Breast cancer is surprisingly common; most people in New Zealand will, over their lifetime, know a friend or family member who develops this disease. Fortunately, early detection and treatment mean that most women with breast cancer will get through treatment and return to normal health. For many women who lose a breast to cancer, having a Breast Reconstruction is an important step in the process of recovering from breast cancer and getting on with their lives.
The history of Breast Reconstruction in Otago parallels that of plastic surgery. The ‘Father’ of modern plastic surgery Sir Harold Gilles was born and raised in Dunedin and his family home remains one of Dunedin’s stately homes, standing at 44 Park St (near the Cosy Dell tennis courts). In spite of this there was no plastic surgeon residing in Dunedin until the arrival of Mr Patrick Lyall in February 2007. Patrick undertook his medical training at Otago School of Medicine and trained as a plastic surgeon in centres around New Zealand before heading overseas to undertake Fellowship training in the UK. He completed his breast reconstruction training at the Queen Victoria Hospital, East Grinstead in 2006 and returned to New Zealand to become Dunedin Hospital’s first plastic surgeon. Previously, most women who wanted a breast reconstruction had to travel to Christchurch or further afield.
As demand grew, Dunedin Hospital gained a second plastic surgeon; Mr Will McMillan. Will is also a graduate from Otago School of Medicine and trained in various centres around New Zealand. He returned to Dunedin in September 2009 after undertaking further training at the Sydney Melanoma Unit (now Melanoma Institute Australia) and with the Melbourne Institute of Plastic Surgery.
The arrival of Mr McMillan has allowed the development of a Regional Service where surgery and clinics can now be attended in Southland Hospital.
Recently a third plastic surgeon, Dr Rebecca Ayers, commenced work at Dunedin Public and Mercy Hospitals. Rebecca is also a graduate of Otago Medical School and trained in New Zealand before undertaking Fellowship training in the UK. During this time she worked at Great Ormond Hospital for Sick Children, The Royal Free and The Wellington Hospitals in London. Rebecca then moved to Sussex, also working at the Queen Victoria Hospital in East Grinstead. A significant proportion of her work overseas consisted of primary and revision breast reconstruction as well as skin cancer and hand surgery. All surgeons are heavily involved with breast reconstruction and often work together in complex reconstructions or where both breasts need to be reconstructed at the same time.
Breast reconstruction involves the creation of a new breast shape from either the patient’s own tissues or using an artificial implant or both. The technique used depends on a range of factors, and not all women are suitable for all types of reconstruction. A reconstruction may be carried out at the time of removal of the breast or may be performed at a later date. Again, the timing will vary from woman to woman depending on factors such as the need for post-operative radiotherapy. The aim of breast reconstruction is to achieve breast symmetry. In a proportion of patients the ‘normal’ breast may need to be lifted or reduced to achieve symmetry. Nipple reconstruction is performed as a minor procedure at a later date once the new breast has healed and settled into position. There are two types of reconstruction most commonly performed in Dunedin. In the first, the patient’s own tissue is taken from the lower abdomen and shifted up to the chest. This is done while leaving the tissue attached to its blood-supply so that it survives in its new location. This is known as a TRAM flap (Transverse Rectus-Abdominus Myo-cutaneous flap). This is a long procedure with a relatively prolonged recovery time but gives a very natural looking and feeling breast. This technique cannot be used for reconstructing both breasts. The second common technique involves using a broad sheet of muscle taken from the back with its blood supply and a section of overlying skin (Latissimus dorsi muscle). This is brought through the armpit to the chest wall to provide cover for a breast implant. The implant is required because there is not enough tissue on the back to get the necessary volume to match the normal breast on the other side. Again it is a major operation especially when performed for bilateral breast reconstruction. It is more difficult to get a normal feeling breast.
The type and timing of breast reconstruction depends on many factors and patients discuss this with the surgeons well in advance of the procedure. Breast reconstruction surgery is now a reliable and commonly performed procedure. It is usually more time-consuming than the original removal of the breast and not all women are safely able to undertake the duration of surgery required.
Women who have had a breast reconstruction commonly report feeling happier and more self-confident.
Generally any woman who wants to discuss breast reconstruction can make an appointment through their General Practitioner, either at Dunedin Hospital or at Mr Lyall's, Mr McMillan’s, & Dr Ayers' clinic at Fernbrae House.