Whenever possible we try to treat breast cancer with breast conserving surgery, sometimes, however removal of the whole breast (mastectomy) might be unavoidable, or maybe chosen by a woman as the treatment she would prefer.
If you are going to have a mastectomy you will have the opportunity to discuss breast reconstruction with your Surgeon and Breast Care Nurse who will explain what options are available to you so you can decide if you would like to consider this. Breast reconstruction is the recreation of a breast mound following mastectomy. It can be carried out at the same time as the mastectomy (immediate reconstruction), or later on after all treatments have been completed (delayed reconstruction).
If it is carried out at the same time as the mastectomy then usually the surgeon will carry out what is called a ‘skin-sparing’ mastectomy, where the nipple is removed but most of the skin of the breast is kept to allow a better shape to the reconstructed breast. Some women may be suitable for a ‘nipple-sparing’ mastectomy where the nipple is preserved, particularly if they are having surgery to prevent breast cancer in the future (‘risk-reducing mastectomy’) rather than to treat a breast cancer that has already developed. Your Breast Care Nurse and Surgeon will be able to advise you on which would be best for you.
There are several techniques of breast reconstruction; you will be able to discuss which ones are suitable for you and it is important you spend time thinking about what is the right one for you and your lifestyle. It can be a lot to consider at a very stressful time; your Breast Care Nurse will be there to support you, and you can be reassured that if you don’t feel able to make a decision at this time you could always have a delayed reconstruction later. There is no time limit or age limit on returning for a delayed reconstruction but if you have radiotherapy as part of your treatment then a delayed implant reconstruction may no longer be an option for you.
In broad terms breast reconstruction is carried out using an implant alone (implant reconstruction), or using your own tissues (‘autologous’). With autologous reconstruction this can be your own tissues alone eg a DIEP flap or a combination of your own tissues with an implant (eg a latissimus dorsi reconstruction). Some women may be suitable for a ‘Goldilocks mastectomy’ which uses the skin and fat of the breast to form a mound. Implant only reconstruction is the simplest method and the quickest to recover from as it doesn’t affect any other part of your body. Autologous reconstruction is more complex, takes longer to carry out and longer to recover from but as it uses your own tissue is likely to give you a more natural feeling breast.
No form of reconstruction can recreate the breast that you had, and breast reconstruction is best thought of as a process whereby you might need several procedures before you have a final result. Reconstructed breasts are usually numb, and although this may improve slightly over time you should not expect to regain normal feeling. The main aim will be to allow you to have a good volume match for your remaining breast when you are wearing a bra without needing an external prosthesis. Unclothed there will usually be noticeable differences in the breasts and a reconstructed breast will not change as you age in the same way that a natural breast would. You may choose to have surgery to the other breast to match things up better in the future (‘symmetrisation’), this is not usually done at the time of reconstruction, but there is no time limit to returning for it later. Nipple reconstruction can be done, and again this is usually done as a later procedure.