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About breast reconstruction

Breast reconstruction is surgery to make a new breast shape after removing breast tissue. A mastectomy means that the surgeon removes all your breast tissue, and most of the skin covering it. The main ways of making a new breast after mastectomy are

  • An implant under the skin or muscle that covers your chest
  • Reconstruction with your own living tissue, taken from another part of your body
  • A combination of your own tissue and an implant

You will need to speak to your surgeon or breast care nurse to find out which type of reconstruction is suitable for you. 

Some women have breast reconstruction if they have part of the breast removed.

When to have breast reconstruction

You can have reconstruction at the same time as your breast cancer surgery or later on. We have detailed information about the benefits and drawbacks of each approach.

How to find a surgeon

Reconstruction is very specialist surgery. So it is very important to have your reconstruction done by a breast or plastic surgeon who is experienced in these techniques. To find an experienced surgeon locally, talk to your breast cancer consultant or GP.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating breast cancer section.

 

 

What breast reconstruction is

Breast reconstruction is surgery to make a new breast shape after removal of the breast (mastectomy) or removal of some breast tissue (lumpectomy or wide local excision).

A mastectomy means that the surgeon removes all your breast tissue. Usually, they also remove the skin covering the breast, including the nipple.

The main ways of making a new breast shape include

  • Removing the whole breast and the skin and then putting in an implant to gradually stretch the remaining skin and muscle
  • Removing just the breast tissue, but leaving the skin, and putting in an implant (a skin sparing mastectomy)
  • Reconstruction with your own living tissue taken from another part of your body
  • A combination of your own tissue and an implant

You will need to speak to your surgeon or breast care nurse to find out which type of reconstruction is suitable for you.

Your surgeon aims to create a breast similar in size and shape to your own breast. But a reconstructed breast won't be identical. When you are undressed you are likely to notice differences in symmetry and shape. After your reconstruction, you may need to have further surgery to create a nipple or change the shape of your other breast to match your reconstructed one. The next page in this section is about the pros and cons of the different types of reconstruction.

It is also possible to have breast reconstruction if you've only had part of your breast removed (breast conserving surgery). There is information about reconstruction after breast conserving surgery below.

 

When to have breast reconstruction

You can have reconstruction at the same time as your breast cancer surgery (immediate reconstruction) or some time later (delayed reconstruction). It is a very personal decision and there is no right or wrong way to approach it. 

If you are having a mastectomy, your surgeon will discuss with you whether you want to have immediate breast reconstruction. They will advise you, taking into account

  • The type and stage of your cancer
  • Other treatments you are likely to need
  • Your feelings and preferences

Benefits of immediate 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

Drawbacks of immediate reconstruction

  • You may not have as much time to decide on the type of reconstruction you want
  • If you are having radiotherapy after surgery for breast cancer, 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

The last point is an important one. 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 may not be possible if things don’t go according to plan with the reconstruction.

Delayed reconstruction

Some women prefer to get over the mastectomy and breast cancer treatment before they think about reconstruction. With delayed 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 may have a larger scar on the reconstructed breast

Remember that if you are interested in immediate reconstruction (during mastectomy surgery) talk it over beforehand with your surgeon. They will tell you if it is advisable or not, and can talk through the pros and cons with you. We have some suggestions for questions to ask your doctor in this section. 

 

Who can have breast reconstruction

Breast reconstruction is possible for most women who have had their whole breast removed. Even if you

If you are well enough, you may have a breast reconstruction at any age. But reconstruction may be difficult in women who smoke, are very overweight, or who have illnesses that increase the risk of surgery. Your doctor will discuss this with you.

You may need to go on a waiting list for breast reconstruction as there are a limited number of breast and plastic surgeons experienced in this type of surgery. There is information about finding a surgeon further down this page.

 

Reconstruction and conservative surgery

The appearance of the breast after conservative surgery plus radiotherapy is usually very good. Few women need reconstructive surgery when only part of their breast is removed. But for some women reconstruction of the remaining breast tissue during the initial operation is needed. It may be possible to have

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 may 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.

