
Whether a patient requires radiotherapy depends very specifically on many factors including the type of tumour, the size of the tumour, whether lymph nodes are involved in the axilla and the presence or absence of hormone receptors on the tumour cells. The requirements for radiotherapy is always something very extensively discussed between the patient and the radiation oncologist. In certain circumstances, certainly radiotherapy provides significant improvements in disease-free and survival rates. From the reconstruction point of view though there is a price to pay for radiotherapy.
In the primary breast reconstruction, basically radiotherapy has an adverse affect upon all types of reconstruction both with autologous flaps (your own tissue) or with prosthetic reconstructions. It is conventional wisdom now that if the lady is known to require radiotherapy postoperatively, then it is best to delay the reconstruction to the secondary stage after the radiotherapy is completed. This avoids the breast reconstruction being irradiated and the potential complications and suboptimal results that could eventuate under that circumstance.
In the delayed or secondary reconstructions, for multitudes of reasons, prosthetically-based reconstructions are generally not ideal and are to be avoided unless there is absolutely no other option available. Prosthetic reconstruction in the face of radiotherapy to the chest wall results in an unsatisfactorily high complication rate and poor cosmetic results. Although nothing is an absolute, usually a better solution can be found for a breast reconstruction under this circumstance.
Serving breast reconstruction patients from Sydney, Kogarah, Wollongong, and throughout New South Wales, our practice welcomes you to contact us today if you have any questions or if you would like to arrange a consultation with Dr. Perkins.
Types of Breast Reconstruction
In broad terms, breast reconstruction falls into three groups.
- Prosthetically-based involving either the use of a tissue expander or a silicone style of prosthesis.
- An autologous flap (your own tissue) which commonly today would take the form of the TRAM flap (transverse rectus abdominus myocutaneous flap). This is the roll of fat and muscle in in the lower abdomen in the region where tissue would normally be removed during an abdominonplasty (tummy tuck).
- A combination. This most commonly is a Latissimus dorsi flap which usually requires having a prosthesis placed as well to get adequate volume for the reconstruction. The latissimus dorsi is a broad, flat muscle in the back and usually requires a paddle of skin to be taken to replace the skin that is missing following a mastectomy.
All these forms of reconstruction can produce excellent results or ordinary results. It is very important that each patient is individually analysed and the various prejudices, ideas and preferences of the patient are taken into account to come up with an appropriate solution for the patient in that circumstance. In my practice I come across many patients with many different lifestyles, past experiences and factors unbeknown to me which need to be put into the mix to make a decision that is right for that particular patient. For example, a patient with very young children or a baby may steer away from an operation with a long recovery time simply for the practical reality of having to care for their children.
Contact Our Breast Reconstruction Practice Serving Patients from Sydney and across New South Wales
Contact our practice serving breast reconstruction patients from Sydney throughout New South Wales to meet with Dr. Darrell Perkins and discuss the technique that’s right for you.