I am passionate about breast reconstruction surgery and restoring what has been taken away during my patient’s cancer treatment.
Breast reconstruction is one of Dr Julian Liew’s subspecialties. After careful history and examination, Dr Liew will outline a specific breast reconstruction journey that will be unique to you.
Immediate vs Delayed Reconstrucion
Like your breast cancer treatment, breast reconstruction is also a journey. Breast reconstruction is composed of a series of operations and can usually commence at the time of your mastectomy operation (immediate reconstruction), or it can be done later (delayed reconstruction) after all of your breast cancer treatment has been completed. These operations will be aimed at achieving your best result and will be fully described to you in your initial consultation. At The Clinic Plastic Surgery, we aim to complete your reconstruction with the smallest number of secondary procedures, and we also aim to complete them within 6 months of commencing your journey with us.
What Are The Different Types of Breast Reconstruction?
There are 2 main types of reconstructive options for breast cancer: using your own tissue (autologous) or using a breast implant (alloplastic).
Autologous Breast Reconstruction
Using your own tissue is most commonly referred to as “flap reconstruction”. It has several benefits. First of all, no foreign material is used. By using your own tissue, the reconstruction changes with you when your body changes. Once your desired result is achieved, it is yours forever. It has no lifespan and rarely requires long term revision. It also has minimal long term complications. Patients are afraid of this type of reconstruction because it requires a longer surgery time and is more complex than implant reconstruction. However, even though the initial reconstruction may take longer, there are less total operations, and you do not need to have your implants revised every 10-15 years. Overall, patients who undergo autologous breast reconstruction report better satisfaction with their reconstruction.
Are There Contraindications for Breast Reconstruction?
There are several contraindications for this type of breast reconstruction. First of all, this type of reconstruction is not performed on people who smoke. Smoking and nicotine significantly increases the risk of flap and donor site complications, increases the risk of mastectomy skin flap healing problems and increases the risk of anaesthetic complications. BMI is also a relative contraindication for this surgery. Patients with a BMI greater than 35 having a significantly increased complication profile when compared to patients with a BMI less than 35.
What Are The Different Types of Autologous Breast Reconstruction?
There are many types of flaps that can be used for breast reconstruction and Dr Liew will outline these at your initial appointment. Such flaps include:
– Latissimus Dorsi Flap (using your back tissue)
– Upper Gracillis Flap (using your thigh tissue)
– Gluteal Artery Perforator Flap (using your buttock tissue).
– Abdominal-Based Free Flap (using your tummy tissue).
What Is A DIEP Flap?
Using your tummy tissue (abdominal free flap) is the most common form of flap reconstruction. Specifically, the DIEP (Deep Inferior Epigastric Artery Perforator) flap is heralded as the “gold standard” in breast reconstruction. Dr Julian Liew is a specialist in this procedure and very well known in this field. Your tummy tissue is the part of your body that most resembles your breast tissue. Another advantage is that by using your abdominal fat and skin from your lower abdomen, after the abdominal donor site is closed, it can resemble a cosmetic tummy tuck procedure that will complement your breast reconstruction.
Implant Breast Reconstruction
Breast implants are safe to use for breast reconstruction. At The Clinic Plastic Surgery, we use the most up-to-date and proven technologies to ensure safety for our patients. Implant reconstruction is usually performed as a series of operations, but in specific cases, can be completed in a single operation.
What Are The Benefits of Implant Breast Reconstruction?
The benefits of breast implant reconstruction include a quicker and more simple operation. Implant reconstruction is also a very good option when you are unable to use your own tissue for autologous reconstruction, or do not have enough tissue for your desired result.
What Are The Disadvantages of Implant Breast Reconstruction?
However, breast implants do carry some disadvantages. Primarily, they have a 10-15 year lifespan which means that it is recommended that your implants are changed every 10-15 years. This involves additional cost and these additional operations can impact your lifestyle. There is also a risk of capsular contracture which is when your body reacts severely to your implant and it can become firm, painful and can sometimes move or change in shape. The only method to treat this problem is to replace your implant or consider a different type of implant. There are many other risks that will be covered by Dr Liew at your consultation.
What Does Breast Implant Reconstruction Involve?