 

How to find a surgeon

Reconstruction is very specialist surgery. So it is very important to have your reconstruction done by a breast or plastic surgeon who is experienced in these techniques. Breast cancer surgeons who are specialised in reconstruction techniques are called oncoplastic surgeons. In some hospitals, breast cancer surgeons and plastic surgeons work together and combine breast cancer surgery with reconstruction.

To find an experienced surgeon in your area, it is best to talk to your own breast cancer consultant or GP. Your surgeon may offer most types of reconstructive surgery. If you want to consider a different type of reconstruction, they can refer you to a surgeon who specialises in the technique that you want to discuss. 

You can find information about breast reconstruction surgeons on the Dr Foster website. The British Association of Plastic, Reconstructive and Aesthetic Surgeons gives a list of hospitals with plastic surgery units.

When you find your surgeon, ask as many questions as you need to about

 

Photographs before and after reconstruction

Your surgeon will ask you to have photographs taken of your breasts before and after reconstruction. This is an important record of the surgery. A photographer takes the photographs in a private area of the medical photography department in the hospital. Some women feel embarrassed about showing their breasts but the photographer is very used to taking such pictures. The photographs are only of your chest area and so your face does not show on the pictures.

The medical photography department stores the photographs and will only share them with members of your health care team.

 

Helping yourself before reconstruction

There are 3 main ways to help yourself before any type of surgery

Stop smoking

If you smoke you are more likely to get a chest infection after your anaesthetic. Smoking also affects blood supply and delays healing. If you are having reconstruction with your own body tissue, there is a higher risk of complications if you smoke. Body tissue reconstruction can fail because of a poor blood supply. Smokers also have a higher risk of hernia after abdominal flap reconstructions. Your surgeon is likely to ask you to stop smoking 3 months before your surgery. You can find helpful information about stopping smoking on our News and Resources website. 

Lose weight

If you are overweight, you are more likely to have complications with living tissue surgery and more likely to have complications from the anaesthetic. Ask to see a dietician and see if they can help you to lose weight before the surgery. You will feel better and it will help you to recover from your operation more quickly.

Get fitter

Getting fitter is a good idea before any operation. With abdominal flap reconstructions, surgeons recommend doing sit ups. Strengthening the abdominal muscles lowers the risk of hernia later and gives better muscle function after the operation. You should aim to build up to 30 sit ups a day, but don’t overdo it too quickly. If you are very unfit, it might be best to get some advice from a fitness trainer before you start. You could ask at your local gym, but make sure you tell them about your medical history.

 

Feelings about reconstruction

An audit published in early 2011 looked at how satisfied women were after mastectomy with or without reconstruction. They found that 9 out of 10 women who had reconstruction were satisfied with their surgery. The audit looked into how women felt in various situations such as how confident they were socially. Just over 8 out of 10 women (85%) who had reconstruction felt confident compared with just over 3 out of 4 women  (77%) who hadn't had reconstruction. 

The audit also looked into how the women felt emotionally and their sexual well being. Women who had reconstruction were more likely to feel confident and happy and sexually attractive. Generally most of the women were satisfied with their surgery and their care whether they had had reconstruction or not.

 

Where to find more information

It is natural to have concerns about having a breast reconstruction. You have a lot to think about. You may worry about how you will look afterwards, what your partner will think, and who is the best surgeon to do your reconstruction. Hopefully this section and our links to other information will help you feel less anxious and answer many of your questions. The main thing is that you feel you have all the information you need to make the right decision for you.

You could look for books and booklets about breast reconstruction (some of which are free) on the breast cancer reading list. If you want to talk to someone other than your doctors or breast care nurse, you could contact one of the cancer information organisations listed on our breast cancer organisations page. They will be happy to help. You can also contact our cancer information nurses, who will be happy to help.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum. Or go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.

You may worry about how your surgery will affect your sex life. Our section on how cancer affects sex and sexuality gives helpful information.

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Updated: 16 October 2012