The decision to have breast reconstruction is a personal one that should be taken carefully, but if you decide this surgery is for you, there are several aspects you might need to take into account.
In this article, leading consultant oncoplastic breast surgeon Mr Jaroslaw Krupa, provides a comprehensive overview of the procedure, explaining if it’s possible to have mastectomy and breast reconstruction at the same time, if breast reconstruction can lead to a return of cancer, and what are some of the results that patients can expect.
Women who have had mastectomy or lumpectomy may choose to have breast reconstruction to rebuild the shape of the lost breast and restore the silhouette. While in some cases, it might be done soon after the surgery to remove cancer, breast reconstruction can also be performed at the same time as mastectomy or lumpectomy in a procedure called immediate reconstruction. In fact, the National Institute of Clinical Excellence (NICE) recommends that immediate breast construction should be offered to all patients facing a mastectomy if this is clinically appropriate.
What are my breast reconstruction options?
There are several options available for breast reconstruction. The first involves transferring a patient's own tissue from a different part of the body to the breast area.
Autologous tissue reconstruction
Another option is breast reconstruction using silicone implants, and this is performed for most cases in the UK. Worldwide, it is the preferred choice for many patients. The use of biological measures can also improve cosmetic outcomes after surgery.
Breast cancer reconstruction can be quite complex for some patients, as is the experience of being diagnosed with breast cancer. For patients who find it difficult to make a decision about breast reconstruction when they’re under pressure of time, delayed reconstruction (performed after breast cancer surgery) allows time to concentrate on cancer treatment first and then consider reconstruction at a later stage.
However, there are some technical considerations which are important and can be very relevant for individual patients. For example, with modern techniques of reconstruction, a breast surgeon can often preserve some of the skin that covers the breast when doing immediate reconstruction. This is a procedure called skin sparing or nipple-sparing mastectomy, and can significantly enhance the outcome of breast reconstruction. On the other hand, with a delayed reconstruction, a mastectomy is performed first, causing most of the skin to be removed. This skin will therefore have to be revealed.
The second situation where delayed reconstruction may be more appropriate is if an issue with the tumour(s) exists, for example if the cancerous tumour is close to or invading the skin, and the illness is more advanced. As a result, from the perspective of cancer treatment, it is more advisable to remove the skin rather than trying to preserve it. In these scenarios, delayed reconstruction could offer better results for the patient.
Finally, there are some instances in which breast cancer patients will require additional treatments like chemotherapy or radiation therapy after surgery. In these situations, radiation can have a tremendous effect on reconstruction and patients may find themselves in a situation where breast reconstruction initially looks very good after surgery and then may deteriorate after radiotherapy.
When to have breast reconstruction
When reconstruction is considered, there are several issues that a breast surgeon will take into account to determine which type of breast reconstruction is best for each patient.
The first one concerns a patient’s cancer treatment, which always take priority in any decision-making process. It’s not the cosmetic outcome, but the treatment of the cancer which is more important, and a surgical planning of breast reconstruction strategies are built around that.
The second one involves the patient’s general health or other medical conditions, which can limit some reconstructive options. Patients who opt for abdominal flap reconstruction (DIEP flap) may not be good candidates, for example, if they have previously undergone extensive abdominal surgery, and if they have scarring in the abdomen. These are lengthy operations that require microsurgical procedures as well, so breast reconstruction will not be suitable for patients with significant comorbidities.
Another consideration is breast shape or size, because it is challenging to reconstruct a breast with the same size or shape as a healthy breast. Some patients thus have to consider either increasing the volume of the breast or decreasing the size through a procedure called symmetrisation surgery, which occurs when operations are performed on a healthy breast just to improve symmetry. Examples include a breast uplift, augmentation, or reduction.
A patient’s expectations and the location of cancer are taken into account by a breast surgeon.
What results women can expect with mastectomy and breast reconstruction is one of the most important considerations and through multiple consultations, a breast surgeon will try to understand a patient’s expectations and try to communicate possible options from the surgical point of view. Although breast reconstruction can often achieve excellent results, this procedure is not a cosmetic operation done purely for cosmetics. Improving body image and - to some extent - restoring or rebuilding the breast that was removed as a result of cancer treatment are some of the results, but a reconstructed breast isn’t as good as a natural breast. It can be a very close replica, but it will not look or feel the same.
The safety of breast reconstruction has also been documented in several clinical studies, which show that breast reconstruction has a detrimental effect on cancer outcomes, including the risk of cancer, cancer recurrence and overall cancer survival.
To acquire a better understanding of what is achievable and what is possible, patients are encouraged to attend breast reconstruction support groups.
Mr Jaroslaw Krupa is a highly experienced consultant oncoplastic breast surgeon based in Leicester and Nottingham, who specialises in breast cancer, breast reduction, breast augmentation and mastopexy. If you’re thinking about breast reconstruction and wish to consider your options, don’t hesitate to visit Mr Krupa’s Top Doctors profile today.