1. What is breast reconstruction?
2. Who can have a breast reconstruction after a mastectomy or breast-conserving surgery?
3. Deciding whether to have breast reconstruction
4. Limitations of breast reconstruction
5. What should I ask my breast surgeon?
6. Why might I have a breast reconstruction?
7. When should I have breast reconstruction?
8. LD flap, DIEP flap and other breast reconstruction options
Breast reconstruction surgery is the creation of a new breast shape, or mound, using surgery. It may be done after removal of a whole breast (mastectomy) or part of the breast (breast-conserving surgery).
You can have reconstruction at the same time as breast cancer surgery (immediate reconstruction), or months or years later (delayed reconstruction). Breast reconstruction often involves several operations to give you the best outcome possible.
There are usually different options available for breast reconstruction and your breast surgeon will explain which one is likely to suit you best.
The new breast shape can be created using an implant and/or your own tissue from another part of the body, usually the back or lower abdomen (belly). Reconstructed breasts don’t usually have a nipple but one can be created with surgery and tattooing. Prosthetic stick-on nipples can also be used.
The aim of breast reconstruction is to create a breast shape that looks as natural as possible and to try to match the breast on the other side in size, shape and position. However, even with the best outcome, there will be differences between the remaining breast and the reconstructed one, and sometimes surgery on the other side can help. This can be done at the same time as the reconstruction, but waiting for the reconstruction to heal and settle into position may be better. Your specialist team will give you an idea of how long this is likely to be.
Where both breasts are being reconstructed, the aim is to recreate breasts that match and are in proportion to the body shape.
There are usually different options available for breast reconstruction and your breast surgeon and breast care nurse will explain which one is likely to suit you best. It’s helpful if you can take some time to consider these options without feeling under pressure to make a decision. You may need a couple of discussions with your specialist team before you feel confident deciding what to do.
Having a breast reconstruction will not increase the chances of the breast cancer coming back.
Most women who have had a mastectomy, and some who have had breast-conserving surgery, can have either immediate or delayed breast reconstruction.
National guidance says the choice of immediate breast reconstruction should be discussed with anyone having a mastectomy. However, a delayed reconstruction may be a better option for some people. All suitable breast reconstruction options should be offered and discussed, even if they are not available locally.
Some people are advised not to have a breast reconstruction because of other existing medical conditions that might increase the risk of complications following surgery.
If it’s likely you’ll need radiotherapy this may affect the options and timing of breast reconstruction. Radiotherapy can increase the risk of hard scar tissue forming around an implant. This is known as capsular contracture. Capsular contracture can also affect a reconstruction that uses your own tissue, making the breast feel firmer, reducing its size and possibly altering its shape. Because of this, if radiotherapy is a likely treatment you may be advised to delay reconstruction for up to 12 months.
If you’re advised against reconstruction your surgeon should explain why. You can ask for a second opinion if this would be helpful.
Reconstruction is not commonly offered to men who have a mastectomy for breast cancer, but it’s possible to improve the appearance and evenness of the chest with surgery.
Choosing whether or not to have breast reconstruction is a very personal decision. Some women feel reconstruction is necessary to restore their confidence; others prefer to wear an external breast form (prosthesis); and some women choose not to have reconstruction and not to wear a prosthesis.
You may choose to delay your reconstruction, which can be a good option if you don’t want to decide straight away. If you decide not to go ahead, this doesn’t mean you won’t be able to have one later.
There’s no right or wrong choice and it’s important to do what’s best for you. It can be helpful to talk to other women who have had breast reconstruction before making your decision. Your breast care nurse may be able to arrange this. Breast Cancer Care can also put you in touch with someone who has had the type of breast reconstruction you are considering, through our Someone Like Me service.
Discussing breast reconstruction with your surgeon
Discussing reconstruction with your surgeon before making a decision is important. They will want to make sure you fully understand the reconstruction process and have realistic expectations of how your reconstructed breast will look and feel.
You might find it helpful to discuss breast reconstruction with more than one specialist in order to choose the right option for you. If so, your GP, surgeon or breast care nurse may be able to recommend someone else in your area.
A lot of women who have reconstruction are satisfied with the result. However, not everyone’s experience is positive and some women feel unsure about their new shape or self-conscious about their new breast.
- Reconstructed breasts will not feel, look or move exactly the same as before. They tend to be less sensitive and sometimes very numb.
- If you lose or gain weight, this will affect the natural breast but not the reconstructed breast, causing a difference in shape and size.
