What is immediate breast reconstruction?

Dr Cheung is a strong advocate for immediate breast reconstruction because she understands that minimising the physical impact of surgery can immensely improve how a woman copes with her cancer treatment.

In breast-conserving cancer reconstruction, the cancer is removed but the breasts are preserved, although they may appear slightly smaller.

This type of surgery is called a lumpectomy and is recommended in certain cases with early detected, small breast cancer.

The procedure requires removing only the lump with an adequate margin of surrounding normal breast tissue (wide local excision).

It is performed in a manner as to provide the best possible cosmetic outcome, as breast cancer surgery can have a powerful impact on a woman’s relationship with her body and her sense of femininity.

The surgery is conducted under general anaesthetic in hospital as a day procedure.

Additionally, during the operation some lymph nodes in the axilla (armpit) will be removed and tested (sentinel lymph node biopsy) to check if cancer cells have metastasised (spread to lymph nodes) or will be removed if cancer cells are detected.

Radiation therapy is almost always recommended after surgery to reduce the risk of recurrence in the breast.

Dr Cheung also performs lipofilling or fat grafting during immediate reconstruction if required. This is a procedure used to reshape your breasts by modifying the shape, increasing the volume and profile of your breasts through the transfer of fat cells from one part of your body to another.

Breast reconstruction using lipofilling can improve defects, symmetry, volume and refine your breasts soft tissue and the for correction of scarring. Many women say this means they can wake up with breasts  and not feel as if they have “lost their womanhood” after cancer surgery. Find out more here. 

What do patients need to know about this surgery?

• The national rate of immediate breast reconstruction surgeries is currently 12%
• However, when given the option 95% of patients choose immediate breast reconstruction
• Recent statistical data of medium and long term results for immediate breast reconstruction shows it is safe with no adverse impact on survival rates
• “Sacrifice the breast and worry about reconstruction later” is an outdated approach to managing breast cancer as it is rarely necessary.

What is the treatment?

Dr Cheung performs several different breast reconstruction techniques using advanced technologies.

Every patient is assessed to provide a tailored, personalised holistic treatment plan, taking into account their condition, body shape, physical fitness and other factors.

Many patients have reconstruction surgery at the time of cancer removal, which can eliminate the need for a second major surgery and the cost, pain and recovery time of a second surgery.

There are instances where immediate breast reconstruction surgery may be delayed due to radiation therapy or a high-risk situation, but Dr Cheung will advise on the most appropriate treatment for your situation, prior to surgery.

Generally there is  quick recovery, where admission for full or partial mastectomy and reconstruction only requires admission into hospital for 1-3 nights depending on the fitness of the patient.

What are the risks of fat transfer breast augmentation?

Risks of fat transfer breast augmentation includes cysts, infection, and less commonly breast microcalcification (tiny deposits of calcium salts too small to be felt which are often detected on imaging).

In most cases, these deposits are benign, but occasionally can be an early sign of breast cancer. 

Another rare complication is necrosis or death of fat cells which may cause a lump (of  fat cells). These are usually painless and harmless and do not increase your cancer risk.

Fat transfer procedures have been around for more than 20 years, however the amount of fat transferred previously was quite low volume because surgeons were initially concerned this could cause lumpiness with just 10 to 20 mls of fat.

However in the newer style procedures up to 400mls can be transferred to provide usually permanent breast augmentation with a risk of lumpiness that is very low.    

What does the treatment involve?

Dr Cheung performs several different breast reconstruction techniques using advanced technologies.

Every patient is assessed to provide a tailored, personalised holistic treatment plan, taking into account their condition, body shape, physical fitness and other factors.

Many patients have reconstruction surgery at the time of cancer removal, which can eliminate the need for a second major surgery and the cost, pain and recovery time of a second surgery.

There are instances where immediate breast reconstruction surgery may be delayed due to radiation therapy or a high-risk situation, but Dr Cheung will advise on the most appropriate treatment for your situation, prior to surgery.

