3 Questions with Dr Buthainah Al-Shunnar on Breast Reconstruction

Dr Buthainah Al Shunnar is an American Board-Certified Plastic and Reconstruction Consultant, who received her US boards in both general surgery and Plastic Surgery. She is based in Dubai.

Q: What does a mastectomy involve?

Dr Buthainah: 1 in every 8 women is diagnosed with Breast cancer every year in the United States. With the diagnosis of breast cancer comes the fear of losing ones’ breast which definitely affects a woman’s identity and can be very scary.

A mastectomy involves removing the breast tissue and usually also the nipple as well. Nowadays the surgeon aims to try and save some of the skin as well in a mastectomy; that is called a skin sparing mastectomy when a reconstruction is done at the same time. The reason for that is that it creates a more natural look with the reconstruction.

Q: What is the goal of breast reconstruction?

Dr Buthainah: Reconstruction essentially involves creating a new breast which matches the other side. The goal is to create breasts which are symmetric with each other. This may involve lifting the other breast or the normal breast, augmenting it or even reducing it such that it creates symmetry.

The reconstruction is either immediate, which is performed at the same time as a mastectomy or it can be delayed. It can be performed for example, several months to even years after a mastectomy. This usually involves 3 stages in reconstruction:

  1. Creating the actual mound which matches the other side
  2. If a nipple reconstruction is performed, this occurs 3 months later under local anaesthetic. This is done by just recreating the local skin, to create a nipple which matches in position and size of the other side.
  3. 6 weeks after the second stage, a tattoo is performed by a tattoo artist to essentially match the color to the other side.

Q: Which options are available for breast reconstruction?

Dr Buthainah: There are 3 options available for breast reconstruction:

  1. Reconstruction with implant
  2. Reconstruction with the back muscle (Latissimus surgery)
  3. Reconstruction with stomach muscle and fat (TRAM surgery)

In terms of the breasts using an implant alone, this can either be done in one stage or two stages. For the single stage reconstruction we usually require the aid of a mesh to create the symmetry with the other side. The two stage implant reconstruction requires a temporary expander replaced finally by a permanent implant several months later.

Implant reconstructions are excellent if they’re done on both sides. If it’s a bilateral reconstruction, the implant works the best because you can create really nice symmetry using the same implant on both sides.

The Latissimus reconstruction involves using the back muscle and fat. The muscle and fat are brought forward and if there is enough fat no implant is required but occasionally we need to add an implant under the muscle to match the other side in terms of volume and even shape.

The third option is called a TRAM which involves the abdominal muscle and fat. It is essentially like doing a tummy tuck but instead of throwing away the fat, it is brought up to the breast and then shaped to match the other side. The advantage of the TRAM reconstruction is that it does not require an implant.