What's involved in Breast reconstruction following mastectomy?
Breast reconstruction surgery aims to replace the tissue removed due to breast cancer or other reasons, so that your breast regains some of its original shape and appearance. This can be done immediately after having a complete or partial breast removal (mastectomy), or at a later date.
A breast can be reconstructed using a breast implant or the patient’s own tissue. There are several techniques available to do the procedure. Some surgeons use a combination of methods to get the most acceptable result.
Breast reconstruction may involve more than one operation. Usually the first operation is the most complex.
The operation is usually done under general anaesthesia. This means you will be asleep during the procedure. You will need to stay in hospital for several days. The length of your stay will depend on the extent of your surgery and how you feel afterwards.
Your surgeon will explain the potential benefits and risks of having a breast reconstruction, and will discuss the alternatives to the procedure. Your surgeon will also give you advice about the size and type of bra you will need to take to hospital for after the operation.
About the breast reconstruction operation
There are three main approaches to breast reconstruction. Your surgeon will advise which method is most suitable for you.
Breast implants for breast reconstruction
Usually a silicone breast implant is used. This is placed either directly under the skin or deeper behind the muscle on which the breast lies. An implant can be used to replace breast tissue, especially if the breast skin and nipple are preserved during the mastectomy.
Once the implant has been adjusted to the correct shape and position, the skin cut is closed with stitches.
Tissue flap breast reconstruction
Tissue is taken from other parts of the body and used to reconstruct the breast. There are two types of tissue flaps used for breast reconstruction.
- Pedicled flap – the skin, fat and muscle from your abdomen or back is repositioned (tunnelled) to the chest area, while keeping its connection and blood supply to the original site.
- Free flap – an area of skin and fat with or without muscle is completely removed from the abdomen, back or buttocks and transplanted to the chest area. So that the flap survives when moved to the chest, a new blood supply is created by connecting the blood vessels of the flap to the blood vessels in the chest.
Depending on the technique used your operation can take one to three hours.
After surgery, you are likely to have some discomfort and swelling in the breast and from where the tissue flap was taken. Bruising, twinges and pain may continue for the first few weeks. It may take several months for your breast to settle into shape.
You will be left with fine but permanent visible scars on your breast and, depending on the type of operation you have, at the site where the tissue flap was taken.
A reconstructed breast will not restore the feelings and sensations of a natural breast. However, in time some feeling over the skin and in the breast tissue may return.
Breast reconstruction is generally a safe operation. For most women, the benefits are greater than any disadvantages. However, all surgery carries an element of risk.
Complications specific to this operation include infection, which may need to be treated with antibiotics and sometimes further surgery.
There is a small risk that the alteration in the blood supply may result in the loss of part, or even all, of the breast.
With breast implants, there is a risk of capsular contracture. This is when a layer of scar tissue hardens around the implant causing the breast to feel hard. The implant may need to be removed and, if you wish, replaced with another one.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how any risks apply to you.