Dr. Davison specializes in all types of breast reconstruction after cancer treatment. His hospital practice is based at the MUHC Royal Victoria Hospital. Reconstructive surgery is offered to women to restore and optimize their breast shape and symmetry. This can be done following either a total mastectomy, partial mastectomy, or often at the same time as the mastectomy surgery. Consultations for breast reconstruction are seen at Dr. Davison’s hospital clinic. 

Goals of Breast Reconstruction

  • Symmetrical in Clothing

  • Balanced & Aesthetic shape

  • Proportionate size

  • Comfortable & Pain-free

  • Nipple reconstruction or Nipple preservation (if safe from the cancer perspective)

Timing of Breast Reconstruction

Reconstruction can be done either immediately  (at the same time as the mastectomy) or in a delayed fashion. There are many reasons why it may be better for a patient to have a delayed or 2-stage reconstruction, depending on what other cancer treatments are needed (Chemotherapy or Radiation Therapy), the skin quality and vascularity (healthy  blood supply) at the time of mastectomy.

Implant-based Reconstruction

Breast implants can be used to fill the internal space where the breast tissue has been removed. The outside skin and even nipple of the breast can often be saved if they are not involved with the tumor and an implant of similar size will be used to recreate the breast volume. It is never exactly the same since implants will be more round than natural breast tissue.  If you have only a unilateral (one-side) mastectomy & reconstruction, an optional procedure may be suggested to the other (natural) breast to improve the symmetry, such as  a reduction, mastopexy,  and/or small implant augmentation.

Recovery after Implant Reconstruction

Most women are comfortable to go home the same day after their mastectomy and immediate reconstruction with an implant or expander. It is necessary to use a drain, one per breast, which will be removed  on average 1-2 weeks later.  Most women are able to return to work in 2 – 4 weeks for an office job and could resume a more physically demanding job or full exercise 6 – 8 weeks after surgery. 

DIEP flap Reconstruction

In simplistic terms, this procedure takes the lower abdominal tissue, essentially a “tummy tuck” and transplants this to the chest.  The transplanted tissue is designed and tailored for the size and shape needed to remake the breast.  The blood vessels of the abdominal tissue are isolated and are then reconnected at the chest.  Microsurgery techniques are needed to reconnect one artery and one or two veins, each of 2-3 mm in diameter.

What to Know About the Procedure

Implants vs. Flap Tissue Reconstruction

  • Shorter surgery 

  • Faster recovery 

  • No scarring of other areas of the body

  • Predictable size

  • Your own tissue; no need for an implant

  • Tissue changes and ages with you

  • Potentially better match for the other breast

  • Essentially an abdominoplasty “tummy tuck”

  • Good for small breasts with minimal ptosis (no excess or deficiency of skin)

  • May need secondary (optional) Correction/touch ups

    • Approximately 30%

  • Sometimes using Mesh sling for support (Synthetic or Biologic)

This type of reconstruction involves 2 Stages.  The first stage is to place the expander and the second stage to remove the expander and place the final implant.  Tissue expanders are used to expand the breast envolope (Skin +/-muscle). Their job is to create a pocket for the final implant. Expanders are sequentially filled with saline fluid until the goal volume is achieved. This is typically done every 2 weeks, on average for 3 – 5 times. It is generally not painful, but may cause 1-2 days of mild soreness. It is usually stopped during chemotherapy and radiation treatments.

  • Inadequate skin envelope for immediate implant placement (such as when skin and/or the nipple-areola complex is removed)

  • Patient’s desire  to augment the Breast size

  • Significant excess skin with low nipple position

  • Skin flaps too thin, poor blood supply, or injured during mastectomy