Losing a breast affects women in different ways. Everyone’s circumstances are unique, therefore women react differently to the available treatment options and surgery. However, it is important to take an informed decision about the options at your disposal.

Considerable progress has been made in the field of breast surgery, breast reconstruction and radiotherapy. When a woman undergoes initial counselling, she should discuss the possibility of breast conserving therapy with her doctor, in other words, the removal of the tumour and surrounding tissue (wide local excision), without removing the breast, following by radiotherapy.

If breast conserving treatment is not possible or chosen, and a mastectomy is performed, breast reconstruction should be considered. Reconstruction involves rebuilding the breast. It is an option that should be considered by every woman who has to undergo a mastectomy.

Breast reconstruction is a surgical procedure for mastectomy patients to restore the breast contour and, if desired, also the nipple and/or areola. The procedure is usually performed by a plastic surgeon who has experience in this field. It can be performed immediately after the mastectomy as part of the same operation, or at a much later stage. If radiotherapy is recommended, breast reconstruction can be performed once radiation has been completed, breast reconstruction may involve one or more operations, depending on the type of mastectomy and type of reconstruction.

It is important to discuss the advantages and possible risks of breast reconstruction in your case with your doctor and with a plastic surgeon. In general, breast reconstruction has the following advantages:

  • The contour or shape of your breast is restored, with or without nipple and areola, thereby restoring the symmetry, or balance, of your body.
  • The general appearance of your body is restored because the size of your breasts are more or less the same and your cleavage is restored.
  • It is no longer necessary for you to wear an external prosthesis in your bra.
  • By restoring the shape of your body, your body image and self-confidence are also improved.
  • The main purpose of breast reconstruction is to restore your body symmentry and your appearance when wearing a bra.
  • The results will depend on the scope of the mastectomy and on the type of reconstruction performed. The shape of the scar depends on specific circumstances, but it will fade eventually.
  • The general shape of your breast will be rebuilt to resemble the other breast as closely as possible. Most women find that the size and shape of the two breast are not exactly the same, but that the results are satisfactory nonetheless. In some cases the other breast is adapted to resemble the reconstructed breast.
  • Your expectations should be realistic. Breast reconstruction can improve a woman’s body image and self-confidence, but cannot solve existing psychological or personal problems.
There are different methods of performing breast reconstruction. These are divided mainly into two procedures: implant (internal prosthesis) and flap procedures (tissue transfer). The choice depends on specific circumstances and on the doctor’s recommendation.

A simple implant involves creating a pocket behind the skin and chest wall muscles and placing an internal prosthesis to create the shape of the breast. The existing mastectomy scar is used for the incision, or new incision may be made just below the breast.

Flap procedures, or own tissue reconstruction, are used when skin or muscle tissue is needed, for example after a total or radical mastectomy, or when an implant is not used.

Most women experience considerable pain, particularly during first few days. Bu means of modern anaesthesia and pain control discomfort is limited to a minimum. The advantages of the procedure ultimately outweigh the discomfort.
An implant, or internal prosthesis, is an artificial breast shaper. It consists of a silicone shell filled with silicone gel or a saline (salt water) solution.
If enough healthy skin and tissue are available to cover the prosthesis, placing the implant behind the chest wall muscle is a relatively simple procedure. The existing mastectomy scar in generally used for the incision. If the tissue is not sufficient, a tissue expander can be used. A temporary prosthesis is implanted and gradually inflated with saline over a period of weeks. In this way the tissue is stretched out until enough tissue is available and a permanent implant can be inserted.
After a total or radical mastectomy there might not be enough skin and muscle tissue to cover and internal prosthesis. A flap of skin and muscle tissue from another part of the body may be used for reconstruction. A flap procedure is a more extensive procedure than an implant. This means that you need to stay in hospital for a longer period and that more complications may arise. The procedure may be performed in different ways:

  • Latissimus dorsi – skin and muscle tissue is taken from the big muscle of the back and tunnelled under the arm to the breast. This leaves a horizontal scar on the back under the bra line and an oval-shaped scar on the breast.
  • Tram flap – this flap is rotated from the abdomen and tunnelled upwards to the breast. It leaves a horizontal scar along the bikini line. The tissue is usually sufficient to create a breast without the use of a prosthesis.
  • Free flap – tissue is taken from another part of the body and transplanted on the chest by means of microvascular surgery.
It is possible, it is usually not done immediately, but only after the reconstruction has healed. Various methods are used. The areola can also be tattooed.
In most cases the shape and appearance of the new breast is satisfactory. However, it is difficult to achieve the exact same firmness, size, shape and profile. The other breast can be adapted to the new one, for example by lifting, enlarging or reducing it.
As with any other surgical procedure there is a risk of infection and of haematomas (blood clots) at the operation site. There are a number of specific risks associated with breast reconstruction. * The tissue surrounding the implant may form a hard scar which might affect the shape and softness of the breast and the position of the implant. * Necrosis, breakdown of the skin and exposure of the implant, is a very rare complication. * The silicone in the implant may leak and affect the surrounding tissue.
It is of the utmost importance to discuss the method that is best in your particular circumstances with your surgeon, preferably a plastic surgeon with experience in this field. Discuss the advantages and disadvantages of the procedure and ask to see photos of breast reconstructions performed by this surgeon. Talk to a Reach for Recovery volunteer who has undergone this procedure. You may prefer to consult more than one reconstructive surgeon. Breast reconstruction is not an emergency procedure; you have enough time to think it over before you decide. Make sure that you have a clear idea of what your expectations are and why you want to have a breast reconstruction. It may help to talk to women who have had breast reconstruction and those who have decided against it. Breast reconstruction can improve a woman’s self-image and general wellbeing, but ultimately the choice is yours.