Breast Reconstruction Options

Breast reconstruction is a deeply personal decision. Before making any choices, you should have the opportunity to receive written information and discuss the different types of reconstruction available to you. This video provides an overview of what those conversations will cover. Your surgeon will explain the types of breast reconstruction and discuss which options may be most suitable for you personally. The risks and benefits of each procedure will be explained. Reconstruction can be performed at the same time as the mastectomy known as immediate reconstruction, or at a later date, known as delayed reconstruction. There are broadly two main approaches to breast reconstruction. The first is to use your own tissues known as autologous reconstruction, the second is to use breast implants. There are advantages and disadvantages of both approaches. Sources of autologous tissue include the abdomen, known as the DIEP flap or tummy flap, and less commonly your thighs or buttock tissue. The DIEP flap is regarded as the gold standard and, if you are suitable offers a warm, living and natural form of reconstruction that will age with your own tissues and also copes well with radiotherapy. The operation has very small but important risks, and is a long operation lasting around 4 to 5 hours, with a 5 to 6 day hospital stay. Implant reconstruction is quicker and does not involve scarring anywhere else on your body. Implants can be placed in front of your pectoral muscle or under the muscle and can be temporary implants which can be expanded or permanent. Some patients with implant reconstruction also need some extra cover from material known as acellular dermal matrix or ADM. Making a decision between autologous reconstruction and implants can be daunting and may also depend on your body shape and breast size as well as whether the nipple can be preserved or not. We often assess your suitability for both approaches and work together to choose what is best for you, based on the cancer treatment and your wishes and preferences. It is common to require more than one procedure to achieve a satisfactory result, for example making a new nipple, changing an expander implant for a permanent one or having an adjustment to the other breast to achieve better symmetry. Your surgeon will explain how many operations may be involved and the expected length of hospital stay for each. This helps you plan and prepare for your overall journey. Each approach has its own advantages and considerations, and your surgeon will discuss the pros and cons of both options with you. If you are having implant-based reconstruction, there may also be a discussion about how radiotherapy can affect the reconstructed breast, as this can influence your choice. It is important to know that reconstruction is not the only option. Some people choose not to have any reconstruction at all. An alternative is to use a breast prosthesis, which is worn inside a bra. Many factors can influence the outcomes of breast reconstruction surgery. These include the firmness and feel of the reconstructed breast, its position on the chest wall, and how it moves and feels in terms of warmth. Results vary from person to person. You may be shown photographs of breast reconstruction results, including examples that represent a wide range of outcomes. This can help you develop realistic expectations and consider which approach might best meet your goals. Breast reconstruction is a very personal consideration. You should be offered several appointments to come to a decision, together with your family and your surgeon, supported by a breast care nurse specialist. There is no pressure to decide quickly, and your team will give you the time you need. There is no evidence that having immediate breast reconstruction leads to delays in starting chemotherapy, though your personal circumstances may be important to consider. Having a reconstruction does not affect future breast cancer detection or your ongoing monitoring and care. There is no single right answer when it comes to reconstruction. What matters most is finding the approach that feels right for you. Take the time you need, ask the questions that matter to you, and know that your team will support you throughout.