Some women will require or choose to have a mastectomy as part of their breast cancer treatment. This can be very confronting to the woman and/or her family.
There is now increasing evidence that breast reconstruction (creation of a new breast mound) after mastectomy can help to improve how a woman feels about herself and her body image. In principle, most patients have the option of starting (or sometimes completing) the breast reconstruction at the same time as the mastectomy; this is called immediate breast reconstruction. Some women will want to defer the decision about reconstruction till after all other treatments for their breast cancer have been completed, and in some cases, your breast cancer surgeon may recommend deferring your breast reconstruction till other treatments such as radiotherapy have finished. This is called delayed reconstruction. Breast reconstruction is more complex surgery and lots of different techniques are available. The two basic “building blocks” used in breast reconstruction are the woman’s own tissue, and artificial material such as silicone breast implants. Your breast surgeon will initially discuss with you what your particular treatment options might be, and if you have a number of options, what the pros & cons are of each method. Your surgeon will refer you to one of the plastic and reconstructive surgeons that they work closely with if you are potentially interested in, or they recommend, a tissue based reconstruction. The most common tissue option is the use of the skin and fat and sometimes muscle from the lower tummy. This results in a tummy tuck as well. This operation usually takes between 4-8 hours of operating per side and commonly results in a very natural feeling result (the normal breast contains a lot of fatty tissue of similar consistency to that of the tummy fat). Women are typically in hospital for 1 week following this sort of surgery and will be restricted in daily physical activities for about 6 weeks post surgery. Perhaps the most common form of breast reconstruction opted for by women is silicone implant based reconstruction. Implant based reconstruction can be done as a 2 stage procedure where a device called a tissue expander is inserted under the chest wall muscle. This is then gradually inflated by injecting fluid into it every week or two, in the surgeon’s rooms. It is common to stay 1 or 2 extra nights in hospital after this operation. Once the pocket around the tissue expander is sufficiently mature (typically a minimum of 6 weeks) the expander can be exchanged for the final silicone gel implant. Generally speaking this is a smaller operation that can be done as a day surgery procedure. In some situations, an implant can be inserted directly at the time of the mastectomy in a single-stage procedure. Your breast surgeon will be able to do both the cancer operation and your reconstruction if you choose implants, or you may request for a plastic surgeon to be involved if you like. Your surgeon will be able to show you photos of what you may expect the result to look like. Reconstruction surgery is inherently more complex and therefore comes with a higher risk of complications. Your breast surgeon will discuss these risks with you. Of particular note though is smoking. Smoking increases the rate of significant complications by at least 4 fold. As a result your surgeon may advise against taking on overly complex options till you have become a non smoker. Although the majority of patients will recover very well following this sort of surgery, you will be asked not to do any heavy lifting for 4-6 weeks following a breast reconstruction. This is to try to minimise the risk of the silicone implant changing position.