Breast reconstruction guide

Survival rates for breast cancer have significantly improved, not least due to early detection and advanced treatment. Lumpectomy plus radiation therapy is often preferred so as not to lose the whole breast, but it is not always possible or suitable.

In which case there are a number of mastectomy options available, which partly depend on whether or not you want to consider immediate reconstruction. See our article on mastectomy and types of breast cancer surgery for more information and talk the options through with your consultant; here we look at reconstruction after mastectomy.

Immediate reconstruction

You can choose to have your breast reconstructed during the same operation as your mastectomy, and your plastic surgeon will insert a breast implant straight after your breast tissue has been removed. It is advisable to make sure you fully understand the implications of immediate reconstruction work, as you will be dealing with the emotions of the mastectomy as well as recovery from major surgery.

Delayed reconstruction

If the remaining chest skin and tissue is tight and flat, or you require further treatment after a mastectomy, then it is unlikely that you will be able to have immediate reconstruction; instead you can opt for a two-stage delayed procedure. In this instance, a tissue expander is implanted under the chest muscle and is injected with a saltwater solution, through a tiny valve under the skin, at regular intervals over a 4-6 month period.

Once the tissue and skin has expanded enough, you will have a second operation to remove the expander and replace it with a permanent implant. This procedure can sometimes be achieved with one operation, and the expander implant is left in, but the valve removed under local anaesthetic. This process is not suitable for anyone who has had, or is likely to have, radiotherapy as the skin’s elasticity is significantly compromised as a result of the treatment.

Implants

As with regular breast augmentations, implants used in reconstruction can be a silicone shell filled with either saline or silicone. Breasts with implants tend to be rounder and less natural-looking, which are probably more suitable for younger women with small firm breasts. Remember that implants don’t last forever and therefore you will need further surgery to replace them at some point.

Alternately, you can opt to reconstruct your breast using tissue flap procedure, where you use your own tissue from your tummy, back, thighs or buttocks to rebuild your breast. Tissue flaps are often used when recreating larger breasts with a droop, as the implant is natural and the tissue acts like the rest of your body. The disadvantages of this type of reconstruction are that you will be left with two scars, one each from both the donor and recipient surgeries, and the skin colour and texture may also differ, depending on the donor site. You also can choose to have an implant with the tissue flap surgery to get the desired look.

Nipple reconstruction

A mastectomy typically removes the whole breast, including the nipple and areola, but it is possible to have the nipple reconstructed after the breast has settled following surgery. There are several options available, so it’s best to discuss it with your consultant, but generally you can use skin from the other areola, the top of the inner thigh as it is darker than the rest of the body, or the reconstructed breast can be folded to create a nipple shape. For the latter procedure, the area is usually stained with a permanent pigment, like a tattoo, to match the other nipple and areola. Some women just opt for a straight tattoo and there are specialists who pride themselves on creating perfect images of a nipple.

Surgery to your other breast

While your plastic surgeon will aim to reconstruct your breast to be as close to the remaining one as possible, you might like to discuss the option of surgery on the healthy breast to ensure an even appearance, particularly if you are considering implants.


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