Breast reconstruction is surgery to make a new breast after removal of the breast or part of the breast.
The main ways of making a new breast include:
- removing the whole breast and skin, and using an implant underneath the remaining skin
- removing the whole breast, leaving skin behind, and using an implant (skin sparing mastectomy)
- using tissue taken from another part of your body
- using your own tissue and an implant
The aim of reconstruction is to make a breast of similar size and shape to your own breast. They won't be identical.
After reconstruction surgery you might consider more surgery to:
- create a new nipple
- change the shape of your other breast to match
When to have breast reconstruction
Breast reconstruction can be done:
- at the same time as the cancer surgery (immediate reconstruction)
- after your cancer surgery (delayed reconstruction)
When discussing reconstruction options with you, doctors will consider:
- the type and stage of your cancer
- other treatments that you might need
- your feelings and preferences
Immediate breast reconstruction
An immediate reconstruction gives you a new breast straight away. The breast will be different to the one that was removed, but some women find that immediate reconstruction helps them cope more easily with their feelings about the loss of a breast.
- You will have your new reconstructed breast when you wake up after your mastectomy or breast conserving surgery.
- You have fewer operations, so fewer anaesthetics.
- Your finished breast may look better because the surgeon is usually able to use the breast skin already there.
- You will have less scarring on the reconstructed breast itself – usually you have a small patch of skin where your nipple was, with a scar around it.
- You may not have as much time to decide on the type of reconstruction you want.
- If you are having radiotherapy after surgery, it may damage the reconstruction.
- Your doctor may advise you not to have implant reconstruction if you are having radiotherapy afterwards, but you may have a temporary implant during radiotherapy with a second reconstruction operation after the radiotherapy.
- If you have complications of surgery, it may delay any chemotherapy you need.
This last point is important. Chemotherapy stops the body from being able to heal itself so well. So if you have any problems with wound healing after your reconstruction, you won’t be able to start chemotherapy until the problems have cleared up. Chemotherapy at this time would stop the wound healing and you could get a serious infection.
There is good research evidence that chemotherapy works best if you start it within 6 weeks of your cancer surgery. And that might not be possible if things don’t go according to plan with the reconstruction.
Delayed breast reconstruction
Some women prefer to get over the mastectomy and breast cancer treatment before they think about reconstruction.
- You have more time to look at your options and discuss them with a specialist surgeon.
- Your breast cancer treatment will be finished and won’t be affected by your reconstruction surgery.
- You have a time after the mastectomy with no breast tissue but you can choose to wear a false breast.
- You may have a larger scar on the reconstructed breast than after immediate reconstruction.
Who can have breast reconstruction
Breast reconstruction may be possible for you even if you have:
- radical mastectomy
- large breasts
If you are well enough you may have breast reconstruction at any age. There is a higher risk of complications if you smoke, are very overweight, or have other serious medical conditions.
For men, implants currently available don't recreate the correct shape of a man’s breast. So it is not usual to have breast reconstruction. Your surgeon might be able to improve the appearance of the chest with more surgery after mastectomy.
Reconstruction after breast conserving surgery
Breast conserving surgery removes only part of the breast. The appearance of the breast after this type of surgery followed by radiotherapy is usually very good. Few women need reconstructive surgery when only part of their breast is removed. But some women need reconstruction of the remaining breast tissue.
It may be possible to have quadrantectomy or breast re-shaping.
Quadrantectomy and mini flap reconstruction
A quadrantectomy means the surgeon removes about a quarter of the breast tissue. This type of surgery leaves a dent in the breast and means the treated breast ends up smaller than the other breast. But is is sometimes possible to get back the shape of the breast by filling the dent with a small area of living tissue. The surgeon usually uses tissue from your back to do this – called a latissimus dorsi flap. You will need radiotherapy to the remaining breast tissue to reduce the risk of the cancer coming back.
Reshaping the breast
Reshaping might be an option if you need part of your breast removed and you have quite large breasts. It is called therapeutic mammoplasty. The surgeon removes the tumour and an area of surrounding tissue. They then reshape the remaining breast tissue to create a smaller breast. You will need radiotherapy to this remaining breast tissue to reduce the risk of the cancer coming back. At the same time as your reconstructive surgery you can also have surgery to make your other breast smaller (breast reduction) so that they match in size.
Helping yourself before breast reconstruction
You will recover more quickly after reconstruction surgery if you do the following things before your operation.
Smoking can damage blood supply to tissue. It can also increase your risk of getting an infection. If tissue is taken from your tummy (abdomen), smoking increases the risk of hernia.
Maintain a healthy weight
There is an increased risk of complications from an anaesthetic if you are overweight. Ask for a referral to a dietitian if you would like to lose weight before the operation.
Keep physically active
If tissue is going to be taken from your tummy (abdomen) it can be useful to do sit ups. You could aim to build up to 30 sit ups per day. Talk to your doctor or specialist nurse before starting any exercise.
Your breast surgeon
Surgeons specialising in breast reconstruction for cancer are called oncoplastic surgeons. Your surgery may involve a breast and plastic surgeon working together.
You can ask your surgeon:
- what to expect
- about their experience and expertise
- about risks associated with different types of surgery
Your surgeon will need to take photographs of your breasts before and after reconstruction. This is an important record of the surgery. The photographs only show your chest area and won't show your face.
Feelings about reconstruction
Breast reconstruction options can be a lot to think about.
You might feel worried about:
- the surgery and how to find the right surgeon for you
- how you might look and how you might feel about your body
- what your partner might think
- how surgery may affect sex and your relationships
It can be helpful to discuss your feelings with someone close to you.