Generally there is  quick recovery, where admission for full or partial mastectomy and reconstruction only requires admission into hospital for 1-3 nights depending on the fitness of the patient.

What are Dr Cheung’s breast credentials?

Onsite Ultrasound

Dr Cheung has extensive experience in-room targeted breast ultrasound  that can enable direct clarification of symptoms, and provide more detailed analysis for preoperative planning for her patients. With her extensive experience in this technique, lesions that were not obvious in a patient’s initial presentation are detected and dealt with,  minimising any chance of a missed lesion or surprises when a patient proceeds for surgery.

What is a sentinel lymph node biopsy?

This procedure is where the sentinel lymph node is located, removed and tested to detect if cancer cells are present.

Lymph nodes are part of the body’s immune system which fight infection and filter cancer cells from the body.

The theory is that cancer can spread from one part of the body to another through lymph nodes and the sentinel is the hypothetical first lymph node draining a cancer.

Breast cancer cells are most likely to spread to lymph nodes in the armpit or axilla next to the affected breast.

A positive SLNB indicates the presence of cancer which may have spread to other nodes and possibly, other organs.

It is important information for a doctor to help determine work out the extent of the disease in the body and to formulate an appropriate treatment plan.

A SLNB is usually done in the same surgery to remove the primary tumour.

What happens during a sentinel lymph node biopsy?

Patients require two procedures to isolate the sentinel lymph nodes.

The first is a nuclear medicine scan usually performed on the day of the operation.

While under general anaesthetic, a radioactive substance and/or a blue dye is injected into the patient, near the tumour, to identify the position of the sentinel lymph node.

A device known as a gamma probe is then used to detect radioactivity or search for lymph nodes that are stained with blue dye.

Once located the surgeon makes a small incision and removes the node.

A pathologist checks for the presence of cancer and, if found, the surgeon may remove additional lymph nodes either during the same biopsy procedure or in a follow up operation.

The benefit of SLNB is that only a few lymph nodes are removed thereby avoiding or reducing complications that can arise with a more extensive lymph nodes surgery (complete axillary lymph node dissection).

What are the effects of a sentinel lymph node biopsy?

As with any surgery, a sentinel lymph node biopsy can cause short-term pain, swelling and bruising and there is an increased risk of infection. Some patients may have an allergic reaction to the blue dye used but it is rare.

What are Dr Cheung’s breast credentials?

Deborah Cheung MBBS (Sydney) FRACS is an Oncoplastic Breast Surgeon accredited at St Vincent’s Private Hospital, Nepean Public Hospital, Nepean Private Hospital, the NSW Breast Cancer Institute, Breastscreen NSW and Macquarie University Hospital.

Dr Cheung is currently Sydney’s only surgeon who specialises in both breast cancer and breast cosmetic services, and her years of training in the most complex of breast cancer surgeries, are often highly valued by cancer and cosmetic patients alike. 

Dr Cheung has worked in world renowned surgical and research units, and has been mentored by world-class breast surgeons and plastic reconstructive surgeons at Brigham Women’s Hospital, Harvard Medical School Boston, the Raven Institute in London and  the European Institute of Oncology in Milan.

Dr Cheung offers a truly comprehensive breast care system including preventative breast care, breast cancer detection in rooms (by herself) along with intraoperative breast imaging for a highly accurate and precise assessment.

Dr Cheung works with a multidisciplinary cancer team that includes a radiologist, radiation oncologist, medical oncologist, pathologist, mammographer/sonographer and breast care nurses. 

Second opinion service

Many patients – already devastated by the devastation of breast cancer may feel alternately to exhausted or sometimes find it intimidating to tell their current kind and caring doctor they would like a second opinion.

However Dr Cheung is happy to perform second opinions for patients seeing other doctors, or to follow up on initial imaging results.

Dr Cheung also performs her own ultrasound imaging on site, which in about 5% of cases picks up second lesions that may have been missed with the first lot of imaging.

Dr Cheung is also happy to provide a second opinion and quote for all of her cosmetic breast patients.