What is breast reconstruction?
Breast reconstruction is the rebuilding of the breast after all or part of it has been removed as part of cancer treatment. It is also performed for congenital absence of the breast and for marked developmental asymmetry.
This is not an additional cosmetic procedure. Losing a breast affects the sense of bodily integrity and daily life directly; reconstruction is planned as part of cancer treatment as a whole. For that reason the decision is taken together with surgical oncology and, where necessary, radiation oncology.
Timing: immediate or delayed?
| Immediate | Delayed | |
|---|---|---|
| When | In the same session as the operation to remove the breast | After treatment has been completed, within months or years |
| Advantage | The skin envelope is preserved and the result is usually more natural; the patient does not live through a period without a breast | The oncological treatment plan has become clear; the decision is not made in haste |
| Needs attention | If radiotherapy is going to be needed, the result may be affected | Because the skin and tissues have contracted, more extensive repair may be required |
The need for radiotherapy is the most important factor determining timing. In cases where irradiation is expected, repair with the patient’s own tissue gives a more durable result; the plan is therefore built around the decision on radiotherapy.
Methods
| With an implant | With the patient’s own tissue (flap) | |
|---|---|---|
| How | An implant following a tissue expander, or a single-stage implant in suitable cases | The patient’s own skin, fat and, where necessary, muscle taken from the abdomen, back or thigh |
| Operation | Shorter, with no additional incision | Longer, may require microsurgery; there is an incision at the donor site |
| Recovery | Faster | Longer |
| Long term | Change or replacement may be needed over time | Being the patient’s own tissue, it changes along with weight and is more lasting |
| After radiotherapy | The rate of problems is high | More suitable |
In repair using tissue from the abdomen, the tissues are raised together with their vessels and joined by microsurgery to the vessels of the chest wall. Tissue from the back may be used together with an implant or on its own.
Creating the nipple and the darker ring around it is usually the final step; it is done with a small procedure or by medical tattooing. To achieve symmetry, reduction or lifting of the other breast may be required, and this too is included in the plan.
The process and recovery
Reconstruction is often not finished in a single operation; it is a staged process. The hospital stay is short in repair with an implant and longer in repair with the patient’s own tissue. A drain is used for a period after the operation.
Return to daily life is gradual, over weeks, according to the method used. Touch sensation in the reconstructed breast is not the same as in the breast that was removed; this is an aspect of the process that should be discussed from the outset.
Is oncological follow-up affected?
Reconstruction does not interfere with cancer follow-up. Surveillance is continued in a manner appropriate to the method used and is carried out according to the plan of the oncology team. This is the subject patients ask about most often and worry about most; it is also the reason the decision is taken together with the oncology team.
Who is suitable?
Suitability is determined by assessing together the stage of the tumour and the treatment plan, general health, smoking, weight and the patient’s own preference. Because smoking impairs the blood supply to tissue, patients are asked to stop before surgery, particularly where repair uses their own tissue.
For patients who do not want reconstruction, this is not a shortcoming either; the decision belongs entirely to the patient and can also be made later.
Assessment
The right method emerges when the requirements of tumour treatment, body build and the patient’s expectations are read together. Different methods may be right for two patients who have had the same operation.
If you would like to discuss reconstruction options before or after breast cancer treatment, you are welcome to book an appointment; bringing your current pathology and treatment information will speed up planning.