If you are going to have a mastectomy, you will usually be able to have breast reconstruction. This can be done at the same time as your mastectomy (immediate reconstruction) or months or years later (delayed reconstruction).
If you’re waiting to have breast surgery you should be given the chance to discuss reconstruction beforehand. National guidance recommends that the option of immediate breast reconstruction should be discussed with all patients who are being advised to have a mastectomy.
Breast Cancer Care has worked with the British Association of Plastic Reconstructive and Aesthetic Surgeons and the Association of Breast Surgery to produce a summary for patients of the guidelines.
Your specialist team will be able to explain your options to you. All appropriate breast reconstruction options should be offered and discussed, even if they’re not available locally. If local services can’t offer breast reconstruction or a specific type of reconstructive surgery, you may be referred to another hospital.
Sometimes having a reconstruction is not advised because of other existing medical conditions that may increase the risk of problems or complications following surgery. If you are advised against reconstruction your surgeon will explain why.
Reconstruction can involve major surgery and should be considered carefully. You may prefer to wait and see how you feel after breast surgery.
Some women find that during the waiting period they become used to living without a breast and decide against a reconstruction.
Reconstruction is not commonly used in men who have a mastectomy for breast cancer because it is harder to recreate the shape of a man’s breast. Also, men have less volume of breast tissue to replace. But it is sometimes possible to improve the appearance and symmetry of the chest with surgery, so men may want to discuss some of the techniques described in our booklet Breast reconstruction with their specialist. For more information, please see our resource pack Men with breast cancer.
Oncoplastic reconstruction techniques are an emerging area of surgical expertise and can be used during/after breast-conserving surgery. Breast-conserving surgery is usually called wide local excision or lumpectomy, and is the removal of the cancer with a margin [border] of normal breast tissue around it.
Oncoplastic reconstruction techniques combine removing the cancer with reconstruction if there is likely to be a noticeable defect in the breast after surgery, for example because of a large cancer. This means there is less likely to be a visible indentation in the breast after surgery and that the shape and symmetry of the breasts are maintained. However, most women will not need this type of surgery after having only part of their breast removed.
For further information on the techniques used please see our Breast reconstruction booklet.
Reconstruction can be an important part of treatment that can help emotional recovery and wellbeing.
Discuss your options with the surgeon who is going to do the operation and ask to see photographs of operations they’ve done. Talk it over with your breast care nurse or ask to meet someone who has had the same type of reconstruction. Our One–to-One Support service can put you in touch with someone who has had breast reconstruction.
There are two main types of breast reconstruction – reconstruction using only a breast implant and reconstruction using your own tissue (a tissue flap) with or without an implant. This tissue can be taken from a number of places in the body, although the most common sites are the back or the lower part of the abdomen.
You may have a number of choices available to you, although one type of operation may be more suitable depending on your shape and build, your expectations, lifestyle and whether you are having or have had radiotherapy treatment to the breast.
Implant reconstruction is usually possible if the breast isn't very large and the cancer can be removed without taking too much skin. The implant is placed under the chest muscle. Breasts reconstructed like this tend to be round and firm and move less naturally. Using a breast implant alone is the simplest type of reconstruction operation and the recovery time is usually quicker than for other reconstruction procedures. It is most often done as an immediate reconstruction operation.
If you haven't got enough skin left to take an implant, it may be possible to stretch the skin gradually using a tissue expander implant. Implant reconstruction using a tissue expander usually involves two operations but can sometimes be achieved with one. The two-stage operation involves first placing an inflatable implant behind the chest muscle; this helps keep the implant in the right place and hides its outline. The implant is slowly inflated by your surgeon or nurse during outpatient appointments every one or two weeks. This gradually stretches the muscle and overlying skin. The number of appointments needed varies from person to person.
A saline (salt water) solution is injected into a small injection port. The port is located in either the actual expander or in the armpit where a small tube connects the port to the implant. The port is placed just under the skin.
A further small operation is needed to remove the expander and port, and replace it with a permanent implant, which will be your final breast shape.
The other option is to use a permanent expander implant from the start. As before, the expander is gradually inflated over several weeks and left slightly over-inflated for a further few weeks to allow the skin to stretch. When you and your surgeon are happy with the shape and size of the breast, any excess fluid is removed to try to match your new breast with your other breast. The port is taken out under local anaesthetic leaving the expander implant in place.
