Breast Reconstruction

Overview
Breast reconstruction is commonest after mastectomy (removal of the breast) for breast cancer, but may be done for congenital absence of a breast (Poland syndrome) or other causes. This surgery will create a breast mound, in place of the absent breast, which may or may not be followed by a nipple reconstruction at a later stage.

Several types of operation are available to create your newly shaped breast. Mr Nduka may use a breast implant or your own tissue flap, taking tissue from your back (a latissimus dorsi flap) or from the abdomen (TRAM flap or a DIEP flap). He may also use a combination of the two.

Reasons for choosing breast reconstruction
Women choose breast reconstruction for different reasons. The goals of reconstruction are:
- to make your breasts look balanced when you are wearing a bra so you feel comfortable about your appearance in most types of clothing
- to permanently regain your breast contour
- to give the convenience of not needing an external prosthesis

Important factors to consider in deciding about breast reconstruction
Breast reconstruction does not affect your ability to have other breast cancer treatments such as chemotherapy or radiotherapy and follow up after treatment is the same as if you have had a mastectomy only. The difference between the reconstructed breast and the remaining breast can be seen when you are nude. A breast reconstruction will not be an exact match and will not be as sensitive to touch as the other breast.

Your body image and self-esteem may improve after your reconstructive surgery, but this is not always the case. Breast reconstruction is not a ‘cure for all ills’ and will not fix everything you were unhappy about before your surgery. You may be disappointed with how your breast looks after surgery. You and those close to you must be realistic about what to expect from reconstruction.

It is important that you make your decision about having breast reconstruction only when you feel fully informed about the procedure. There are often many options to think about as you and Mr Nduka explore what is best for you. The reconstruction process may require one or more operations. You should discuss the benefits and risks of reconstruction with your doctors and breast care nurses before the date of surgery to give yourself plenty of time to make the best decision for you.

Breast reconstruction surgery takes longer than a simple mastectomy and is a major operation. This means your overall hospital stay may be longer than for a mastectomy alone.

Questions you may wish to ask
It is very important that you ask as many questions of your surgeon as you need before having breast reconstruction. Here is a list of questions you may wish to ask. It is always useful to write down any questions as you think of them. Bring a friend or family member with you to help you remember what was said. It may also be helpful to bring a notepad and pencil to make notes as the answers to these questions may help you make your decisions.

- What type of reconstruction is best for me? Why?
- What results are realistic for me?
- Will the reconstructed breast match my remaining breast in size?
- Will I have any feeling in my reconstructed breast?
- What are the risks of this surgery?
- How much discomfort or pain will I feel?
- How long is the recovery time?
- What do I do if I get swelling in my arm (lymphoedema)?
- Can I talk with other women who have had the same surgery?
- Will reconstruction interfere with chemotherapy?
- Will reconstruction interfere with radiotherapy?
- How long will the implant last?
- What kinds of changes to the breast can I expect over time?
- How will aging affect the reconstructed breast?
- What happens if I gain or lose weight?
- Are there any new reconstruction options that I should know about?

Immediate or delayed reconstruction with breast cancer
Immediate reconstruction is reconstructive surgery that is done at the same time as the mastectomy when the entire breast is removed. Immediate reconstruction means that the chest tissues are undamaged by radiotherapy or scarring. Also, immediate reconstruction means one less operation.

Delayed reconstruction is reconstructive surgery that is undertaken at a later time and may be performed several years after initial breast cancer surgery. For some women, this may be advised if radiotherapy is to follow mastectomy. This is because radiotherapy following breast reconstruction may increase complications after surgery.

Decisions about reconstructive surgery will depend on many personal factors such as:

- Your overall health
- The stage of your breast cancer
- The size of your natural breast
- The amount of tissue available
- Your desire to match the appearance of the opposite breast
- Your desire for bilateral (both sides) reconstructive surgery
- The type of procedure
- The size of implant or reconstructed breast