What is the Best Option for Breast Reconstruction?

Women who undergo surgery to remove one or both of their breasts, known as a mastectomy, often choose to follow up with reconstructive breast surgery. 

But having breast reconstruction after a mastectomy is a deeply personal journey. There are several different surgical options available and what may be the best option for some women may not be suitable for others. In short, there is no ‘one-size-fits-all’ when it comes to breast reconstructive surgery.

So it is important that you understand which surgical options are open to you to help you make an informed decision about your treatment.

The best option for when to get a breast reconstruction

As far as the ‘when’ is concerned, there are two options for breast reconstructive surgery - immediate reconstruction, which is carried out at the same time as your mastectomy, and delayed reconstruction, which is carried out after your surgery at a later date. The decision on whether to have immediate or delayed surgery is typically based on several factors, including the timing of radiotherapy or chemotherapy treatment, as these can impact upon recovery times.

Immediate or Same Day Mastectomy and Breast Reconstruction

As touched upon, immediate breast reconstruction, also known as same day breast reconstruction, is exactly that - reconstructive breast surgery carried out at the same time as a mastectomy. The surgeon will create a new breast straightaway, with the aim of matching the reconstructed breast to the other breast as closely as possible. Depending on your wishes and the size and shape of your anatomy, the surgeon may use a breast implant or natural fatty deposits taken from elsewhere on your body to create a new, natural-feeling breast.

One of the main pros of having same day mastectomy and breast reconstruction is that you will have a new breast or breasts as soon as you wake up from surgery. Some women who undergo breast cancer reconstruction find that this helps them to cope with the loss of a breast. Another benefit of carrying out immediate breast reconstruction after a mastectomy is that fewer operations are required, reducing risks associated with anesthesia. The surgeon performing the procedure will also be able to see a direct comparison, plus there is a lower potential for scarring and it is more likely the surgeon will be able to preserve the nipple.

One drawback for opting for immediate breast reconstructive surgery is that this may not leave you much time to decide which type of breast reconstruction you want. If you are undergoing radiotherapy after your reconstruction this may change the appearance of your breast. Your surgeon may advise against having an implant if you are going on to have radiotherapy. There is a longer downtime associated with immediate breast reconstruction after a mastectomy and further minor surgery may be needed further down the line, for example creating a new nipple in the event that your nipple could not be preserved following your mastectomy. In the event that you experience any side effects after your immediate breast reduction, this may delay any radiotherapy or chemotherapy that you need. If radiotherapy or chemotherapy is carried out during the healing process, this may lead to complications, such as delay healing and infection.

Delayed Breast Reconstruction After Mastectomy

The alternative to immediate breast reconstructive surgery is delayed breast reconstruction after mastectomy. This means the operation is carried out at a later date once you have healed from your mastectomy. Reconstruction can be carried out using an implant or via fat transfer.

The benefits of delayed breast reconstruction after mastectomy is that it gives you more time to discuss treatment options with your surgeon, considering them inline with your medical history and your own personal preferences. By delaying your reconstructive breast surgery you can also ensure that your breast cancer treatment has finished, eliminating any potential risks associated with radiotherapy or chemotherapy and reconstructive breast surgery. Recovery for delayed breast reconstruction after mastectomy is generally quicker than immediate breast reconstructive surgery as it is not as demanding on the body.

The main drawback when it comes to delayed breast reconstructive surgery after mastectomy is that you will be left without one of your breasts in the interim period. Although some women may not mind, others may choose to wear a filled bra or a false breast, known as a prosthesis. Another downside of leaving your breast reconstructive surgery until a later date means that there is a higher risk of pronounced scarring, which may require further corrective surgery for aesthetic purposes.

Key takeaways for the best option for when to have a breast reconstruction

Deciding what is the best breast reconstruction surgery is an entirely personal choice, based on your health journey and patient journey.

If you are unsure about the procedure, or you don’t feel ready or able to consider it at the moment, then delayed reconstructive breast surgery will give you the time and space needed to adjust to the idea.

Consult your doctor about breast reconstructive surgery and bear in mind that any future radiotherapy may alter your reconstruction results, so it is important to think of the long term benefits and the next steps beyond recovering from surgery.

The best option for which kind of breast reconstruction

When considering breast reconstructive surgery, there are three different surgical techniques to consider - using breast implants, analogous fat transfer (natural implants using tissue and fat taken from elsewhere on your body), or a combination of the two. There are a number of pros and cons for each of these types of breast reconstruction.

Reconstruction using breast implants

This type of breast cancer reconstruction involves using silicone or saline implants. This method of reconstructive breast surgery is only possible if the mastectomy or radiation therapy have left sufficient tissue on the chest wall to cover and support a breast implant. 

Reconstruction using realistic breast implants takes less time than the fat transfer method, only adding an extra 45 minutes to the total surgery time if carried out as part of a same day mastectomy and breast reconstruction. Breast implants can be viable for all body types and the procedure requires less downtime than the fat transfer method.

However, breast implants usually need to be replaced every 10 to 20 years, which will mean further surgery. Implants will require ongoing monitoring in order to spot any changes which may identify any potential issues. There is also a risk of displacement or the implant rupturing.

Reconstruction using analogous fat transfer (or ‘flap reconstruction’)

Reconstructive breast surgery using analogous fat transfer is the preferred option for women who do not want implants or do not have sufficient breast tissue to support an implant.

This method involves harvesting natural fatty tissue from a donor site elsewhere on the body and using it to create a new breast. The surgeon will commonly use lower abdominal skin and fat taken from the area between the belly button and the pubic bone. Alternatively, donor tissue may be taken from the thighs or buttocks. 

As this method uses your own tissue, flap reconstruction can result in a more natural-feeling breast, often feeling softer and larger. It can also provide more uniform results with your natural breast and, as it will be made of your natural tissue, it will age at the same rate as a natural breast would.

However, you will need enough tissue on your abdomen, thighs or buttocks to be taken and used in the procedure. Fat transfer may not be suitable for thinner or slender women.

If you opt for the fat transfer method for same day breast reconstruction after a mastectomy, this will add around three to six hours on to your total operation time, compared to just 45 minutes for the implant option. Fat transfer breast reconstruction can also impact on the donor site, with the risk of further scarring, a loss of sensation and a longer healing time.

Key takeaways for what kind of breast reconstruction to opt for

Breast reconstruction after a mastectomy is a personal choice, but this choice can be affected by a number of different factors. For example, you may find that with a bilateral mastectomy you would prefer implants over natural fat transfer when considering how much tissue may need to be taken from other areas of the body. Or if you are having a unilateral mastectomy then fat transfer may seem like the preferred option as less fat is needed and this will result in a more natural-looking breast.

Your own and your surgeon’s thoughts for your body’s reaction to the surgeries, your healing, future treatments and your relationship to implants will also influence the decision you make.

You may find the thought of a mastectomy upsetting and the options for breast cancer reconstruction overwhelming. We understand that you may find these decisions difficult and hope that we can help you to find the best reconstructive breast surgery to suit you.

Book a consultation with one of our experts here at the Cadogan Clinic to find out more about the patient-centred options available to you.