Breast reconstruction

Women may choose to have breast reconstruction following breast cancer surgery. Other procedures to create nipple-areola shapes on a reconstructed breast or to improve breast evenness (symmetry) are also available.

What is breast reconstruction?

Breast reconstruction is a surgical procedure performed after you have had a breast removed (mastectomy) to make a permanent replacement breast. This can be done either using an implant or from tissue (skin, muscle or fat) from another part of your body.

Depending on your treatment (if you have had a mastectomy due to breast cancer), breast reconstruction may be performed at the time of your mastectomy or at a later date.

Do I need a reconstruction?

The decision to have a reconstruction is entirely up to you. Women who choose to have a reconstruction do so for a range of different reasons. These include to:

• improve their body image or self-esteem
• regain body symmetry and to replace the weight of their removed breast
• help them move on from having cancer.

Some women don’t feel the need for a reconstruction following their mastectomy. They may choose a synthetic breast (prosthesis) worn in a bra or under their clothing. This looks like a real breast when worn in this way.

Other women are content with their altered appearance and decide not to wear a prosthesis nor have a reconstruction.

Types of breast reconstruction

The two major types of breast reconstruction use either implants or your own tissue.

Breast reconstruction with implants

Reconstruction with silicone implants is usually at least a two-stage process:

• The first stage is the mastectomy where much of the breast skin is preserved. A tissue expander (a silicone balloon with a metal valve) is then placed under the chest (pectoral) muscles and the skin closed. Once the skin and wound are healed, the expander is filled with saline until it is the desired size.
• In the second stage the expander is removed and the silicone breast implant is inserted. This usually occurs after a period of some months to allow the skin to stretch.

In some circumstances it is possible for a woman to have an implant reconstruction performed in a one-stage process, avoiding the tissue expander step. Your doctor will advise if this is possible for you.

Most women who have an implant breast reconstruction will require another operation within ten years. This may be due to problems with the implant such as leaking or concerns about how the reconstruction looks, such as unevenness (asymmetry) between the reconstructed breast and the natural breast.

Breast reconstruction with tissue (flaps)

For this method of reconstruction, tissue is commonly taken from the tummy (abdomen) or the back to replace the breast tissue removed during the mastectomy. Other methods involve taking tissue from the upper thigh or from the buttocks.

• Tissue breast reconstruction tends to be more complex than implant reconstruction and usually requires a longer stay in hospital.
• Once it has healed, the reconstruction is permanent and is less likely to require further maintenance operations compared to implant reconstructions.
• You will be left with more than one scar (including on the donor site), although these will fade over time.

Procedures to improve breast symmetry after surgery

Some women may choose to have further procedures to improve breast symmetry after surgery or to lift or reshape their breasts that have dropped due to the natural process of ageing.

• Mastopexy is an operation to lift and possibly reshape the breast. It is often used to lift a natural breast so that its shape and nipple position match the reconstructed breast.
• Breast augmentation involves placing a breast implant under the breast. The aim is to increase the size or change the shape of the natural breast to match the reconstructed breast.
• Breast reduction involves removing breast fat, glandular tissue and breast skin to reduce the size, reshape and generally lift the natural breast.
• Liposculpture (also called lipofilling or fat grafting) is the injecting of fat from another site on your body into the breast to increase volume or improve breast symmetry.
• Nipple areola reconstruction is the making of a nipple and areola (the ring of darker coloured skin around the nipple) shape on a reconstructed breast. It is made from skin from the reconstructed breast mound that is folded in a way to produce a nipple shape.

After your reconstruction

It is reasonable to expect some pain and discomfort after surgery and it is not unusual to have some swelling or bruising. This will gradually reduce in the weeks following surgery.

All breast surgery will leave some form of scar. There is also the risk of some reduction or even loss of feeling with many procedures.

Your doctor will discuss all the risks and possible disadvantages of any surgery before it is performed.

It is very important to contact your doctor or breast service if you have any signs of infection, such as increasing pain, redness or swelling around the wound, or fever.

Your wellbeing after breast surgery and reconstruction

Breast cancer and surgery can affect your body image and the effect on your perception of yourself can be profound. It can lead to lack of confidence, difficulty in relationships and lack of interest in intimacy and sex.

Your reconstructed breast will not feel or look the same as your natural breast. It may take some time to get used to how your body has changed and to once again feel comfortable with sex or with your partner seeing your body.

If you have ongoing concerns or problems, speak to your local doctor (GP) or breast service about referral to a counsellor.

More information on what to expect following breast reconstruction and related surgery is available from the links below.

---

---