What to consider when choosing breast reconstruction
It may be difficult to think about further surgery when you are already facing a mastectomy as part of your breast cancer treatment. However, breast reconstruction can improve your confidence and make you feel more like yourself again after breast cancer. Consultant Breast Surgeon, Mr Jason Lee, and Medstars’ Annabel Beales advise what to consider when choosing breast reconstruction.
What is breast reconstruction?
Breast reconstruction surgery is the creation of a new breast shape, or mound, using surgery. It is important to realise that reconstruction is a process, often involving multiple operations, sometimes to both breasts, to achieve the optimal result in terms of both shape and symmetry. There are two important areas of consideration when planning your breast reconstruction: If and when you are going to have it and what you are going to have done.
Immediate Breast Reconstruction
You can choose to have your reconstructive surgery done at the same time as your mastectomy. This is known as an immediate breast reconstruction. The cosmetic results of an immediate breast reconstruction are often better, as it’s possible to save more of the skin and possibly the nipple as well, plus the scarring is less obvious.
However, immediate reconstructive breast surgery isn’t for everyone. There are some scenarios when your surgeon may recommend prioritising the cancer treatment, and not going down this route. If you have to have radiotherapy after your mastectomy, this may have a deleterious impact on the reconstruction. If you are due to have chemotherapy after the procedure, any complications might delay the treatment. This is not desirable as there is evidence to suggest that chemotherapy is more effective if undertaken six weeks after a mastectomy. Outside of having breast cancer, if you are very overweight, smoke or have a pre-existing health condition then immediate surgery may not be possible. Instead you may have to work to address these factors before surgery is possible for you.
Delayed Breast Reconstruction
Some women choose not to have an immediate reconstruction, instead opting for what’s known as a delayed reconstruction. This allows your cancer treatment to proceed as it were, and allows for a faster recovery time after your mastectomy. Some women also find it easier to deal with. You’ll have more time to go through your options – whether you want a reconstruction at all, and if so, what procedure you’re going to choose. The main negative of a delayed reconstruction is having a flat chest wall, whilst either deciding to proceed or waiting for surgery. Patients can of course wear an external prosthesis which sits in the bra, and can produce excellent symmetry whilst in clothing.
It’s important to note that you will always have access to reconstructive surgery, even if you initially decide not to have one. Consultant Breast Surgeon, Mr Jason Lee, advises, ‘it is better to come to a decision that you are happy with, and to wait for the operation that you want, rather than make a quick decision, and have future regrets.’
The exact type of surgery you have is very dependent on you as an individual: your body type and exactly what was carried out during your mastectomy. However, the types of procedure can roughly be divided into two.
Some breast reconstructions are done using silicone implants similar to those used in cosmetic breast surgery. These implants are placed under the skin and muscle of the chest. This can be done straight after your mastectomy. If you choose to have a delayed reconstruction, you may have to have a tissue expander inserted first. This is inflated in an outpatient setting before the operation and stretches the skin appropriately.
Implants may be the best choice for you if you are slim and do not have spare tissue to use in a reconstruction. They work best for women who have small breasts, as it may be harder to achieve a natural looking result for a woman with larger breasts. It is, however, worth noting that if you are having one breast reconstructed with an implant, over time it will probably look different to your other breast. This is because it is likely to stay high on the body, whereas the other is subject to weight changes and ageing and so sometimes surgery on the other side can help.
Jason advises, ‘implant surgery usually involves one night in hospital and a 4-6 week recovery time.’
Natural Tissue Flap Surgery
The alternative option for your breast reconstruction is to have what is known as natural tissue flap surgery. This is when tissue is taken from somewhere else in the body, for example the abdomen, the back, the bottom or the thighs, and used to reconstruct the breasts. This can achieve a more natural result than implants, and the tissue will move with the rest of your body as time goes on. However, this type of surgery is more invasive and complicated, and will result in scarring on other parts of your body. It may also weaken the part of the body that donated the tissue, so may not be suitable depending on your lifestyle. If you are slim, you might not have enough excess tissue to reconstruct your breasts.
Jason advises, ‘tissue flap surgery usually involves 4-5 nights in hospital and an 8 week recovery time.’
‘It is important to remember that reconstruction is an attempt to rebuild the breast, and will never be as authentic as the original breast.’ – Mr Jason Lee
There are usually different options available for breast reconstruction and your breast surgeon will talk through the options with you and explain which one is likely to suit you best. You may need a couple of discussions with your specialist team before you are able to make a confident decision. Jason emphasises the importance of ‘good communication, shared decision making and appropriate levels of expectation when considering what is achievable’ in order to ensure patients are happy with the results. Jason also advises, ‘It is important to remember that reconstruction is an attempt to rebuild the breast, and will never be as authentic as the original breast. It is also a staged process, so do not judge the outcome after one operation. That said, you are in charge of how far down the process to go, and if you are more than satisfied after just one operation, then it is perfectly fine to say “enough”.’
Consider writing down any questions you want to ask and taking notes during consultations. Also, taking someone with you can help you to remember what has been discussed and provide you with extra support.
Having a breast reconstruction will not increase the chances of the breast cancer coming back.
This blog has been co-created by Consultant Breast Surgeon, Mr Jason Lee and Medstars’ Annabel Beales.
You can book a consultation with Mr Jason Lee, here.