What Is Breast Reconstruction?

Breast reconstruction is surgery to make a new breast after removal of the breast or part of the breast. The aim is to make a breast of similar size and shape to your original breast. But they won't be identical.

Types:

1. implants to replace all or some of your breast tissue
2. using tissue taken from another part of your body ("flap" reconstruction)
3. using your own tissue and an implant 

Your surgeon will talk to you through the different types of reconstruction. Some may not be suitable for you. The aim of the surgery is to match your other breast as much as possible.  

They can show you examples of different types of breast reconstruction giving you an idea of how the reconstructions will look immediately following surgery and beyond.

Other things to consider after reconstruction surgery include - 

• create a new nipple (a nipple reconstruction)
• change the shape of your other breast to match

Breast reconstruction can be done:

1. at the same time as the cancer surgery (immediate reconstruction)
2. after your cancer surgery (delayed reconstruction) 

Things to consider:

• the type and stage of your cancer 
• other treatments that you might need 
• your feelings and preferences

An immediate reconstruction gives you a new breast straight away. Surgeons will try to match the breasts but they will not be exactly the same 

The new breast will feel and look different from the one removed and most women find that immediate reconstruction helps them to cope more easily with their feelings about the loss of a breast.

Reasons for an immediate reconstruction - 

• You will have your new reconstructed breast when you wake up after your mastectomy or breast conserving surgery.
• Fewer operations, so fewer anaesthetics.
• Your finished breast might look better because the surgeon is usually able to use the breast skin already there.
•  You will have less scarring on the reconstructed breast itself –you might have a small patch of skin where your nipple was, with a scar around it. But sometimes the surgeon may not need to remove the nipple.

Reasons against an immediate reconstruction - 

• You might not have as much time to decide on the type of reconstruction you want.
• If you are having radiotherapy after surgery, it might change how the reconstruction looks. 
• Recovery time after surgery is longer with a reconstruction compared to having a mastectomy only.
• You may have more scars on your body, this depends on the type of reconstruction you have.
• It is likely you will need more surgery, this is usually minor surgery to get the best cosmetic effect, and can include creating a new nipple.  

Some people prefer to get over their mastectomy and breast cancer treatment before thinking about having a reconstruction.

Reasons for a delayed reconstruction - 

• You have more time to look at your options and discuss them with a specialist surgeon.
• Your breast cancer treatment will be finished and won’t be affected by your reconstruction surgery.
• Your recovery is generally quicker as you have time to prepare yourself for your surgery.

Reasons against a delayed reconstruction - 

• You have a time after the mastectomy with no breast tissue, you can choose to wear a false breast (prosthesis) if you want to.
• You might have a larger scar on the reconstructed breast than after immediate reconstruction.
• You may need more surgery afterwards to get a good cosmetic effect. This is usually minor surgery that you may have as a day case.

Breast reconstruction might be possible for you even if you have:

1. a radical mastectomy (removal of the breast and the muscle behind it)
2. radiotherapy
3. large breasts 

If you are well enough you can have breast reconstruction at any age. 

Breast conserving surgery removes only part of the breast. The appearance of the breast is usually very good after this type of surgery followed by radiotherapy.

Few women need reconstructive surgery when only part of their breast is removed. But some women may need reconstruction of the remaining breast tissue. It may be possible to have a partial reconstruction or breast reshaping.

Some women will need to have a larger amount of breast tissue removed. This type of surgery leaves a dent in the breast and means the treated breast ends up smaller than the other breast. But it is sometimes possible to get back the shape with a partial reconstruction of the breast by filling the dent with a small area of living tissue. 

The surgeon may use tissue from your back to fill in the dent. This is called a latissimus dorsi flap (LD flap). There are other ways to carry out this procedure and your surgeon will talk you through it. 

Reshaping might be an option if you need part of your breast removed and you have quite large breasts. It is called therapeutic mammoplasty. The surgeon removes the tumour and an area of surrounding healthy tissue. They then reshape the remaining breast tissue to create a smaller breast.

At the same time as your reconstructive surgery, you can also have surgery to make your other breast smaller (breast reduction), so they match in size. You can choose to have this at a later time.

Things you may wish to ask your surgeon:

1. what your operation will involve
2. how it might affect you 
3. about the risks and benefits of different types of surgery