Breast reconstruction after a mastectomy is a vital part of recovery and rehabilitation after breast cancer. It is now an intrinsic part of breast cancer treatment (the most common reason for a mastectomy although there are other reasons). There are a number of ways that your breast can be reconstructed after a mastectomy. They can broadly be broken down into reconstruction using a breast implant, reconstruction using a combination of a breast implant and transferring your own tissue, and reconstruction using a transfer of your own tissue alone.
The exact option of reconstruction available to you will depend on a number of factors including if you have needed radiotherapy to your breast, the size and shape of your opposite breast if one or both breasts are being reconstructed, what tissue you have available that is suitable to transfer and use to reconstruct your breast and practical considerations such as local availability, recovery time, time off work. Breast reconstruction may be immediate (done at the time of your mastectomy) or delayed (done at a later stage and after any chemotherapy or radiotherapy needed). A second stage to further adjust the reconstruction size or shape or to reshape or resize the opposite breast to achieve a better match is often needed.
Reconstruction using an implant is best for small to medium-sized breasts that have not undergone radiotherapy. It may be necessary to expand (stretch out gradually) your chest skin with a tissue expander before placing the planned implant if performed sometime after your mastectomy. The mastectomy scar can be used to place the implant and no additional scars or surgery areas are needed. Further surgery will be needed in the future to replace the implant when it reaches the end of its lifespan (long-term rather than life-long device).
Reconstruction using a combination of an implant and your own tissue e.g. skin and latissimus dorsi muscle from your back can be used to reconstruct a medium to the large breast. The tissue from your back gives additional padding over the implant and therefore a softer feel and shape to your breast and also adds some volume to achieve a slightly larger breast.
Reconstruction using your own tissue alone is better for breasts that have undergone radiotherapy and larger breasts. Although it too has size limits and it can also be used to reconstruct small and medium-sized breasts. Common areas to donate tissue (flaps) to reconstruct breasts include your abdomen (DIEP and TRAM flaps), thighs (TUG and PAP flaps), back (latissimus dorsi flap), and bottom (SGAP and IGAP flaps). Apart from the back tissue, these tissues are detached from the donor area and reattached using microsurgery to your chest blood vessels and shaped into a breast shape. While these are long operations, once any adjusting operations for size and shape are done, no future surgery is anticipated and soft, natural feeling and looking breasts can be created for the long term.
Symmetrising surgery (surgery to match your opposite breast in size and/or shape) may be carried out at the same time or separately at a later stage. Nipple reconstructions can be carried out under local anaesthesia.
Light dressings and a support bra will be needed afterward. Support bras are usually advised to be worn between one and three months after surgery. You will also be advised on the care of your breast scars while they heal and fade. If tissue transfers are done, you will have dressings and/or support garments for these areas too.
Ensure you consider all aspects of a procedure. You can speak to your surgeon about these areas of the surgery in more detail during a consultation.
1 to 8 hours depending on type of reconstruction and if one or both breasts
Day surgery for implant procedures, 2 to 5 night stays for tissue transfer procedures
Risks can include early risks of surgery such as bleeding, infection, seroma (fluid build-up), wound healing problems, clots in your leg veins, breast risks such as the altered sensation of the nipple (usually numbness but can be oversensitivity, usually temporary but can be permanent), asymmetry, recurrence of lax, sagging tissue, loss of tissue including the nipple and areola, poor scarring and implant risks such as capsular contracture (tight scar tissue around the implant), implants not sitting in the correct position, implant rupture, development of breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) or breast implant associated-squamous cell carcinoma (BIA-SCC) (uncommon forms of cancer found in the capsules around breast implants), breast implant illness symptoms. There may be other risks related to the specific area tissue transfers (flaps) come from.
Risks can be reduced by having your surgery at a healthy and steady weight, planning your surgery in relation to pregnancies and your lifestyle, avoiding nicotine in the run-up to recovery from your surgery, optimising any health conditions e.g. diabetes, and following your surgeon’s aftercare advice.
Your breasts will be swollen, tight, and tender particularly in the first two weeks, but usually up to six weeks. Your breast tissue will gradually soften as you heal and as the swelling goes down. Depending on the technique used, you may have to allow some time for the final shape and implant position to take place. You will need to wear a support bra and look after your scars as your surgeon advised. One to four weeks off work may be needed depending on the type of reconstruction and your work. Return to exercise is after six to eight weeks.
Results are long-lasting but are affected by weight gain, weight loss, and hormonal changes such as pregnancy or breastfeeding. The average lifespan of a breast implant is 10 to 15 years so you will need to allow for future surgeries to change your implant if an implant is used. Tissue ageing will continue as well but from the new post-surgery position.