For many women who have undergone a mastectomy, reconstructive surgery is often seen as the next step, but it’s a big decision and it can be stressful, with results not always meeting expectations.
Whether you're newly diagnosed with breast cancer after a mammogram screening facing the possibility of mastectomy, or considering a delayed reconstructive surgery, there are a range of options available which can be confusing to process. And some people find it difficult to talk about.
We discuss your options and a new approach designed to help cut through the confusion.
What is breast reconstruction?
You can usually have breast reconstruction to make a new breast shape at the same time as a mastectomy or later. It may be done after removal of a whole breast (mastectomy) or part of the breast (breast-conserving surgery). This new breast shape can be made either by using a breast implant or tissue from another part of the body (usually the back or lower abdomen).
The surgeon aims to match the reconstructed breast to your other breast as much as possible, but further surgery may be necessary to improve the final appearance.
While the new breast mound won't have a nipple, these can be tattooed on, or prosthetic stick-on nipples can also be used.
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.
Your breast surgeon talk you through the different options available and will explain which one is likely to suit you best.
Immediate breast reconstruction after mastectomy
An immediate reconstruction gives you a new breast straight away. Surgeons try to match the reconstructed breast to your other breast, but it will not be exactly the same.
It's important to understand that the new breast will feel and look different from the one removed. Some decide not to go ahead with a more complicated surgery and instead opt for a mastectomy tattoo. But some women find that immediate reconstruction helps them to cope more easily with their feelings about the loss of a breast.
Every woman's breast reconstruction experience is unique. Right after surgery, you may have tenderness, numbness, and twinges of pain. These sensations usually come and go, and often decrease within the first few months after surgery. However, some may last months, even one year or longer.
Delayed breast reconstruction
A delayed reconstruction may be a better option for some people to allow their bodies to recover from the initial mastectomy, particularly if existing medical conditions could increase the risk of complications.
If it’s likely you’ll need radiotherapy this may affect the options and timing of breast reconstruction, as radiotherapy can increase the risk of scar tissue forming around an implant, whether synthetic or from your own tissue. If radiotherapy is a likely treatment you may be advised to delay reconstruction for up to 12 months.
Where to get breast reconstruction support
Deciding whether or not to have reconstruction is a very individual choice and whatever you decide must be the right decision for you. It is your body and you are in control.
You should be given the opportunity to discuss all types of reconstruction, however pre- and post-operative support/care varies from hospital to hospital.
Consult with your own hospital to discuss your personal care plan, and if you don't feel that your healthcare providers are giving you enough support to make the decision, there are groups and charities that can help:
Breast Cancer Now have specialist nurses available to talk to via their helpline, as well as online and face-to-face courses so you can get the support you feel most comfortable with.
Macmillan have a support line, online chat and anonymous forums so you can talk to others who understand what you're going through. Their service is available 24/7 and has dedicated forums where you can get advice from experts.
Keeping Abreast offer support so that women make an informed choice about whether or not to proceed with breast reconstruction. Keeping Abreast also supports women considering elective reconstruction surgery due to a hereditary breast cancer risk or the discovery of a breast cancer gene.
As well as local face-to-face Support Groups, there are many other resources available from Keeping Abreast, such as online and telephone support. Their aim is to help people build their support network so that they don’t feel they are facing these choices and situations alone.
Patient’s Expectations and Goals: Assisting Shared Understanding of Surgery
Before you make a decision about having breast reconstruction you will talk to your surgeon and breast care nurse. It often helps to have a list of questions to ask. Both your breast surgeon and your reconstructive surgeon will be sensitive to your thoughts and feelings about breast reconstruction. So do not be afraid to ask about anything you are concerned about.
To help women take an active role in considering and discussing their individual expectations and goals for reconstructive surgery a new decision-making tool called PEGASUS (Patient’s Expectations and Goals: Assisting Shared Understanding of Surgery) has been made available to hospitals.
When trialed, the PEGASUS tool was found to help some women decide whether or not to have breast reconstruction, as well as helping health care professionals focus on what was important for each individual.
“Six months after reconstructive surgery, the researchers found that women who received this support experienced lower levels of distress and remorse following their surgical decision than those who had not. We hope this is a step towards shared decision making between women undergoing reconstructive surgery and healthcare professionals who can access the resource online for free,”says Dr Kotryna Temcinaite, senior research communications manager at Breast Cancer Now.
Breast reconstruction FAQs:
How long does breast reconstruction take?
You'll be put under aesthetic for the surgery, which can take 1-6 hours. You’re likely to feel tired and sore for a week or two. When you're discharged you'll be prescribed some pain medication, given advice on how to care for your wounds, and also may be recommended some exercises to build up the tissue around the surgical site.
Most women can start to get back to normal activities within 6 to 8 weeks. If synthetic implants are used rather than your own tissue, your recovery time may be shorter.
Recovery after breast reconstruction will take longer than if you have a mastectomy without reconstruction.
What do reconstructed breasts feel like?
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. It's important to regularly check your breasts post surgery and let your GP know of any concerns.