Breast reconstruction is surgery to make a new breast after removal of the breast or part of the breast. The aim is to make a breast of similar size and shape to your original breast. But they won't be identical.
Types of reconstruction
The main ways of making a new breast include:
- implants to replace all or some of your breast tissue
- using tissue taken from another part of your body (autologous or "flap" reconstruction)
- using your own tissue and an implant
Your surgeon will talk to you about the different types of reconstruction. They may not all be suitable for you. They aim to match your other breast as much as possible.
They can show you pictures of different types of breast reconstruction. You can see how the reconstruction looks straight after surgery and several months later.
After reconstruction surgery you might consider more surgery to:
- create a new nipple (a nipple reconstruction)
- 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. Surgeons try to match the reconstructed breast to your other breast, but it will not be exactly the same.
The new breast will feel and look different from the one removed. But some women find that immediate reconstruction helps them to 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 usually have fewer operations, so fewer anaesthetics.
- Your finished breast might 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 –you might have a small patch of skin where your nipple was, with a scar around it. But sometimes the surgeon may not need to remove the nipple.
- You might not have as much time to decide on the type of reconstruction you want.
- If you are having radiotherapy after surgery, it might change how the reconstruction looks.
- Your doctor might advise you not to have implant reconstruction if you are having radiotherapy afterwards. But you can have a temporary implant during radiotherapy and a second reconstruction operation after the radiotherapy.
- Recovery time after surgery is longer with a reconstruction compared to having a mastectomy only.
- You may have more scars on your body, this depends on the type of reconstruction you have.
- It is likely you will need more surgery, this is usually minor surgery to get the best cosmetic effect, and can include creating a new nipple.
- If you have complications after surgery, it might delay any chemotherapy or radiotherapy you need.
Chemotherapy and radiotherapy can sometimes stop the body from being able to heal itself so well. So if you have any problems with the wound after your surgery, you won’t be able to start these treatments until the wounds have healed. Radiotherapy or chemotherapy at this time would stop the wound healing and you could get a serious infection.
The timing of chemotherapy is important. There is good research evidence that chemotherapy works best if you start it within 6 weeks of your cancer surgery. That might not be possible if things don’t go according to plan with the reconstruction.
Delayed breast reconstruction
Some people prefer to get over the mastectomy and breast cancer treatment before they think about having a 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.
- Your recovery is generally quicker as you have time to prepare yourself for your surgery.
- You have a time after the mastectomy with no breast tissue, you can choose to wear a false breast (prosthesis) if you want to.
- You might have a larger scar on the reconstructed breast than after immediate reconstruction.
- You may need more surgery afterwards to get a good cosmetic effect. This is usually minor surgery that you may have as a day case.
Who can have breast reconstruction
Breast reconstruction might be possible for you even if you have:
- a radical mastectomy (removal of the breast and the muscle behind it)
- large breasts
If you are well enough you can 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, the implants currently available don't recreate the correct shape of a man’s breast. So it is not usual for men 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 is usually very good after this type of surgery followed by radiotherapy.
Few women need reconstructive surgery when only part of their breast is removed. But some women may need reconstruction of the remaining breast tissue. It may be possible to have a partial reconstruction or breast re-shaping.
Having a partial reconstruction
Some women will need to have a larger amount of breast tissue removed, for example, a quadrantectomy. This means that 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 it is sometimes possible to get back the shape with a partial reconstruction of the breast by filling the dent with a small area of living tissue.
The surgeon may use tissue from your back to fill in the dent. This is called a latissimus dorsi flap (LD flap). There are other ways to do this. Your surgeon will explain these to you. 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 healthy 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 they match in size. Or you can choose to have this at a later time.
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
It can be useful to do sit ups if tissue is going to be taken from your tummy (abdomen). You could aim to build up to 30 sit ups a 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 might involve a breast and plastic surgeon working together.
You can ask your surgeon:
- what your operation will involve
- how it might affect you
- about their experience and expertise
- about the risks and benefits of different types of surgery
Your surgeon will need to take photographs of your breasts before and after your reconstruction. These are an important record of your surgery. They show your chest area only, and won't show your face. They are kept with your confidential medical records and are not shared anywhere else.
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 your type of reconstruction
- how you might look afterwards and how you might feel about your body
- what your partner might think
- how surgery might affect sex and your relationships
It can be helpful to discuss your feelings with someone close to you.