Breast reconstruction may be appropriate for women who:

• are undergoing mastectomy for breast cancer
• have previously undergone mastectomy
• have breast asymmetry or deformity following cancer surgery
• have congenital breast absence or deformity
• desire improvement in breast contour following previous reconstruction.

Good candidates are generally medically well, able to safely recover from surgery and have realistic expectations regarding reconstruction and recovery.

Factors that can affect suitability include:

• smoking
• obesity
• poorly controlled medical conditions
• previous radiation therapy
• previous abdominal surgery
• poor nutritional status.

If these factors are relevant to you, the Morphē team will work with you before surgery to help optimise your preparation and recovery. This may include support from our dietitians, physiotherapists, psychologists, breast care nurses, oncologists and other members of your treating team.

Your breast reconstruction will also be closely coordinated with your breast surgeon, as well as medical and radiation oncologists where appropriate.

Preparation for reconstruction focuses on optimising healing, minimising complications and supporting long-term reconstructive success.

Preparation may include:

• coordination with your breast surgeon and oncology team
• smoking cessation
• nutritional optimisation
• physiotherapy
• psychological support
• management of medical conditions
• imaging and reconstructive planning.

During your consultation, Dr Alex Cameron will assess:

• chest wall anatomy
• skin quality
• previous scars
• radiation history
• donor tissue availability
• breast symmetry
• body proportions
• reconstructive goals.

The goal is not simply recreating a breast mound, but achieving a reconstruction that feels balanced, durable and appropriate for your body and lifestyle.

Breast reconstruction is performed under general anaesthetic. The exact procedure depends on the reconstructive technique selected, your cancer treatment plan, your anatomy and whether reconstruction is being performed immediately or at a later stage.

Immediate reconstruction is performed at the same operation as mastectomy in collaboration with your breast surgeon. Delayed reconstruction is performed months or years after cancer treatment has been completed.

Implant-based reconstruction involves creating a pocket beneath the skin and soft tissues for an implant. Some patients undergo direct-to-implant reconstruction, while others require staged reconstruction using a tissue expander. A tissue expander is a temporary inflatable implant used to gradually stretch the skin and soft tissues before it is exchanged for a permanent implant.

In some patients, internal support techniques or acellular dermal matrix may be used to help support the implant and improve long-term shape.

Autologous reconstruction uses your own tissue to recreate the breast. The most common donor site is the lower abdomen.

DIEP flap reconstruction transfers skin and fat from the lower abdomen to the chest while preserving the abdominal muscles. This can provide a softer and more natural breast reconstruction while also improving lower abdominal contour.

Latissimus dorsi flap reconstruction uses muscle and soft tissue from the back to recreate breast shape. This may be appropriate for patients with limited abdominal tissue, previous radiation therapy or more complex reconstructive needs.

Fat grafting may also be used as part of breast reconstruction or revision reconstruction. This involves transferring fat from another area of the body to improve contour, soften transitions, address rippling or refine symmetry.

Revision reconstruction may also be performed to improve symmetry, contour irregularities, implant position, capsular contracture, rippling, volume mismatch or previous reconstruction outcomes. These procedures may involve implant exchange, fat grafting, mastopexy, flap revision, capsulectomy or contralateral breast symmetrisation procedures.

Drains and supportive garments are commonly used following surgery. Hospital stay varies depending on the procedure performed, however most reconstructions involve at least an overnight stay.

Dr Alex Cameron performs breast reconstruction procedures at Burnside Hospital, St Andrew’s Hospital or Glenelg Community Hospital.

Breast reconstruction aims to restore breast shape, contour and body proportion following breast cancer treatment, mastectomy or breast deformity.

For many patients, reconstruction can help restore a sense of balance in the body and make clothing, bras and swimwear feel more comfortable again.

The procedure can improve breast symmetry, chest contour and overall body confidence. It can also play an important role in emotional recovery following cancer treatment.

Your final result will depend on factors such as the reconstructive technique used, previous cancer treatment, radiation exposure, tissue quality, healing characteristics and body shape.

It is important to understand that a reconstructed breast will not feel or behave exactly like a natural breast. However, the aim is to create a breast shape that feels balanced, comfortable and appropriate for your body.

Some patients require staged procedures or revision surgery over time to refine contour, improve symmetry or support the best long-term result.

Recovery following breast reconstruction varies depending on the type of reconstruction performed.

Implant-based reconstruction generally involves a shorter recovery than flap-based reconstruction, such as DIEP or latissimus dorsi flap surgery. Flap reconstruction usually requires a longer recovery because it involves both the breast reconstruction and healing at the donor site.

Most patients can expect swelling, tightness, bruising and fatigue during the early recovery period. Pain is managed with a combination of simple analgesics and stronger prescription pain relief where required.

Drains and supportive garments may be used after surgery depending on the type of reconstruction performed.

As a general guide following implant-based reconstruction, most patients are able to return to regular activity as follows:

• Walking: day of surgery
• Driving: usually 3–4 weeks
• Desk-based work: usually 2–6 weeks
• Gym and strenuous activity: around 6–8 weeks
• Heavy lifting: around 6–8 weeks.

Recovery following DIEP or latissimus flap reconstruction is generally longer and will be discussed with you in detail during consultation.

Follow-up appointments are scheduled throughout your recovery and Dr Cameron is happy to review you at any stage if you have concerns.

All surgery carries some degree of risk. These risks are reduced through careful preparation, surgical planning, post-operative care and the experience and judgement of Dr Cameron and the Morphē team.

General risks associated with breast surgery will be discussed with you before your procedure.

Risks specific to breast reconstruction may include:

• Scarring. Scars are permanent, although most fade significantly over time.
• Wound healing problems. Delayed healing may occur, particularly following radiation therapy or in smokers.
• Infection. Infection may require antibiotics, implant removal or further surgery.
• Seroma. Fluid collections may occur and occasionally require drainage.
• Capsular contracture. Scar tissue around implants may cause firmness or distortion over time.
• Implant-related complications. These may include rupture, malposition, rippling or the need for future revision surgery.

Risks specific to breast reconstruction may include: (cont.)

• Fat necrosis. Small areas of firm scar tissue can occur within flap reconstructions or fat grafted areas.
• Partial or total flap loss. Microsurgical flap procedures carry a risk of vascular compromise requiring urgent return to theatre.
• Asymmetry. Minor asymmetry is common and additional revision procedures may be required.
• Abdominal weakness or bulging. This may occur following abdominal flap reconstruction, although it is less common following DIEP flap reconstruction than older TRAM flap techniques.
• Donor site complications. These may include scarring, contour irregularity or weakness at the donor site.