Breast reconstruction after cancer surgery

Breast reconstruction is surgery to make a new breast shape after mastectomy or lumpectomy.

A mastectomy means that the surgeon removes all your breast tissue. Usually, the skin covering the breast is also removed, including the nipple.

The main ways of making a new breast shape include:

• -  Removing the whole breast and skin and then inserting an implant to gradually stretch the remaining skin
• -  Removing just the breast tissue, but leaving the skin, and inserting an implant (skin sparing mastectomy)
• -  Reconstruction with your own living tissue, taken from another part of your body
• -  A combination of your own tissue and an implant

You will have to speak to your surgeon or breast care nurse to find out which type is suitable for you.

Your surgeon aims to create a breast similar in size and shape to your own breast.  But a reconstructed breast won't be identical. When you are undressed you are likely to notice differences in symmetry and shape. After your reconstruction, you may need to have further surgery to create a nipple or change the shape of your other breast to match your reconstructed one..

It is also possible to have breast reconstruction if you've only had part of your breast removed (conservative surgery).

When to have breast reconstruction

You can have reconstruction at the same time as your breast cancer surgery or later. It is a very personal decision and there is no right or wrong way to approach it.

Doctors call it

• -  Immediate reconstruction - if done at the same time as your breast cancer surgery
• -  Delayed reconstruction - if done later

If you are having a mastectomy, your surgeon will discuss with you whether you want to have immediate breast reconstruction. They will advise you, taking into account the type and stage of your cancer, other treatments you are likely to need, and your feelings and preferences.

Benefits of immediate reconstruction

An immediate reconstruction, it gives you a new breast straight away. The breast will be different to the one that was removed, but some women find that immediate reconstruction helps them cope more easily with their feelings about the loss of a breast.

With immediate reconstruction:

• -  You will have your new reconstructed breast when you wake up after your mastectomy or lumpectomy
• -  You have fewer operations, so fewer anaesthetics
• -  Your finished breast may look better because the surgeon is able to use the breast skin already there
• -  You will have less scarring on the reconstructed breast itself - usually you will have a small patch of skin where your nipple was, with a scar around it

Drawbacks of immediate reconstruction:

• -  You may not have as much time to decide on the type of reconstruction you want.
• -  If you are having radiotherapy after surgery for breast cancer, it may damage the reconstruction
• -  You may be advised not to have implant reconstruction if you are having radiotherapy afterwards, but you may have a temporary implant during radiotherapy with a second reconstruction operation after the radiotherapy
• -  If you have complications of surgery, it may delay any chemotherapy you need
• -  The last point is an important one. Chemotherapy stops the body from being able to heal itself. So if you have any problems with wound healing after your reconstruction, your doctors won’t let you start chemo until the problems have cleared up. Chemotherapy at this time would stop the wound healing and you could get a serious infection. There is good research evidence that chemotherapy works best if you start it within 6 weeks of your cancer surgery. And this may not be possible if things don’t go according to plan with the reconstruction.

Delayed reconstruction:

• -  Some women prefer to get over the mastectomy and breast cancer treatment before they think about reconstruction. With delayed reconstruction
• -  You have more time to look at your options and discuss them with a specialist surgeon
• -  Your breast cancer treatment will be finished and won’t be affected by your reconstruction surgery
• -  You may have a larger scar on the reconstructed breast
• -  Remember that if you are interested in immediate reconstruction (during mastectomy surgery) talk it over beforehand with your surgeon. They will tell you if it is advisable or not, and talk through the pros and cons.

Who can have breast reconstruction?

• -  Breast reconstruction is possible for most women who have had their whole breast removed. Even if you
• -  Have had a radical mastectomy
• -  Have had radiotherapy
• -  Have large breasts
• -  If you are well enough, you may have a breast reconstruction at any age.
• -  You may need to go on a waiting list for breast reconstruction as there are a limited number of breast and plastic surgeons experienced in this type of surgery. There is more information about finding a surgeon further down this page

Reconstruction after conservative surgery

The cosmetic results of conservative surgery plus radiotherapy are usually very good. Few women need reconstructive surgery after having only part of their breast removed. But for some women reconstruction of the remaining breast tissue is possible. It may be possible to have

Quadrantectomy and mini flap reconstruction

A quadrantectomy means the surgeon removes about a quarter of the breast tissue. This type of surgery leaves a dent in the breast and means the treated breast ends up smaller than the other breast. But it is sometimes possible to get back the shape of the breast by filling the dent with a small area of living tissue. The surgeon usually uses tissue from your back to do this - called a latissimus dorsi flap. You will need radiotherapy to the remaining breast tissue to reduce the risk of the cancer coming back.

Reshaping of the breast

This may be an option if you need part of your breast removed and you have quite large breasts. It is called therapeutic mammoplasty. The surgeon removes the tumour and an area of surrounding tissue. The remaining breast tissue is then reshaped to create a smaller breast. You will need radiotherapy to this remaining breast tissue to reduce the risk of the cancer coming back.

At the same time as your reconstructive surgery you can also have surgery to make your other breast smaller (breast reduction) so that they match in size.

How to find a surgeon

Reconstruction is very specialist surgery. So it is very important to have your reconstruction done by a breast or plastic surgeon who is experienced in these techniques. Breast cancer surgeons don’t usually carry out the more complex types ofbreast reconstruction using body tissue. Breast cancer surgeons who are specialised in reconstruction techniques are called oncoplastic surgeons. At the Emirates Hospital our Australian trained female breast cancer surgeon (Dr Sama Zebda) and our German female plastic surgeon (Dr Gie Vanderhault) work together and combine breast cancer surgery with reconstruction.

How to help yourself before surgery

There are three main ways to help yourself before any type of surgery

• -  Stop smoking
• -  Lose weight but don't crash diet
• -  Get fitter

If you smoke you are more likely to get a chest infection after your anesthetic.  Smoking also affects blood supply and delays healing. If you are having reconstruction with your own body tissue, there is a higher risk of complications if you smoke. Body tissue reconstruction can fail because of a poor blood supply. Smokers also have a higher risk of hernia after abdominal flap reconstructions. Your surgeon is likely to ask you to stop smoking 3 months before your surgery.

If you are overweight, you are more likely to have complications with living tissue surgery and more likely to have complications from the anesthetic. Ask to see a dietician and see if they can help you to lose weight before the surgery. You will feel better and it will help you to recover from your operation more quickly.

Getting fitter is a good idea before any operation. With abdominal flap reconstructions, surgeons recommend doing sit ups. Strengthening the abdominal muscles will lower the risk of hernia later and gives better muscle function after the operation. You should aim to build up to 30 sit ups a day, but don’t overdo it too quickly. If you are very unfit, it might be best to get some advice from a fitness trainer before you start. You could ask at your local gym, but make sure you tell them about your medical history.