Breast implants in breast reconstruction are placed below the pectoralis major muscle. Traditionally, implant reconstruction is performed as a 2 stage operation, where you have a tissue expander inserted initially, which is progressively expanded with normal saline to the desired volume. This expansion process usually takes about 6 weeks. The tissue expander creates a new space between your pectoralis muscle and your rib cage. The tissue expander is a temporary device, and 3 months after your tissue expander has been inflated to your desired volume, it is replaced with a definitive implant in a second operation.
More modern techniques and technology allow implant reconstruction to be performed as a single operation. This utilises a synthetic mesh or an acellular dermal matrix (ADM) to help create the space for a definitive implant as a single stage. This is the preferred method used by Dr Liew. There are some limitations to this technique, but Dr Liew will outline them with you in great detail at the time of your consultation.
Enhanced Recovery After Surgery (ERAS)
Regardless of the type of breast reconstruction that you decide to have, all of Dr Liew’s patients benefit from an Enhanced Recovery After Surgery pathway. These pathways ensure that you progress through your surgery and recover faster with fewer complications. Every step of your journey with The Clinic Plastic Surgery has been analysed and optimised to give you the best outcomes and results.
Read moreThe primary aim for breast reconstruction is to look good in clothing. Anyone who sees you, should not be able to tell that you have had an operation.
Research shows that women can benefit both physically and emotionally from breast reconstruction, restoring your confidence and self-esteem.
Breast reconstruction can help patients who have already undergone breast cancer surgery to improve symmetry without the need of an external prosthesis
Breast reconstruction can help to improve your body image by improving how you think and feel about your body after surgery and throughout your breast cancer journey.
Before
After
DISCLAIMER: All before and after photographs are actual cases of Dr. Julian Liew, and are examples only.
All surgical results are subject to individual patient variability and do not constitute an implied or certainty for the result.
Using your own tissue or autologous breast reconstruction is commonly referred to as “flap reconstruction”. The main benefits are that no foreign body is used. Flap reconstruction also has no lifespan, and rarely requires long term revision. This means that once your desired result is achieved, it is generally yours forever.
Patients are often afraid of this type of breast reconstruction because it requires a longer surgery time and is more complex than implant reconstruction. However, even though the initial reconstruction may take longer, there are usually less operations than in implant reconstruction, and you do not need to have revision procedures every 10-15 years.
Breast reconstruction is one of Dr Liew’s subspecialities, and during your consultation he will outline all of the risks and benefits of the various breast reconstructive techniques that would be most suitable for you and that would help you achieve your desired result.
Smoking/Nicotine significantly increases the risk of wound healing complication and even increases the risk of mastectomy skin flap healing problems. Smoking also increase the risk of anaesthetic complications. Smoking is a contraindication to breast reconstruction surgery, and this also includes nicotine patches and gum.
The type of reconstruction that you choose, will determine the type of garments that you will require. At The Clinic Plastic Surgery we will size you for your complementary post-surgical garments and these will be fitted to you after your surgery.
The lifespan of breast implants vary from person to person and cannot be predicted. All patients with breast implants will require additional surgery at some stage. It is recommended by the breast implant companies that you should have your breast implants changed every 10-15 years.
All patients at The Clinic Plastic Surgery enter our Breast Implant Health Check Program. This consists of regular clinical assessments supplemented by clinical imaging to monitor the health and integrity of your breast implants.
All breast implants used by Dr Liew have been approved for supply in Australia. Dr Liew does not use any implants that have been suspended from inclusion on the register as this usually means that there are concerns regarding the safety and performance of that particular implant. Implant technology has progressed so that there is no reason to not use an implant on this register.
The Australian Breast Device Registry (ABDR) is a registry for implantable breast devices. It is a Commonwealth Government health initiative that records information on surgeries involving breast implants. It tracks the outcome and quality of all breast device surgery performed across Australia.
Breast implant associated cancer is also known as breast implant associated anaplastic large cell lymphoma (BIA-ALCL). This is a rare cancer of the immune system. It is not breast cancer. It is a rare cancer that grows in the fluid and scar tissue around a breast implant.
In your consultation, Dr Liew will discuss in detail the issues surrounding this rare cancer and what to look for to detect it. He will also discuss your ongoing Breast Implant Health Check Program that will take place at The Clinic Plastic Surgery. If you have any concerns regarding your breast implants, please contact the expert team at The Clinic Plastic Surgery.
After surgery you are able to walk straight away, but you should refrain from exercise for several weeks. You should avoid any heavy lifting (more than 5kgs) for at least 6 weeks.
