Deciding to have a breast reconstruction is a personal choice that needs to take into account how the surgery may affect you physically and emotionally.
As another option, some women choose not to have a breast reconstruction preferring to use prostheses.
Having a breast reconstruction at the time of your mastectomy can give you good cosmetic results, however if you cannot make a decision it can be done at a later time.
The two major methods of breast reconstruction include implant reconstruction, where breast implants are used to replace the breast tissue and flap reconstruction, where tissues are taken from another part of the body to replace the breast tissue.
Who is this surgery for?
When considering breast reconstruction it is vital to discuss your options with your Oncologist and/or your Cosmetic Surgeon
While Cosmetic Surgeons can reconstruct any type of breast shape after any type of breast cancer procedure, the most important priority is to treat the breast cancer. It is very important that breast reconstruction does not compromise the treatment of your breast cancer.
Patients with all types of premalignant disease or breast cancer and at all stages of treatment can be referred to Cosmetic Surgeons for breast reconstruction. This includes women who have:
- Had a positive gene test for breast cancer in which a preventative mastectomy was recommended,
- Been diagnosed with DCIS (a pre-invasive type of breast cancer), or
- Already been treated for breast cancer but were recommended to delay the breast reconstruction.
The decision to undergo breast reconstruction is a personal choice that will impact you physically and emotionally. It is important to consider factors including your lifestyle, job requirements, recovery length, and your current and desired breast shape and size.
Women contemplate breast reconstruction surgery for many reasons including:
- Wanting to feel ‘whole’ again after mastectomy surgery,
- Having their breasts match each other,
- Being able to wear clothing without needing prostheses,
- Feeling more comfortable and confident with their partner.
How is breast reconstruction performed?
The breast reconstruction techniques your Cosmetic Surgeon undertakes will depend on whether they use implant or tissue grafts. This surgery is generally performed under general anaesthesia and will require a couple of nights in hospital.
The incisions used will vary with every effort being made to make visible post-operative scarring as discreet as possible.
Implant reconstruction
The first step in an implant reconstruction procedure is to place the implant into the pocket from which the breast tissue was removed.
If you have a shortage of skin, you will need to have 2 separate procedures scheduled several months apart. A tissue expander is used to stretch the breast skin and over a period of several months the skin is stretched and expanded with injections of saline.
Once your skin has been sufficiently stretched, the Cosmetic Surgeon will perform the second procedure. This will involve removing the expander and placing a permanent breast implant inside. During this second surgery the nipple can also be constructed.
Each procedures takes approximately 1 to 3 hours and the recovery time is usually faster than with other types of reconstruction.
You will need to stay in hospital for the first stage of this procedure but be able to have the second procedure performed as day surgery.
Find out about the possible complications from implant breast reconstruction here.
Flap reconstruction
This reconstruction method involves using a living piece of your body tissue (called a ‘flap’) to reconstruct the breast.
This results in the breast feeling more natural than when implants are used. The tissue is usually taken from the lower abdomen, which is then repaired as a tummy tuck. However tissue can also be taken from your back, buttock or inner thigh area.
After the tissue has been secured it is transferred onto the chest and the blood supply is connected to an artery and vein in the chest wall via microsurgery.
Because the implant is created from living tissue the Cosmetic Surgeon can achieve a greater variation of the final shape. A reconstructed breast using this method can be easily modelled to look like the opposite breast. Nipple construction is done in a second procedure.
Because this procedure takes longer than implant reconstruction you will need to stay in hospital for at least 7 days.
Find out about the possible complications from flap reconstruction here.
Follow-Up Procedure
After your breast reconstruction, after 6 months most patients will benefit from day surgery to do a final shaping of the reconstructed breast.
This follow-up procedure is usually a simple one with a fast recovery time. Most women only require only a couple of days off work.
During this procedure scars can be improved and nipples can be constructed by a medical tattooist, which match your other nipple.
Essential questions to ask before you have a breast reconstruction
While breast reconstruction is usually safe and effective and can improve the shape of your breasts, complications can happen.
It is very important to consider your options carefully and have realistic expectations about the results. The surgical plan will depend upon your body shape, the cancer treatment you have had, and the shape of the other breast.
We suggest you make a schedule a couple of appointments with specialist Breast Reconstruction Cosmetic Surgeons. You will need to have one or more consultation visits with the Cosmetic Surgeon before the surgery to develop a plan for the breast reconstruction.
We recommend you ask questions that include:
- How will my reconstructed breast(s) feel to the touch?
- If using a tissue flap, will there be pain, scars, or other changes in the parts of my body where the tissue is taken from?
- If I get a breast implant, how long will it last?
- What kinds of changes to the breast can I expect over time?
- How will ageing affect the reconstructed breast?
- What types of reconstruction could I have and which one would best suit me?
- How long would it take me to recover from each type of procedure?
- How many of these breast reconstruction procedures have you performed?
- Will the reconstructed breast match my other breast?
- Could I have the nipple reconstructed if I choose to? How would this be done?
What is the breast reconstruction recovery like?
Breast reconstruction is a cosmetic procedure and some patients are dissatisfied with the results. If you have had radiation treatment your Cosmetic Surgeon will have unique challenges because the breast tissue will have tightened. In some cases recovery can be more painful and prolonged than for patients who have not had radiation treatment.
Your recovery time will depend on the technique your Cosmetic Surgeon uses. To prevent blood and fluid from building up, you might have a dressing over your breasts with drains in. Your Cosmetic Surgeon and their medical team will give you information on post recovery care, including which pain medication to take.
It is normal to feel tired and sore for 2 to 3 weeks after surgery with most women being able to get back to normal activities within 6 to 8 weeks. Bruising and swelling is normal and can take up to 8 weeks to resolve the scar tissue can take 1 to 2 years to fully heal. While the scars will fade they will never disappear.
It is important to note that breast reconstruction may not restore normal feeling to your breast.