Breast surgery following a mastectomy
Friday 3 February 2017
Breast cancer is the most common cancer in the UK. If you’ve been diagnosed with breast cancer or you have a very high risk of developing it in the future, you may need, or choose, to have a mastectomy (surgical removal of the entire breast).
Before you have a mastectomy you should consider whether to have breast surgery during or after your mastectomy and if so, what options are available to you. Deciding if you would like to have a breast reconstruction is a very personal choice. Current evidence suggests that having your breasts reconstructed does not increase the chances of the cancer recurring. Oncoplastic breast surgeons may also be able to preserve the affected breast by removing only the area involved and perhaps reducing the other side to match, particularly in large breasts to avoid a mastectomy.
What is breast reconstruction?
Breast reconstruction surgery recreates your breast shape and volume to carefully match it as closely as possible to your remaining natural breast. If you are having or have had a double mastectomy, breast reconstruction will rebuild both breasts.
Breast reconstruction may improve your body image and self-esteem and help with your physical and psychological recovery.
When to have breast reconstruction
Breast reconstruction can be:
Immediate reconstruction – performed at the same time as your mastectomy Delayed reconstruction – after your cancer surgery and treatment
Your breast surgeon will discuss with you the type and stage of your cancer and other treatments that you might need as well taking into account your feelings and preferences before you make the decision about when to have breast reconstruction. Sometimes, for example if you have a certain type of tumour or you need further treatment such as radiotherapy, immediate reconstruction will not be recommended or possible.
Both have different benefits and fulfil the needs of different women.
According to the National Institute for Health and Clinical Excellence (NICE), all women should be offered breast reconstruction at the same time as their mastectomy. The benefits of an immediate breast reconstruction include:
More, and often most, of your breast skin can be preserved.
You will usually have just one anaesthetic, one hospital stay and, one recovery period.
You will have your new reconstructed breast when you wake up so you don’t spend any time without a breast.
The cosmetic results may be better particularly for implant based reconstruction.
Scarring on your breast is usually less.
The benefits of a delayed reconstruction include:
Your cancer treatment can go ahead without any delay.
You will have less to deal with at the same time.
This two stage surgery approach will mean an easier and a shorter recovery after each procedure.
You have time to consider whether reconstruction is right for you and, the options of reconstructive breast surgery available.
How is breast reconstruction carried out?
There are two main categories of breast reconstruction:
Implant reconstruction - uses a breast implant to recreate your breast shape.
Flap reconstruction – uses your own tissue from another area of your body to recreate your breast.
Your breast surgeon will discuss all options available in detail with you.
Implant reconstruction typically inserts silicone or saline implants under the skin and muscle of your chest. The main advantages of implants are:
It is a relatively simple operation that does not involve scars elsewhere on your body.
It involves a short stay in hospital and fast recovery time.
Implants may be offered if you don’t have any spare tissue to use or you are not well enough for a larger operation.
It’s worth taking into consideration that when using implants: it is impossible to create a breast that is an entirely natural shape and feel, it can also be more difficult to match the shape of your existing breast and, if your weight changes your implant will not adjust accordingly.
Flap reconstruction (autologous reconstruction)
Plastic surgeons often prefer to use your own tissue from elsewhere on your body to reconstruct your breast. Tissue is usually taken from your back or stomach, but sometimes it’s taken from your buttocks or upper inner thighs. Women who choose reconstruction using tissue from their back sometime also need an implant to further increase the volume of their breast. The main advantages of flap reconstruction are:
It creates a more natural looking breast.
Your breast gains and loses weight as your body does.
If tissue is used from your stomach area the procedure can also remove excess tissue from this area.
When contemplating flap reconstruction, you should bear in mind that: it requires longer surgery and recovery time and, you will have a scar on your back, stomach, buttock or thigh.
Support to help you make your decision about breast reconstruction
The decision to have breast reconstruction surgery is both emotional and physical. If you're considering reconstruction, you can talk to your GP, breast care nurse and breast surgeon, and have a consultation with a reconstructive plastic surgeon.
Here at Ramsay Health Care UK, our team of experts are here to support you in making your decision about breast reconstruction. You can arrange an appointment with one of our experienced and highly regarded reconstructive or oncoplastic surgeons to discuss this in detail and to ask any questions you may have.
Types of surgeon
These surgeons just deal with breast cancer surgery and may also be called oncological breast surgeons as they deal exclusively with removing the breast cancer. If a reconstruction is also needed they may work with an oncoplastic surgeon or a plastic surgeon in a combined operation to remove the cancer and reconstruct the breast
Oncoplastic Breast Surgeons
An oncoplastic breast surgeon is usually a breast surgeon has done addition training in breast reconstruction or a plastic surgeon who has done additional training in treating breast cancer. They will be able to do the mastectomy or cancer excision and also some of the flap operations. They are also able to perform breast conserving procedures called therapeutic mammoplasty where the remaining non-affected breast tissue can be moved within the breast to reconstruct the breast. If required they will also be able perform a reduction on the other side to match.
Plastic and Reconstructive Surgeons
These surgeons will be able to offer more difficult types of breast reconstruction usually those techniques involving micro-surgery that move tissue from a distant site such as the abdomen. They will work with a breast surgeon or oncoplastic breast surgeon for immediate reconstructions if the breast tissue or breast cancer needs to be removed at the same time.
At Mount Stuart Hospital we are running a complimentary breast surgery clinic on 28th February, this is an ideal opportunity to have all your questions answered by one of our specialist breast surgeons.