- Several visits to the hospital for appointments and further operations are often needed to get the best cosmetic result.
- Recovery after breast reconstruction will take longer than if you have a mastectomy without reconstruction.
- You may have scars on other parts of your body depending on the type of reconstruction.
- Compared with a mastectomy without reconstruction, there is a higher risk of complications, and this may delay further treatment.
- If you need radiotherapy after your reconstruction, this can affect the appearance of your reconstructed breast.
- Reconstructed breasts don’t usually have a nipple, but one can be created with surgery, or a nipple tattoo, often at a later date (your specialist team will discuss timings with you).
A reconstructed breast will not look the same as the breast you have lost – it will often be a slightly different size and shape. Any differences should not be noticeable when you are clothed, even in a bra or in swimwear. But when you are undressed, the differences are more obvious. You’ll be able to see some scarring, although this should fade over time.
You won’t get the same feeling as before from a reconstructed breast and you may have no sensation at all. A natural breast will change over time and droop as you get older. Reconstructed breasts (especially those using implants) will not change in the same way. Over time the differences between a natural and reconstructed breast may become more obvious, and you may need further surgery to restore symmetry.
Where a muscle has been used to cover an implant or is part of the reconstruction you may see movement of the reconstructed breast as that muscle contracts.
Despite these limitations, most women say the results after reconstruction surgery are acceptable and that they feel confident about the way they look.
Make sure you’ve got all the facts you need and have received answers to all your questions before making an informed decision. You may find it helpful to write down any questions you want to ask and to take notes during consultations. Taking someone with you can help you to remember what has been discussed and give you extra support.
Here are some questions you may want to ask your surgeon.
- Can I have an immediate breast reconstruction?
- Which reconstruction would be best for me and why?
- What are the benefits, limitations and risks of this type of surgery?
- When would I be able to have my surgery done?
- How long would I have to stay in hospital?
- What is the recovery time for this operation?
- When would I be able to move about, walk and drive?
- How much pain is there likely to be?
- Can you show me where the scars would be and how big/long?
- Would I have scars elsewhere on my body?
- Would I be able to keep my nipple?
- Can reconstruction surgery delay my other cancer treatments, like chemotherapy and radiotherapy?
- When would I be able to exercise again?
- Can you show me any photographs or images of your previous breast reconstructions?
- Can I speak to someone who has had the same type of reconstruction?
- Would I need to wear a special bra after the operation?
Where can I find a breast reconstruction surgeon?
Your GP, surgeon or breast care nurse may be able to recommend a hospital or particular surgeon for you. You can also contact the Breast Cancer Care Helpline for more information on 0808 800 6000.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has a list of surgeons and hospitals with plastic surgery units.
Some women choose reconstruction for practical reasons such as not having to wear a prosthesis.
Surgery for breast cancer is likely to affect how you look and feel in some way. Some women find it harder than others to come to terms with losing one or both of their breasts. After breast surgery, you might be concerned about the shape of your body and how your breast area will look.
Like many women, you may choose breast reconstruction because your breasts are an important part of your body image, self-esteem and sexuality.
Some women choose to have a reconstruction as they think it will make a difference to their partner, or that it may help them feel more confident during intimacy and sex. However, any decision you make about having a reconstruction should be based on whether it’s right for you.
If you’re not in a relationship at the time of your breast cancer surgery, you may be worried about meeting someone new in future. Breast reconstruction may help you feel more at ease in new relationships, and help you to talk about your breast cancer and feel more confident about showing your body to your partner.
Some women choose to have reconstruction at the same time as their mastectomy, while others need or choose to have it later.
One of the benefits of immediate reconstruction is that the skin of the breast can sometimes be preserved. Your breast surgeon may discuss a skin-sparing mastectomy. This is removal of the breast and nipple area without removing much of the overlying skin of the breast.
Most women who have a mastectomy have their nipple removed as part of the operation. However, for some women, keeping the nipple (a nipple-sparing mastectomy) may be possible.
Your surgeon will discuss which type of operation is appropriate to best treat your breast cancer.
You can have a reconstruction months or even years after your breast surgery, so you have plenty of time to make a decision if you opt for a delayed operation. During this time you may adapt to your mastectomy and feel that you no longer want to go through further surgery; it’s fine to change your mind.
Women who want reconstruction at a later date after completing treatment for breast cancer can still still have their operation on the NHS. However, in some areas there may be a long wait.