Making your decision

It’s important to feel happy about your decision to have breast reconstruction. Discussing the different options available can help. You can talk these through with your surgeon, breast care nurse, or any family or friends you want to involve.

Make sure you have realistic expectations. Breast reconstruction doesn’t result in a ‘perfect’ breast, but there can be many benefits. It may restore your confidence, make your appearance similar to before your mastectomy, and mean you don’t have to wear external breast prostheses. At the same time, you will need several visits to the hospital and are unlikely to have any sensation in your new breast. Consider the benefits and limitations of surgery carefully.

You’ll also need to think about timing. Immediate reconstruction often leaves fewer scars, but delayed reconstruction allows you more time to think things over. Remember, there is no upper time limit for having breast reconstruction. It’s always available – even years after your mastectomy. Your decision will depend on your individual situation. And you’re the best person to know what feels right for you.

Thinking about breast reconstruction

Deciding whether to have breast reconstruction or when to have it will depend on your individual situation. You’re the best person to know what feels right for you.

It’s important you feel happy with your decision – you can discuss it with your surgeon, breast care nurse, any family or friends you want to involve or a support organisation.

You are entitled to free breast reconstruction on the NHS. There are many options for breast reconstruction available.

It’s important that you have the chance to discuss your options for breast reconstruction before your mastectomy. You don’t have to make a definite decision about it at this stage, but it will help the surgeon to plan your initial surgery.

Women have breast reconstruction for different reasons. You may choose it so that you won’t need to wear a false breast (breastprosthesis/form), or you may feel that breast reconstruction will help you to feel more confident or feminine. Or, you may decide that you feel comfortable wearing a breast prosthesis and that you don’t want to go through the additional surgery and recovery that breast reconstruction involves.

Some women who have treatment for breast cancer plan to have reconstructive surgery after their treatment but then change their minds. They find that the loss of a breast doesn’t trouble them as much they thought it would.

Sometimes women decide years after breast cancer surgery that they feel ready to have reconstruction.

If you decide to have it done you will need to think about the timing of the surgery. It may be possible to have it at the same time as your mastectomy so that you will have a breast shape immediately after the operation. Other factors may also affect your decisions about reconstruction, such as your general health, your relationships, commitments and priorities.

It’s important to have realistic expectations about the possible results of breast reconstruction. It can’t give you a perfect breast. A reconstructed breast won’t have as much sensation and may not ‘move’ as well as your natural breast did.

If you’re only having one breast reconstructed after cancer treatment, your surgeon will aim to make the new breast as good a match as possible to your other breast. But there may be differences in the size, shape or position of the two breasts. In general most women are pleased with the results of their surgery, but some women are disappointed.

Typical appearance following masectomy
Typical appearance following masectomy

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Breast reconstruction usually involves having two or more operations over a period of 6–12 months to get the best appearance for your new breast(s). If you’re having breast reconstruction following cancer treatment, it doesn’t increase the chance of the cancer coming back. And it doesn’t interfere with your doctors’ ability to detect the cancer if it comes back in the breast area.

It may be helpful to think about the possible benefits and limitations of breast reconstruction before making your decision.


Benefits of breast reconstruction

  • In clothes (including underwear and swimwear) your appearance will be similar to before the surgery.
  • You won’t have to wear external breast prostheses or a special bra.
  • You will have a cleavage and be able to wear clothes with a low neckline.
  • It can help to restore your self-confidence and feelings of femininity, attractiveness and sexuality.


Limitations of breast reconstruction

  • You will spend more time in hospital and your recovery will take longer.
  • Most women need several visits to the hospital and further minor operations to get the best cosmetic results.
  • As with all operations, problems may occur.
  • You are unlikely to have much sensation in the new breast(s).
  • You may have scars elsewhere on your body (depending on the type of reconstruction).
  • You may not be pleased with the result.
  • If you’re having one breast reconstructed, you may need to have an operation on your other breast to reduce or increase its size, or to lift it so that both breasts are even.


Deciding when to have it

Reconstruction can be done at the same time as a mastectomy, or some time later.


Immediate reconstruction

An immediate reconstruction is done at the same time as the mastectomy. With this operation it is often possible for the surgeon to leave most of the breast skin when removing the breast tissue. The surgeon removes the nipple and areola and just a small circle of skin around it (skin-sparing mastectomy). This gives a more natural looking reconstructed breast with less scarring than delayed reconstruction, where all the spare skin is removed during the mastectomy. Sometimes it is possible to preserve the nipple too (nipple-sparing mastectomy).

Benefits

  • Often gives a better appearance than delayed reconstruction.
  • Less scarring than delayed reconstruction.
  • You won’t have any time without a breast shape.

Limitations

  • If you have radiotherapy to your breast after reconstruction, it may affect the appearance of the reconstructed breast. If your doctors think you may need radiotherapy, they may suggest delayed breast reconstruction.
  • Immediate reconstruction involves a longer operation and recovery time.
  • Other treatments needed after your surgery (such as chemotherapy or radiotherapy) could be delayed if your recovery takes longer due to problems, such as infection. But, this is not common.
  • You may have to wait longer to have your mastectomy if two teams of surgeons are involved.


Delayed reconstruction

Delayed breast reconstruction can be done after you have fully recovered from the mastectomy. If you’re having cancer treatment, delayed breast reconstruction will be done after you’ve recovered from treatments, such as chemotherapy. After radiotherapy there is usually a delay of about 6–12 months before reconstructive surgery is done. This allows the skin over the chest to recover. There is no upper time limit for having breast reconstruction. Some women choose to have it done many years after a mastectomy.

Benefits

  • Breast reconstruction is always available – even years after your original surgery.
  • Having your surgery in stages means a shorter recovery after each procedure.

If you’re having breast cancer treatment, delayed reconstruction means that:

  • There is no risk of reconstructive surgery causing delays to cancer treatments.
  • You have more time to think over whether reconstruction is right for you.
  • You can deal with your cancer treatment first, and then think about reconstruction surgery.

Limitations

  • You will have more scars.
  • You will be without a breast shape for a period of time.
  • The result may not be as good as with an immediate reconstruction.
  • You will need at least one additional operation and an anaesthetic.
  • You will go back to being a ‘patient’ for a while.


Back to Having breast reconstruction

Your feelings

Breast reconstruction surgery can cause many different emotions. It can take time to adjust to your new breast(s).

Talking to your surgeon

Your reconstruction surgeon will explain what types of operation can be done and answer any questions you have.