Breast Reconstruction

Breast reconstruction after mastectomy (surgical removal of the breast) is a very personal and completely individual choice.
If you are considering breast reconstruction, your choice will depend on your cancer management plan, lifestyle, body build, personal circumstance, the skills of your surgeon and whether or not you will accept more scars or the use of implants. Your surgeon will be able to discuss all the available options and discuss the benefits and risks of each method relevant to you.

Frequently Asked Questions About Breast Reconstruction Surgery

• What Are Your Breast Reconstruction Alternatives?
• What Happens During Breast Reconstruction Surgery?
• What Are the Advantages of Each Alternative?
• What Can You Expect After the Breast Reconstruction Operation?

What Are Your Breast Reconstruction Alternatives?

The best method for breast reconstruction depends on you. Your surgeon will take into account the type of breast cancer, treatment plan, and your medical fitness to advise on the best options.
In general, breast reconstruction with implants is simpler, takes less time to perform but does not usually give as satisfying a cosmetic result in the long term as reconstruction with a flap.

• Latissimus dorsi (LD) flaps are generally more reliable than other types of breast reconstruction with a flap. The natural body tissue of the flap gives a warm and pliable reconstructed breast. These flaps are sometimes combined with an implant for women with larger breasts.

• Abdominal (TRAM or DIEP or other perforator) flaps give warm, soft and pliable reconstructed breasts that resemble natural breast tissue. They are more complex procedures that require specialist surgical skills and instruments and are lengthy. They are not suitable for patients who smoke, have hypertension (high blood pressure) or diabetes. When radiotherapy is planned as treatment after the operation, it is sometimes better to delay breast reconstruction with a flap until after the course of radiotherapy is complete.

What Happens During Breast Reconstruction Surgery?

Breast reconstruction is best considered as a process. First, the breast mound is formed either as an immediate or delayed procedure. Any minor adjustments are then made at a later stage and when the shape and size of the reconstructed breast is stable, the nipple-areola can be reconstructed. 

The main methods for creating a breast mound are:

• Reconstruction with an implant or expander.
• Reconstruction using autologous (patient’s own natural body) tissue from either the back (LD flap), or abdomen (TRAM flap/ DIEP flap).
• A combination of the above.

Other less commonly used methods for creating a breast mound include free flaps from the buttock, lateral hip, thigh, back or abdomen. After creation of the breast mound, adjustments may be necessary to the scars and the opposite breast in order to give a good match between the breasts. Reconstruction of the nipple-areola completes the process.

The nipple can be formed using:

• A portion from the opposite nipple -‘nipple share’.
• Local flaps of skin from the reconstructed breast mound.
• Tattooing pigments onto the skin surrounding the nipple can create the areola.

An alternative to surgical reconstruction of the nipple-areola is the use of a nipple-areola prosthesis. Skin adhesives are used to glue the prosthesis into place. The prosthesis can be custom made to match the nipple-areola on the opposite breast or can be purchased ‘off the shelf’.
The use of flap usually requires a hospital stay of 4-8 days. Drains are inserted into the operated sites to remove any fluid that accumulates.

The donor site is closed directly leaving a scar across the lower half of the abdomen often leaving the appearance of having had an abdominoplasty or ‘tummy tuck’.

What Are the Advantages of Each Alternative?

The use of a flap from the abdomen is a major operation and usually takes about 3-6 hours. It is done under a general anaesthetic.

The main advantages of an immediate reconstruction are:

• The woman does not have to live with the mastectomy scar.
• The number of operations is reduced without significantly prolonging the hospital stay.
• The overall time spent in hospital and recovering from the operation is less than having it done as a delayed procedure.

What are the advantages of a delayed reconstruction?

• Sometimes patients wish to have a waiting period in order to address the immediate issues and implications on their life with a diagnosis of breast cancer.
• It gives time to recover from radiotherapy or chemotherapy if they are required. It also gives more time to make an informed decision and to get to know the reconstructive surgeon.

What Can You Expect After the Breast Reconstruction Operation?

When an inflatable implant (expander) is used, the newly reconstructed breast often looks flattened immediately after reconstruction. This is because the implant is positioned behind tissues that are relatively tight. These tissues stretch and soften over the next few months after the implant is inflated to provide better projection and shape.

Inflation of the implant normally starts in the first 2 weeks after the operation. This involves the injection of saline (salt water) into a port, which is just underneath the skin and attached to the implant. There will be a sensation of pressure during this procedure, which normally settles down after several hours. Inflation is usually carried out in the outpatient clinic at weekly or fortnightly intervals.

In a few weeks the scar will become red but will fade with time (usually over a few months).

The recovery period varies but most patients are out of bed the same or next day, may take a shower the next day and may drive a car after 1-2 weeks. It is best to wait 4-6 weeks before gradually resuming exercise and sporting activities.
If an inflatable implant is used, a second operation may be required to remove the injection port or to move it to a hidden position. In certain cases, this operation may be performed under a local anaesthetic.

Consultants Performing Breast Reconstruction Treatments at Cadogan Clinic

• Mr. Jian Farhadi
• Ms. Angelica Kavouni
• Mr. Lucian Ion
• Mr. Simon Eccles
• Mr. Bryan Mayou
• Mr. Adam Searle
• Mr. Stuart James
• Mr. Niall Kirkpatrick
• Mr. Bryan Mayou
• Mr. Nicholas Parkhouse
• Mr. Adam Searle
• Miss Jackie Lewis
• Mr Roy Ng
• Mr Jesper Sorensen
• Mr Patrick Mallucci
• Mr Neil Bulstrode
• Mr Adam Topping
• Mr Peter Butler
• Ms. Rozina Ali

For more information about breast reconstruction surgery in London, or to book a consultation, please call 020 7901 8500 or fill in the form on this website and we will respond to you by email or phone.

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