Breast cancer is a disease that affects 1 in 8 women in the UK at some point in their lives. That’s why it’s important to remember that breast cancer is an issue that affects women year-round. Many breast cancer sufferers require a mastectomy in order to ensure cancer cells are removed from the body. Understandably, this often affects the self-esteem of women. In these cases, breast reconstruction surgery can help to make women feel a bit more like themselves again.
What is breast reconstruction surgery?
Put simply, breast reconstruction is surgery to create a new breast shape after a woman has undergone a full or partial mastectomy. The surgeon will aim to create a breast shape that matches the size and shape of the other breast. It is important to note that it will feel and look different. In most cases, there will be slight differences in symmetry and shape. It is possible to undergo breast reconstruction at the same time as having a mastectomy (known as immediate reconstruction) or after the initial treatment (known as delayed reconstruction). This will depend on the type of breast cancer, any other treatments that may be needed, and the personal feelings and preferences of the patient.
Breast reconstruction does not affect your ability to have other cancer treatments, such as chemotherapy or radiotherapy, and follow-up after treatment is the same as that which you would have after a mastectomy.
Types of reconstruction surgery
Breast reconstruction surgery is carried out to create a mound, with or without nipple reconstruction at a later stage. Breast reconstruction is most common after a mastectomy for breast cancer when you have newly shaped breasts using your own tissue from your abdomen (TRAM or DIEP).
There are a number of different types of breast reconstruction surgery to consider. Undergoing the surgery is an incredibly personal decision so different surgeries will be right for different people.
· Implants – this tends to be the simplest method of reconstructive surgery. It involves using silicone or sterile salt water implants in order to gradually stretch skin and muscle into the new shape. This method causes little scarring but does come with some drawbacks; the reconstructed breast tends to feel less natural and there is always the potential for the body to reject the implant, causing it to become hard and uncomfortable.
· Reconstruction with living tissue from other parts of the body – this is known as flap reconstruction, and many different parts of the body may be used. This is often suitable for women who:
- Have naturally larger breasts
- Have undergone radiotheraphy
- Have had a radical mastectomy which also removes the muscle in the chest wall (this is very rare)
- Have a tight mastectomy scar
- Are looking for a softer, more realistic result
Flap reconstruction involves the surgeon taking skin, fat and sometimes muscle from another part of the body to form the new breast. The McIndoe centre offers flap reconstruction from:
- The inner thigh – this is a relatively new form of surgery and involves taking skin, fat and muscle from the groin area and reconnecting it to blood vessels in the breast. This type of surgery does not decrease functionality in the thigh but will cause scarring in the donor area.
- The buttock – skin, fat and muscle is taken from the buttock and reattached to the breast area. This is ideal for those who don’t have a lot of excess tummy tissue and causes minimal scarring that is easily hidden under the panty line.
- The shoulder – this involves rotating the latissimus muscle from the back to the breast area whilst keeping it attached. This form of surgery may be used with or without an implant.
- The tummy – there are two ways of reconstructing the breast using abdominal tissue. The first is similar to reconstructions from the inner thigh and buttock. Many women enjoy the added benefit of a ‘tummy tuck’ like effect. The second method takes an oval section of skin, fat and muscle and slides it up under the skin to the breast area to reconstruct the breast that way.
This type of reconstruction remains the ‘gold standard’ of breast reconstruction around the world. The DIEP (Deep Inferior Epigastric) or TRAM (Transverse Rectus Abdomenus Muscle) flap breast reconstruction involves removing skin and fat from the lower half of the tummy and using it to create a new breast mound. It is the same tissue that is removed at the time as a tummy tuck, but great care is taken to preserve blood vessels. The surgeons then use microsurgery to join lower tummy tissue and its vessels to an artery and vein in the chest. This often requires the surgeon to remove a little section of the rib in order to access these vessels. This doesn’t have any effect on the patient or the outcome of the reconstruction. The surgeon will then set about sculpting this tissue as close to the shape and size of the other breast as possible. In the process of lifting up the tissue from the tummy, the surgeon will try not to disturb the underlying muscle too much.
If the surgeon does the procedure without taking any muscle it is referred to as a DIEP. If the blood vessels are unsuitable they take a small amount of the muscle from your tummy and this is called a muscle-sparing TRAM. As long as the abdominal incisions and layers are repaired, patients cannot tell the difference if a small segment of muscle is taken. Surgeons are now using scans of the tummy preoperatively to assess the likelihood of needing to take some of the muscle so that the patient will be aware prior to the surgery.
A combination of a tissue donation and implants – it is also possible to combine these two types of reconstructive surgery.
Breast conservation – sometimes a partial mastectomy is needed, and this can leave the treated breast smaller than before or with a different shape. In these cases, it is possible to have a mini-flap operation (see above) or have the breast reshaped by a surgeon.
How to ensure successful surgery
There are a number of things you can do to ensure that your surgery goes as smoothly as possible on the day itself. Even if you take these steps, it’s always important to remember that there is some risk involved in any surgery. Talk to a GP or consultant and get informed before making a decision.
- Stop smoking – anaesthetic can cause chest infections. If you’re a smoker, your risk of getting a chest infection and slowing blood flow to the healing area is increased, meaning your overall recovery is likely to be slower.
- Lose weight – Complications from being overweight include a higher risk associated with general anaesthetic and issues with living tissue transplants. Eat healthily, don’t crash diet.
- Get fit – in the case of living tissue transplants, it’s important to make sure the donor area is strong in order to ensure optimal healing. For example, it’s recommended that patients undergoing a transplant from the tummy do sit ups every day for around 30 days before the operation. This will also lower the risk of hernia later on
Contact a surgeon or specialist breast care nurse to discuss your options if you’re a current or past breast cancer sufferer and are considering reconstructive surgery. They can talk you through all the options available to you, and help you make the decision that’s right for you.
If you’re worried about breast cancer or would like to learn more, you might be interested in our piece: Breast cancer: what to watch out for and how to prevent it.