Breast Reconstruction after Mastectomy
Breast Reconstruction after Mastectomy
After a mastectomy, the removal of a breast most commonly to treat cancer, many women want to have their breast reconstructed for cosmetic reasons and to restore body confidence. You will have two main options and, unlike a lot of cosmetic treatment, the NHS will often pay for UK patients to have breast reconstruction.
What Is a Reconstruction?
Following a mastectomy or lumpectomy, many cancer patients may wish to have their breasts artificially reconstructed with surgery.
A breast reconstruction occurs when a new breast shape is formed using tissue from elsewhere in the breast, an implant, or a combination of the two. If the whole breast has been removed (the case with a mastectomy), an artificial implant may be inserted. This will stretch the remaining muscle and skin around the implant to create the look of a natural breast. It is normally the case that the surgeon will try to replicate the look and feel of the natural breasts by trying to achieve the same size and shape. It’s important to discuss with your surgeon what you envision for your reconstruction so as to manage your expectations.
Further surgery may also be required to achieve a natural look – for example, to recreate a nipple, or address issues of symmetry. If just the tissue but not your skin was not removed during the initial mastectomy (a skin sparing mastectomy), this may not be necessary.
When Can I Have a Reconstruction?
It is possible to have a breast reconstruction at the time of your initial surgery, and this is known as immediate reconstruction. This is a case-by-case issue, however, and will depend on the specific circumstances of your mastectomy and the reconstruction you want, along with any associated treatment after surgery.
During this process, your surgeon will insert the implant and formulate the breast at the same time your natural breasts are removed. This can help some women cope with the loss, and feel more confident as they recover from surgery. Benefits of this include an all-in-one surgery, meaning less anaesthetic and operations, along with less scarring. If you choose to have your reconstruction at a later date, this is known as delayed reconstruction. You may choose this for a number of reasons, such as those pertaining to your ongoing treatment, or wanting to discuss your options and take your time deciding on your method reconstruction with a surgeon after the fact.
When you decide to have your reconstruction will depend on a number of factors, including your personal feelings and thoughts, the stage and type of cancer for which you are being treated, and the prognosis. Ultimately, whether you choose an immediate or delayed reconstruction is a matter of personal choice. Speak to your health care team along with your support network to help you make the right decision for you.
What Are the Options?
- Autogenous reconstruction:. This is where the breast is reconstructed using fat, muscle and skin from elsewhere on the body, commonly the hips or buttocks. The reconstructed breast is connected to the body's blood supply so will continue to be living tissue and look very natural.
- Prosthetic reconstruction:. This means using saline or silicone gel implants in a similar way to what happens with breast enhancement surgery.
- False breast: If you do not want to have reconstruction, you can choose to wear a prosthetic (false) breast.
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What Factors Should Help Me Decide Whether to Have Reconstruction?
Most of the reasons for reconstruction are based around appearance and body image. It can mean you retain your body shape and continue to have a cleavage. The negatives are that you will need to spend more time in hospital and have a longer recovery, you may get additional scarring, and you will likely have little sensation in the reconstructed breast.
What are the Pros and Cons of the Two Reconstruction Options?
Autogenous reconstruction has the benefit that the surgeon can usually recreate the size and shape of the unaffected breast, creating a visually appealing match. The biggest drawback is that it is major surgery and can involve a long hospital stay.
A prosthetic reconstruction is a more minor surgery, though it still involves general anaesthetic. One downside is that there is usually less control over the precise shape and size of the breast after the implant, which could create an imbalance with the unaffected breast. Not every patient sees this as a problem; those who do can consider having enhancement/alteration surgery on the other breast as well.
Some patients even choose to have an elective double mastectomy, meaning both breasts are removed, to reduce the risk of getting cancer in the unaffected breast; this is a major decision and needs to be talked over with a doctor.
What About Nipples?
Whether you will be able to keep your own nipple after a mastectomy depends on the location and extent of the cancerous cells in the breast. If the nipple can be kept safely, there are two options. One is to leave the skin of the breast in place and simply remove the underlying tissue. The other is to remove the nipple and areola during the mastectomy and then graft it on to the reconstructed breast.
If the original nipple cannot be kept, there are several options for replacing it on the reconstructed breast. These include:
- folding the skin to create a nipple shape (a nipple flap)
- using part of the nipple from the unaffected breast (a nipple-sharing graft)
- using a prosthetic nipple made from silicon, which normally needs to be replaced every few months
If you have a nipple flap, it is possible to undergo a procedure similar to tattooing that will make your new nipple the same shade and colour as the one on your unaffected breast.
What Limitations Apply to Breast Reconstruction?
In some cases, particularly when you have had autogenous reconstruction, your breast may have dents or other irregularities in shape. If this happens, you can have a day surgery procedure called lipomodelling that fills the dent with fat from elsewhere on your body. You will normally have to wait six to 12 months after the original breast reconstruction before you can get lipomodelling.
All surgery creates a risk of infection. Because chemotherapy reduces the body's ability to fight infections, you will need to discuss your reconstruction options with a doctor before your mastectomy. It may be that you need to wait until chemotherapy is complete before undergoing reconstructive surgery. In other cases, such as when you have reconstruction at the same time or immediately after the mastectomy, the chemotherapy may need to be delayed until you are fully healed.
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