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Fewer women opt for breast reconstruction after a mastectomy in Australia than in other parts of the world, but a new technique may change all that. Sarah Marinos investigates

This year, more than 15,000 women in Australia will be told they havebreast cancer, and about 6000 of these will have one or both breasts removed. Following a mastectomy, one in 10 of these women will opt for a breast reconstruction.

This can be an invasive and painful journey, which may partly explain why the Australian Society of Plastic Surgeons (ASPS) says breast reconstruction rates are lower in Australia than in the US and UK, where one in two American women and one in five British women have a reconstruction after a mastectomy.

“We’re concerned the relatively low number of women in Australia electing to have a breast reconstruction suggests they’re not being made aware of the options available to them and of the possible benefits of reconstruction,” Hugh Bartholomeusz, reconstructive surgeon and president of the ASPS, says.

“We respect that breast reconstruction is a personal choice and not for everyone. However, we encourage patients and doctors to start the conversation about breast reconstruction early, so women are made aware of all available options and can make an informed choice.”

New technology

The most common reconstruction is an implant (such as saline or silicone), which is inserted under the skin and muscle to create a breast shape. A crucial part of this process is the “expander”, which is inserted to help breast tissue grow and make room for the implant.

In the coming months, several surgeons in Australia will begin using a new device called an AirXpander, which clinical trials have shown to work up to three times faster than traditional saline tissue expanders. That means fewer surgery visits, no saline injections and greater patient control over the pace of expansion. Perth-based plastic and reconstructive surgeon Dr Tony Connell is one of the first practitioners worldwide to use the technology. He says it’s “evolutionary”.

“With saline expanders, a surgeon injects about 60ml of saline each week until you reach the correct volume. That has to be done in surgery,” he explains. “If a woman has dense scar tissue, the injection can create a tight, uncomfortable feeling – there’s also the risk of infection.”

AirXpanders contain carbon dioxide and the patient presses a button on a handheld device to gently inflate up to three times a day. A set amount of CO² is released each time from a reservoir within the device.

Win for rural patients

Bartholomeusz says technologies such as AirXpanders offer potential benefits for women in rural and regional Australia.

“It can cut the number of times they need to visit their surgeon to have their breast tissue expanded. It could also significantly reduce travel time and associated costs,” he says.

Connell adds: “This is great technology for a deserving group of patients.”

Other surgical advances

•               Tissue flap reconstruction: In this case, a woman’s own skin, fat and muscle is used as the implant. The success rate has improved dramatically in recent years.

•               Acellular matrix application: This is a surgical mesh to cover implants. “It’s an extra layer of protection between the implant and the skin,” Dr David Speakman, adviser to Cancer Council Victoria, says.

•               Integrated plastic surgery team: Some hospital breast units have a team that supports a woman’s treatment program. This includes surgeons, specialist nurses, oncologists and reconstructive surgeons.

Know your options

It’s OK to shop around: You can ask for referrals for more than one reconstructive surgeon, and you can also ring around hospitals to find the shortest wait list.

You don’t have to decide immediately: Reconstruction can happen months or years after a mastectomy. 

Reconstructions are available in public and private hospitals, and are free in the public health system, but the waiting times can be longer: You can put your name down on a public list even if you’re still deciding.

Reconstructed breasts will look and feel different: Nerve damage that occurs during a mastectomy means that reconstructed breasts won’t have much feeling. 

Consider a prosthesis: These have the weight, shape and feel of a natural breast, and are often inserted into bras or directly onto skin.

Every woman is different: Your decision will depend on the type of treatment your cancer requires, as well as financial concerns.