Your recovery program will be tailored specifically to your individual surgery and requirements and this will be detailed by Dr Liew at your appointment
You can usually drive 2-3 weeks after your surgery. The requirements for driving are that you are moving freely and not taking any sedating medications. This will be detailed more specifically at your consultation with Dr Liew.
A qualified Plastic and Reconstructive Surgeon is fully accredited by the Royal Australasian College of Surgeons.
The difference between a plastic surgeon and a cosmetic surgeon is significant. Anyone with a medical degree can call themselves a “cosmetic surgeon” and are not accredited to operate in major private hospitals. A Cosmetic Surgeon is not recognised as a Specialist Surgeon or Specialist Plastic Surgeon by any of the regulating authorities such as Medicare Australia or the Medical Board of Australia. They also cannot register themselves as a Surgeon with the Australian Health Practitioner Regulation Agency (AHPRA).
Specialist Plastic Surgeons normally undergo extensive training in aesthetic surgery, maxillofacial surgery, paediatric plastic surgery and reconstructive surgery following trauma, burns or cancer treatment. After completing the mandatory years of training in Plastic and Reconstructive Surgery, many Specialist Plastic Surgeons undertake a fellowship to continue to gain further experience and training in specific branches of the specialty.
Dr Julian Liew is a fully qualified Specialist Plastic & Reconstructive Surgeon accredited by the Royal Australasian College of Surgeons. Dr Liew is registered as a Specialist Plastic Surgeon by the Australian Health Practitioner Regulation Agency (AHPRA).
After completing his medical degree in 2002 at Monash University, Dr Liew trained in both General Surgery and Plastic Surgery before completing his Plastic & Reconstructive Surgery training at the beginning of 2015.
As a skilled Microsurgeon and Specialist Plastic Surgeon his attention to detail and to the skill and precision of the procedure is only paralleled by his passion for the patient-centric experience and his complete involvement along with his talented team, through the patient’s entire surgical journey.
In 2017, Dr Liew realised his vision of combining surgical excellence with an enhanced patient journey by establishing his boutique plastic and reconstructive surgery practice, The Clinic Plastic Surgery, in East Melbourne.
A Specialist Plastic and Reconstructive Surgeon is fully accredited by the Royal Australasian College of Surgeons and is registered as a Specialist Plastic Surgeon by the Australian Health Practitioner Regulation Agency (AHPRA).
Only Specialist Plastic Surgeons are accredited by the Commonwealth Government of Australia through the Australian Medical Council to perform all reconstructive and cosmetic surgery.
The difference between a plastic surgeon and a cosmetic surgeon is significant. A Cosmetic Surgeon is not recognised as a Specialist Surgeon or Specialist Plastic Surgeon by any of the regulating authorities such as Medicare Australia or the Medical Board of Australia. They also cannot register themselves as a Surgeon with the Australian Health Practitioner Regulation Agency (AHPRA).
Specialist Plastic Surgeons normally undergo extensive training in aesthetic surgery, maxillofacial surgery, paediatric plastic surgery and reconstructive surgery following trauma, burns or cancer treatment. After completing the mandatory years of training in Plastic and Reconstructive Surgery, many Specialist Plastic Surgeons undertake a fellowship to continue to gain further experience and training in specific branches of the specialty.
Your qualified Specialist Plastic and Reconstructive Surgeon, Dr Julian Liew, will guide you through your patient journey from beginning to end. Dr Liew will see you at your first consultation, and personally guide you through your post-surgical course. At The Clinic Plastic Surgery, we feel that a close relationship with your surgeon ensures a smooth and satisfying experience.
As of 1st July 2023, new AHPRA (Australian Health Practitioner Regulation Agency) guidelines require all patients obtain a referral from a General Practitioner or a Medical Specialist before scheduling a consultation with a Plastic Surgeon.
Dr Liew operates at St Vincent’s Private Hospital in East Melbourne.
At the time of your consultation, you will be given a detailed quotation for your procedure that will include the surgeon’s fee, anaesthetist’s fee, surgical assistant fees and the hospital’s fees.
Please consult your health insurance provider to ensure that you have adequate coverage for your procedure.
Most cosmetic procedures are not covered by Medicare and as a result you are unlikely to receive a rebate or subsidy for these procedures.
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