Breast reconstruction is essentially the creation of a new breast shape using surgery.
This surgery can be done after the removal of the whole breast (or part of the breast) and you can have the reconstruction either at the same time as breast cancer surgery or months later.
Even though breast reconstruction is a process which often involves several operations to give you the best possible result, it is a viable option for those who suffer low confidence, or just need a pick-me-up after contracting breast cancer.
There are several types of reconstruction too, all of which we’ll explain in due course.
Limitations of breast reconstruction
Reconstructed breasts will not feel and look exactly the same as before. They tend to be less sensitive and sometimes very numb.
Several visits to the hospital for appointments and further operations are often needed to get the best cosmetic result.
Recovery after breast reconstruction will take longer than after a mastectomy.
You may have scars on other parts of your body depending on the type of reconstruction.
The potential risk of complications is greater than having a mastectomy.
If you need radiotherapy after your reconstruction, this can affect the appearance of your reconstructed breast.
Reconstructed breasts don’t usually have a nipple, but one can be created with surgery usually at a later date.
Who can have reconstruction?
Most women who have had a whole or partial mastectomy can have either immediate or delayed breast reconstruction.
Others are advised not to have reconstruction because of other existing medical conditions which might increase the risk of problems and complications following surgery. (i.e. if it’s likely you’ll need radiotherapy; this can influence the choice and/or timing of breast reconstruction)
You should check with your surgeon to ensure you are good to go ahead with surgery before committing.
Types of reconstruction
Reconstruction using implant
Implant breast reconstruction involves the restoration, shaping and volume of the breast using a breast implant. Breasts reconstructed this way tend to be a little more rounded, firm, and will move less naturally than those using your own tissue.
This option can mean it’s a little more difficult to get a natural shape when only one of the two breasts are being reconstructed. The newly formed breast will not droop with age and may appear higher than the other breast.
There may be a slight risk of infection which means the implant may need to be removed
There is no set life-span for any implant, but they won’t generally last a lifetime. At some point, further surgery will be required.
Immediate reconstruction using implant
If breast cancer can be removed without taking away too much skin (skin sparing mastectomy) and the remaining breast is not too large (or doesn’t have a significant droop), an implant can usually be inserted under the chest muscle to replace the removed breast tissue.
Inserting the implant under the chest muscle helps to keep the implant in the right place and hide its outline.
Using a breast implant alone is the simplest type of reconstruction operation and the recovery time tends to be quicker than other reconstruction procedures. It’s also done more often as an immediate reconstruction operation.
Delayed reconstruction using implant
In delayed implant reconstruction, a tissue expander is first placed behind the chest muscle – this helps keep the implant in the right place and hides its outline.
The implant is gradually inflated with (salt water) or saline by a surgeon or nurse. The saline solution is injected into a port just under the skin.
When expander implants are being filled, you’ll feel a stretching sensation and tightness within the breast reconstruction. It can be uncomfortable for a day or two after each inflation, but it shouldn’t be painful.
Reconstruction using implant and a tissue matrix
This technique uses a material derived from pig or cow skin or a synthetic material that has been treated, processed and preserved so it can safely be left in the human body.
This surgical mesh (called an acellular dermal matrix ADM) provides a ‘hammock’ that cradles the breast implant, helping to create a natural droop, shape and contour. The mesh is attached to the chest muscle making a space in which the implant can be placed for internal support.
This method is most suitable for small or medium sized breasts and can be used to achieve a one-stage implant reconstruction with mastectomy.
This procedure can result in a more natural shape and feel than using an implant alone but the technique is not available everywhere in the UK.
Reconstruction using your own tissue
These reconstruction techniques use flaps of your own tissue (with or without an implant), including the skin, usually taken from your back or lower abdomen, or from the thigh or buttock.
This is then reshaped to form the new breast. Because the skin used is taken from another area of the body, it may be a slightly different shade or texture to the rest of the breast. This method is particularly suitable for creating moderate to large-sized breasts that have a natural droop.
Reconstruction using your own tissue (tissue flap) involves a longer operation and more recovery time than an implant-only reconstruction. But you will be less likely to need further surgery in the future than with reconstruction using implants alone.
A reconstructed breast using tissue instead of an implant may also provide a better match with your other breast in the long term.