A newer technique that can be used in implant reconstruction uses a material derived from pig or cow skin that has been treated, processed and preserved so it can safely be left in the human body. This surgical mesh (called an acellular tissue matrix), which looks like very thin white leather, provides a ‘hammock’ that cradles the breast implant, helping to create a natural droop, shape and contour. The mesh is attached to the pectoralis muscle in the chest making a cavity to hold the implant. The brand name of one type of mesh used is Strattice. This method can be used to achieve a one-stage implant reconstruction with mastectomy. Sometimes tissue expansion is still needed. The technique is available in the UK but not in every hospital.
Immediate reconstruction with an implant is not always advisable for women who will be having radiotherapy, which can increase the risk of a hard capsule of scar tissue developing around the implant (capsular contracture). If you are going to have radiotherapy you will usually be advised to delay an implant-based reconstruction for up to 12 months after treatment to allow your skin and tissue to heal.
Another type of reconstruction technique uses flaps of your own tissue, including the skin, usually taken from your back or lower abdomen or from the thigh or buttock. This is reshaped to form the new breast. Because the skin used is taken from another area of the body, it may be a slightly different shade or texture to the rest of the breast. This method is particularly suitable for creating a moderate to large-sized breast and one that has a natural droop.
It is commonly used in delayed reconstruction when women can’t have tissue expansion because they’ve had radiotherapy. Flaps without implants may also be used for immediate reconstructions for women who are going to have radiotherapy treatment.
This type of surgery involves a longer operation and more recovery time than an implant-only reconstruction. But you will be less likely to need further surgery in the future than with reconstruction using implants alone. A reconstructed breast using tissue instead of an implant may also provide a better match with your other breast in the long term. This is because tissue reacts to gravity, aging and weight change more naturally.
There are two ways in which surgery involving a tissue flap may be done:
Pedicled flap – the flap remains attached at one end to its blood vessels
Free flap – the flap is completely detached from the body along with its blood vessels and re-attached in the position of the reconstructed breast.
The type of operation is usually referred to by the initials of the area of the body from where the tissue is taken, for example the name of the muscle used. Below are some of the surgical techniques used; your surgeon will be able to advise you on the best option for you.
- LD - latissimus dorsi (from the back).
- TRAM - transverse rectus abdominis muscle (from the lower abdomen).
- DIEP - deep inferior epigastric perforator (from the lower abdomen).
- SIEA - super inferior epigastric artery (from the lower abdomen).
- SGAP - superior gluteal artery perforator (from the upper buttock).
- IGAP - inferior gluteal artery perforator flap (from the lower buttock).
- TUG - transverse upper gracilis (from the inner thigh).
For information on these procedures please see our Breast reconstruction booklet.
Surgery to a remaining breast
Sometimes surgery on a remaining breast is suggested to help your breasts match. This may mean making the remaining breast a little smaller or larger, lifting it or moving the nipple. These procedures will all leave some scarring, which will fade with time. The surgery might be done at the same time as the reconstructive surgery or at a later date to allow the original surgery to settle into position and any swelling to reduce.
Mastectomy usually means removal of the whole breast including the nipple and areola, but it is possible to have the nipple reconstructed. Nipple reconstruction usually takes place a few months after the breast reconstruction to give the new breast time to settle into its permanent position.
There are several ways of reconstructing a nipple, so you may want to discuss different options with your surgeon.
Skin can be taken from the areola around the other nipple or the top of the inner thigh where the skin is darker than the rest of the body. More commonly the surgeon may use the skin of the reconstructed breast and fold it to create a nipple shape, which is later tattooed to match the colour of the other nipple and areola.
A reconstructed nipple can improve the appearance of your new breast, but it won’t feel the same as a natural nipple. It has none of the nerves that allow it to rise (become erect) or flatten in response to touch or temperature.
As a temporary or permanent solution, if you would like to have a nipple, you can be given a silicone stick-on nipple or you may be referred to have a silicone nipple/areola area individually made which matches your existing one.
Content last reviewed March 2012; next planned review 2013.