Breast Reconstruction in Vancouver

Breast Reconstruction in Vancouver

This page is meant to be a resource for women with breast cancer who are considering breast reconstruction in the Vancouver area. Breast reconstruction is a woman's choice and for some, it is an important part of comprehensive cancer care. Dr. Reid works collaboratively with general surgeons and oncologists in Vancouver, Richmond and Delta to ensure that breast reconstruction is delivered safely, without compromising your cancer treatment.

What if I've recently been diagnosed with breast cancer?

If you have recently received your diagnosis, you may still be waiting for your doctor's final recommendation on the timing and type of cancer treatment that will be required. It can be difficult to understand at what point breast reconstruction can or should be initiated. Although the treatment of your breast cancer is first and foremost on everyone's mind, an early referral to Dr. Reid can help ensure that your breast reconstruction is coordinated at the optimal time. Consultations are meant to be informative, and there is no expectation that you will make a final decision regarding breast reconstruction at that time.

For more information on breast reconstruction with Dr. Owen Reid,
request your consultation today or call our office at 604-343-9309.

What is breast reconstruction?

"Breast reconstruction" is a general term that refers to the many surgical techniques used by plastic surgeons to create a new breast. This type of surgery is most often required following a total or partial mastectomy. The aim of breast reconstruction is not only to create a new breast, but also to improve your quality of life and the way you feel about your body.

How do I make an appointment to see Dr. Reid?

To see Dr. Reid in consultation regarding breast reconstruction, have your oncologist, general surgeon or family doctor make a referral. Breast reconstruction is a core component of Dr. Reid's hospital practice in Richmond. He is one of a handful of surgeons offering this type of care within the Vancouver Coastal Health Region.

What happens during my consultation?

Consultations take place in our Richmond office and last about 30-40 minutes. Dr. Reid will review the documents received as part of the referral made by your doctor. The details of your breast cancer diagnosis and treatment will be reviewed along with your medical history. Dr. Reid will present some of the key considerations regarding breast reconstruction and ask about your preferences. Following a physical examination, Dr. Reid will make some recommendations about the reconstructive options that are best suited to you. We encourage you to bring a friend or family member to the consultation if you think that would be helpful.

Important considerations regarding breast reconstruction

As part of your initial consultation, Dr. Reid will help you focus on some of the key considerations to help you develop a better understanding of the following issues:

  • Is breast reconstruction right for me?
  • When is the best time to begin the process? During or after my cancer treatment?
  • Which breast reconstruction technique is right for me?
  • What are the alternatives to the recommended treatment?
  • What is the expected result?
  • What will the recovery be like?
  • What are the potential risks associated with surgery?

Who is a candidate for breast reconstruction?

Although your age or general health may impact the choice of breast reconstruction technique, it is very rare that a patient is not a candidate for a reconstruction of any type. Dr. Reid will help you weigh the risks and benefits of the proposed treatment options so you can make an informed decision.

When is the right time to have breast reconstruction?

There is no right answer to this question. With respect to timing, breast reconstruction can be either "immediate" or "delayed".

  • The process of “immediate” breast reconstruction begins at the time of the mastectomy (removal of the breast)
  • In contrast, “delayed” breast reconstruction begins anytime following the mastectomy, be it months, years or even decades.

What is the best technique for breast reconstruction?

There is no one best technique. Deciding on a surgical plan is a complex process, and Dr. Reid will make recommendations based on factors related to your cancer diagnosis and treatment, your general health and your preferences.

There are many breast reconstruction techniques to choose from. They can be categorized into those that use:

  • Your own tissue
  • A combination of temporary and/or permanent breast implants, or
  • A combination of your own tissue and a breast implant

Some patients will be ideally suited for an implant reconstruction, while others may be better served by a technique that uses their own tissue. As part of your consultation, Dr. Reid will direct you towards those techniques that are best suited to you.

Immediate Reconstruction with Breast Implants

Immediate reconstruction with breast implants is the most common treatment option. Itís particularly well suited to those patients who:

  • are having bilateral mastectomies and reconstruction
  • have minimal ptosis of the contralateral breast
  • would consider having a breast lift or reduction of the contralateral breast
  • who would prefer to have a smaller procedure and a shorter recovery

For patients with a new diagnosis of breast cancer, our staff will coordinate with the General Surgery office to arrange your treatment urgently. All procedures take place at the Richmond Hospital. To complete the reconstruction, usually two procedures are required.

Your General Surgeon and Dr. Reid will work together during the first procedure which will include the mastectomy, the lymph node biopsies (if indicated) and the first step in the breast reconstruction process which is placement of a tissue expander with or without Allograft. The procedure takes 2 - 3 hours and most patients are discharged home the same day. Patients who are having bilateral mastectomies may be encouraged to stay overnight. Post-operative visits with Dr. Reid will take place after 4 - 5 days, 2 weeks, 4 weeks and as needed thereafter to complete the tissue expansion process.

The second stage of the breast reconstruction process takes place approximately 4 months after the first procedure.

During the second procedure, the tissue expander is removed and a permanent breast implant is placed. In addition, other refinements are often made to the breast and the surrounding areas in an effort to enhance shape and symmetry. To further assist with the restoration of breast symmetry, patients may choose to have a contralateral breast lift, breast reduction or breast augmentation as part of this second procedure. An overnight stay is not required. In comparison to the first procedure, the second procedure is associated with less post-operative discomfort and a shorter recovery.

