Breast reconstruction uses surgery to make a new breast shape. You may have reconstruction after an operation to remove the breast (mastectomy) to treat breast cancer
immediate or delayed breast Reconstruction
Increasingly, a breast reconstruction is performed during the same operation as the mastectomy (termed immediate reconstruction) as opposed to delayed reconstruction, performed months or years later. There is evidence that this increases patient satisfaction with the reconstruction and reduces psychological morbidity in the long term.
The main practical advantage of immediate reconstruction is that the native breast skin (and often nipple) can be preserved during the operation and thus, only the breast volume needs replacing to achieve reconstruction.
Assuming that the patient is fit for a reconstruction procedure, the decision is largely down to patient choice and remains funded by the NHS in breast cancer (or risk reduction) surgery.
Types of Breast Reconstruction
There is a vast array of breast reconstruction options. Broadly speaking, the two categories are:
- Implant reconstruction
- Autologous reconstruction (patient’s own tissue)
The decision making process is very patient centred. The surgeon assesses the patient to establish what options are available for the individual. Factors that contribute to this assessment are:
- Natural breast shape
- Patient’s physique
- Patient’s lifestyle
- General fitness
- Smoking/vaping status
- Whether chemotherapy is required after surgery
- Whether radiotherapy is required after surgery
The options are then discussed with the patient in great detail, so that they understand all the pros and cons and are able to make an informed decision about what is going to be best for them as an individual.
Basic pros and cons of implant-based breast reconstruction:
- Shorter and less invasive surgery due to no donor site, so often day case surgery and faster recovery
- Great cosmetic outcome in the short term, particularly in women with minimal ‘droop’ in the contralateral breast
- Over time, the progressive formation of scar tissue around the foreign body often leads to capsular contracture which makes the reconstruction appear less and less natural over time and at worst, leads to discomfort.
- Often require revisional surgery, usually due to capsular contracture – approx. 60% at 10 years (90% in patients that also required radiotherapy)
Basic pros and cons of autologous breast reconstructions:
- More major surgery and so longer recovery in the short term (around 2-7 nights in hospital depending on the type of surgery)
- As there’s a second area of the body that has undergone surgery, there is the additional risk of ‘donor site’ complications
- In the longer term, appears more natural than an implant
- Much less likely to require revisional surgery
It is important to make sure that you get your information from reputable sources when doing your own research on breast cancer and treatments.
For more detailed information about breast reconstruction surgery, here are some excellent resources: