Breast reconstruction

Breast reconstruction is an invasive 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.

Breast reconstruction can be considered to restore the shape of the breast. It is also a costly procedure that generally requires a private medical aid fund or saved funds.

There are various options available to help improve your self image. Most women who do not undergo breast reconstruction wear a prosthesis. Read more about prosthesis here.

How is breast reconstruction done?

There are different methods of performing breast reconstruction. 

These are divided mainly into two procedures: 

• implant (internal prosthesis) 
•  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.

What is an implant? 

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.

What will a reconstructed breast look like?

The main purpose of breast reconstruction is to restore your body symmetry 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 breasts 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.

Is breast reconstruction a painful procedure?

Unfortunately, yes.

Most women experience pain, particularly during the first few days. By means of modern anaesthesia and pain control discomfort is however limited to a minimum. 

You need to decide if the advantages of the procedure ultimately outweigh the discomfort.

Are there any risks associated with breast reconstruction?

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.

Who should I consult so I can make an informed decision?

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. 

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. Talk to a Reach for Recovery volunteer who has undergone this procedure. 

Breast reconstruction can improve a woman’s self-image and general wellbeing, but ultimately the choice is yours.