Deciding about breast reconstruction
Deciding if and when you want breast reconstruction will depend on your individual situation. Reconstruction can be done at the same time as a mastectomy or at a later date.
Most people focus on removing the cancer. It can feel overwhelming to have to make a decision about having a reconstruction as well.
Deciding whether to have breast reconstruction or when to have it will depend on your individual situation. You can discuss it with your surgeon and breast care nurse. You can also talk about it with a relative or friend you trust. You might want to contact an organisation such as Breast Cancer Now.
Breast reconstruction is available on the NHS. National guidelines say that anyone having a mastectomy should be offered the choice of either immediate or delayed reconstruction. This is unless there is a medical reason why someone cannot have reconstructive surgery.
Breast reconstruction options
There are different breast reconstruction options available. The guidelines also say you should have access to all types of breast reconstruction. Some options may not be available at your local hospital. If the option most suitable for you is not available locally, you may need to go to another breast surgery unit.
It is important to discuss your options for breast reconstruction before you have a mastectomy. You do not have to make a decision about it at this stage. But it will help the surgeon to plan your first surgery.
Breast reconstruction does not increase the chance of a cancer developing in the breast or coming back in the breast (recurrence). Reconstruction does not make it harder for your doctor to diagnose a possible recurrence. They can still check any changes in the breast area.
You should think about any benefits and limitations of breast reconstruction before making your decision.
Benefits of reconstruction
- You will look the same in clothes (including underwear) as you did before surgery.
- You will not have to wear a prosthesis or a special bra.
- You will regain your breast shape.
- It can help restore your confidence in yourself and how you think and feel about your body (body image).
Limitations of breast reconstruction
- You will spend more time in hospital.
- You will take longer to recover from your operation.
- Most people need further minor operations to get the best cosmetic results.
- As with all operations, there can be complications.
- You are unlikely to have much sensation in the new breast.
- You may have scars elsewhere on your body, depending on the type of reconstruction you have.
- You may not be happy with the result.
- You may need to have an operation on your other breast so that both breasts look the same.
Some people choose not to have reconstruction and not to have a prosthesis. Others may plan to have breast reconstruction, but then decide not to. For some people, losing their breast is something they feel they can adapt to in time. Or you may not feel ready to have breast reconstruction until a while after surgery for breast cancer.
It is important to have realistic expectations about breast reconstruction.
Your reconstructed breast will not look or feel the same as the breast that has been removed. It may be a slightly different size and shape and will not have as much sensation. It may also not move as well as your natural breast did.
If you are having 1 breast reconstructed, your surgeon will try to match it to your other breast. But there may be differences in the size, shape or position of the 2 breasts. Most people are pleased with the results of their surgery, but some may be disappointed.
Breast reconstruction usually involves more than 1 operation. There are usually several months between these operations. The reconstruction process can take 12 to 18 months to complete.
Other factors may also affect your decisions about reconstruction. These may include:
- your general health
- your commitments and priorities.
If you decide to have breast reconstruction, you will need to think about when to have it.
It may be possible to have it at the same time as your mastectomy. This means after the operation you will have a breast shape straight away. This called an immediate breast reconstruction.
Or you may want to delay reconstruction. Some people have the reconstruction after they have recovered from other treatment. This is called a delayed breast reconstruction. The surgery can be done months or years later.
You can discuss this with your surgeon and breast care nurse before having a mastectomy. They can also explain about the types of reconstruction that are most suitable for you.
It usually helps to have a list of questions to ask. It is okay to ask about anything you are concerned about. You might want to contact an organisation such as Breast Cancer Now. They have a service called Someone Like Me who can match you with a trained volunteer who’s had a breast reconstruction.
There are benefits and limitations to having an immediate or a delayed breast reconstruction.
You have an immediate reconstruction at the same time as a mastectomy. It is usually possible for the surgeon to leave most of the skin that covers the breasts when they remove the breast tissue. Doctors call this a skin-sparing mastectomy.
Skin-sparing mastectomy leaves less scarring than a delayed reconstruction. This is because less skin is removed.
During this operation, the surgeon sometimes removes:
- the nipple
- the dark area around the nipple (areola)
- a small circle of skin around the areola.
This depends on how close the cancer is to the nipple.
Sometimes it is possible to leave the nipple in place attached to the breast skin. Doctors call this a nipple-sparing mastectomy. Sometimes the nipple is removed and then put back on (grafted) to the reconstructed breast.
Benefits of immediate reconstruction
- Immediate reconstruction usually gives a better appearance than delayed reconstruction. This is because it is easier to keep more of the breast skin.
- There is less scarring than with delayed reconstruction.
- You will not be without a breast shape at any time.
Limitations of immediate reconstruction
- Immediate reconstruction involves a longer operation and recovery time than just having the breast removed.
- If you need chemotherapy or radiotherapy after surgery, this could be slightly delayed. For example, this might happen if problems such as infection slow your recovery. This is uncommon.
- Having radiotherapy after breast reconstruction may affect the look of the reconstructed breast. If you need radiotherapy, your doctors may suggest delayed breast reconstruction.
- You may have a slightly longer wait for surgery, especially if 2 teams of surgeons are involved. This is not likely to affect the success of the surgery.
You can have breast reconstruction after you have recovered from your other treatments. This is called a delayed reconstruction.
For example, if you have radiotherapy, you will usually wait about 6 to 12 months before having reconstructive surgery. It can sometimes be even longer. This gives the skin on your chest time to recover.
There is no time limit for having a delayed reconstruction. Some people choose to have it years after a mastectomy.
Benefits of delayed reconstruction
- It is usually possible to have a delayed reconstruction at any time. It can even be years after your first surgery.
- Delayed reconstruction will not delay other cancer treatments.
- You have more time to think about whether reconstruction is right for you.
- It gives you time to concentrate on each individual treatment. You can focus on your cancer treatment and think about reconstructive surgery later.
Limitations of delayed reconstruction
- You will not have a breast shape for a period of time.
- The appearance of the reconstructed breast may not be as good as with an immediate reconstruction. You may have more scarring.
- You will need at least one additional operation to reconstruct the breast and requires a general anaesthetic.
Below is a sample of the sources used in our breast reconstruction information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
European Journal of Surgical Oncology. Oncoplastic breast surgery: A guide to good practice A. Gilmour et al. Published 5th May 2021. associationofbreastsurgery.org.uk/media/359061/abs-oncoplastic-guidelines-2021.pdf (accessed April 2023)
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. Guidelines. July 2018. Last updated: April 2023. Available from: www.nice.org.uk/guidance/ng101 (accessed April 2023)
European Society for Medical Oncology (ESMO) Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Last updated 2019. Annals of Oncology 30: 1194–1220, 2019. Available from: www.annalsofoncology.org/article/S0923-7534(19)31287-6/pdf (accessed April 2023)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.
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