Breast reconstruction after mastectomy
If your breast cancer treatment plan includes mastectomy (an operation to remove the breast), you'll have a choice about what you do about your missing breast.
Some women choose to live with a flat chest on one side or use a prosthesis (false breast) inside their bra. Others choose to have a reconstruction.
If you have a mastectomy, there is still a chance that the cancer will come back. Having a reconstruction doesn't mean the cancer is more likely to come back.
When is breast reconstruction done?
Reconstruction surgery can be carried out at the same time as your mastectomy (immediate reconstruction), but this isn't always possible. If you need radiotherapy after your mastectomy, you may be advised to wait until after it's finished.
The benefits of immediate reconstruction include having just one anaesthetic, one hospital stay and one recovery period. However, the anaesthetic and recovery period will be longer than if you just have a mastectomy.
Reconstruction surgery may also be carried out some time after mastectomy surgery. This is called delayed reconstruction.
It's important to remember that reconstruction nearly always involves several operations. This is whether it's started at the same time as your mastectomy or later on.
How is reconstruction done?
There are two main types of breast reconstruction: implant and flap.
The surgery for implant reconstruction is shorter than for flap reconstruction.
Your surgeon may suggest using a temporary expandable implant to begin with. This is so the skin on your chest can stretch gradually. The expander will be inflated over several clinic visits and then left to settle for three to six months.
Once the expandable implant is the right size, the surgeon will replace it with a permanent silicone one.
Sometimes it's possible to use a permanent silicone implant at the first operation.
Implant reconstructions sometimes need more surgery after a few years to maintain their appearance.
With a flap reconstruction, tissue is moved from your back, tummy, thighs or buttocks to your chest. It's shaped under the skin to make a new breast. The tissue is alive and natural, so it gives a natural shape and feel to the reconstructed breast.
Flap reconstruction is more complicated surgery, and you have to stay in hospital for longer.
You'll have scars where the tissue is removed from your body.
The new breast is likely to change shape and size in the first few months. Once it has settled the results are likely to be more long-lasting than an implant reconstruction.
Some women need to have a flap procedure with an implant to create a large enough breast.
Whether you have a flap or implant reconstruction your new breast won't have any sensation.
Can my nipple be reconstructed?
Yes. Once the breast has settled into its final shape and size, your surgeon can perform a nipple reconstruction. If you are having immediate reconstruction this can sometimes be done during the first operation.
Nipple reconstruction sometimes involves taking part of the nipple from your remaining breast and attaching it to the new breast (nipple-sharing graft).
More often your surgeon will fold the skin on your new breast into a nipple shape (nipple flap).
Colour can then be tattooed on to the new nipple and the skin around it to give a natural appearance. This is usually done in hospital.
Will the new breast match my other one?
Your surgeon will match your new breast as closely as possible to your existing breast. Some women have surgery on both of their breasts to get a good match.
This can involve lifting the existing breast, or making it larger or smaller.
Some women with a high risk of breast cancer choose to have both breasts removed (double mastectomy), and two reconstructed breasts made, to reduce their risk of getting cancer again.
Who can help me make up my mind?
If you're considering reconstruction, you can talk to your GP, breast care nurse and breast surgeon, and have a consultation with a reconstructive plastic surgeon.
More advice on breast reconstruction
Macmillan Cancer Support has information on breast reconstruction, including:
Article provided by NHS Choices
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