FAQs

Is breast reconstruction covered by MSP?

Yes, reconstruction is a benefit of our provincial health insurance plan.

Will breast reconstruction delay my mastectomy?

If arranging immediate reconstruction is going to significantly delay your mastectomy you will be given the option to proceed with a mastectomy alone.

Will reconstruction interfere with my cancer treatment?

Choosing to have breast reconstruction will not significantly impact your cancer care nor will it elevate your risk of recurrence.

Should I have a contralateral mastectomy?

Dr. Reid can discuss the reconstructive implications of choosing to have, or not to have, a contralateral prophylactic mastectomy. However, if you would like more information regarding your risk of developing cancer in the other breast please ask either your general surgeon or your oncologist.

Timing of radiation?

When indicated, adjuvant radiotherapy should begin within several weeks of the mastectomy. Ideally, the tissue expander would be fully inflated before radiation therapy begins. Radiation may make the skin stiffer and therefore, itís easier to expand the skin prior to the radiation therapy.

What type of breast implant does Dr. Reid use for reconstruction?

Silicone gel implants have been the best and most commonly used option since the late 1990ís. Saline implants are an alternative, but they don't feel as natural or as comfortable and they are more likely to produce visible rippling.

Are breast implants safe?

Every medical device, be it a breast implant or a mechanical heart valve, has the potential to fail or contribute to post-operative complications. Silicone gel implants are the most common choice for breast reconstruction in my practice, in the Vancouver area and across the country. More information is available in the office.

What is a Tissue Expander?

The purpose of a tissue expander is to slowly stretch the skin in preparation for the placement a permanent breast implant. It is a temporary device that allows for gradual filling during office visits.

How is the tissue expander filled?

Tissue expanders have a metal valve that is embedded in to the shell of the device. In the office, the valve is located with a magnet and then a needle is passed through the skin in to the valve (numbness from the mastectomy often makes this painless). Saline is then put through the needle into the expander.

How much saline is added during each expansion? How many expansions will there be?

The volume of saline added during a single expansion is usually 60 - 120cc, but it depends on how tight the skin is. Commonly, 2 - 4 expansions are required.

Is it possible to remove fluid from the expander?

During the post-operative office visits, the tissue expander is filled with saline. The goal, with each expansion, is to induce some stretching of the skin without creating significant discomfort. Rarely, the tightness created by the expansion contributes to discomfort that was not appreciated during the office visit. In such cases, patients can return to the office to have fluid removed from the expander.

How and when do we determine breast size?

The determinants of final breast size include patient preference, the size of the contralateral breast and technical factors. Throughout the tissue expansion process, patients will have an opportunity to direct the final outcome. During the second procedure, tissue expanders are removed and replaced with a permanent breast implant. In one of the office visits prior to this procedure, and with each patient's preferences in mind, Dr. Reid will select a range of breast implants that will be available in the operating room. The final decision is usually made at the time of surgery.

How long can the expander stay in place?

There's no limit to how long the tissue expander can remain in place.

Can I travel with the tissue expander in place?

Yes you may travel and fly with the expander. There is a metal valve embedded in the expander which may be detected at airport security. As such, it is recommended that you carry your 'expander identification card' when travelling.

Mastectomy types? What will happen to the nipple? Incisions?

The incisions used for a mastectomy, prior to immediate breast reconstruction, are variable. Dr. Reid will decide what's best for each patient in conjunction with the general surgeon who is doing the mastectomy. In many cases, it is possible to preserve the nipple and areola. In other cases, the nipple and areola need to be removed in order to adequately treat the breast cancer.

Will I have drains after surgery?

Drains are routinely used following the mastectomy and tissue expander placement. Drains are seldom used after the second reconstructive procedure.

Why I don't normally do direct to implant reconstruction

A 'direct to implant' reconstruction implies that the permanent implant is placed at the time of the mastectomy and thus only one procedure is required. Technical considerations dominate the surgical planning and therefore patients will have less input on the aesthetic outcome. In addition, in my practice, outcomes have not been as good and complication rates are higher.

Nipple reconstruction?

Nipple reconstruction is optional. If chosen by the patient, nipple reconstruction takes place months after the second stage of the reconstruction. Most patients choose to have a tattoo and this is currently being offered by a nurse at the Eagle Ridge Hospital.

What is the role of Allograft?

Dr. Reid may choose to use an allograft material during your reconstruction. The allograft is an Acellular Dermal Matrix. There are numerous indications for its use. More information is available in the office.

What is fat grafting and when is it used?

Fat grafting can be used to improve the contour of a reconstructed breast. This surgical technique has 2 steps: the collection of fat by liposuction, and the re-injection of fat in to the breast area. Fat grafting usually accompanies the 2nd stage of the breast reconstruction. The necessary liposuction may add significant discomfort to an otherwise relatively painless 2nd stage procedure.

Where can I find more information on breast reconstruction?

Please visit our patient resource page to find more information on the available breast reconstruction techniques as well as some links to related websites.

Additional Breast Augmentation Information:

Call 604-343-9309 to request your consultation today for breast reconstruction
with Dr. Owen Reid.