Making your decision about breast reconstruction

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

It is important you feel happy with your decision. 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 Care.

Breast reconstruction is available on the NHS. There are many options available.

It is important to discuss your options for breast reconstruction before you have a mastectomy. You do not have to make a definite decision about it at this stage. But it will help the surgeon to plan your initial surgery.

Thinking about breast reconstruction

Women have breast reconstruction for different reasons: 

  • You may choose it so that you will not need to wear a false breast (breast prosthesis).
  • You may feel it will improve your confidence about how you look and feel about your body after breast surgery.

But you may decide you are comfortable wearing a breast prosthesis. Or you may not want to go through the additional surgery that breast reconstruction involves.

Some women plan to have breast reconstruction but then decide not to. They find that losing their breast does not trouble them as much they thought it would.

Other women may feel ready to have breast reconstruction years after their mastectomy.

Important things to think about

There are different things you may need to think about before you make a final decision about breast reconstruction.  

If you decide to have breast reconstruction, you need to think about when to have it. It may be possible to have an immediate reconstruction done at the same time as your mastectomy. This means you will have a breast shape immediatelyafter the operation or you may want to delay reconstruction until treatment is over.

General factors

Different factors can affect your decisions about reconstruction. These include:

  • your general health
  • your relationships
  • your commitments and priorities.

Expectations

It is important to have realistic expectations about breast reconstruction. It cannot give you perfect breasts. A reconstructed breast will not have as much sensation and may not move as well as your natural breast did.

If you are only having one breast reconstructed, your surgeon will aim to match it to your other breast. But there may be differences in the size, shape or position of the two breasts. Most women are pleased with the results of their surgery, but some women are disappointed.

Operations

Breast reconstruction usually involves having two or more operations. These are usually done over a period of 6 to 12 months.

Concerns about a recurrence

Breast reconstruction does not increase the chance of a cancer coming back or developing in the breast. Reconstruction does not make it harder for your doctor to diagnose a possible recurrence. They can still check any changes in the breast area.

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

Benefits of breast 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 women 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 (s).
  • You may have scars elsewhere on your body, depending on the type of reconstruction you have.
  • You may not be happy with the result.
  • If you are having one breast reconstructed, you may need to have an operation on your other breast, so both breasts look the same.

Deciding when to have breast reconstruction

Breast reconstruction can be done at the same time as a mastectomy or some time later. There are benefits and limitations to having it done immediately or delaying it until later. 

Immediate reconstruction

An immediate reconstruction is done at the same time as a mastectomy. It is often 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. It leaves less scarring than a delayed reconstruction. This is because less skin is removed.

This operation usually removes the nipple, the dark area around the nipple (areola) and a small circle of skin around the areola.

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 to the reconstructed breast.

Benefits of immediate reconstruction

  • Immediate reconstruction often 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

  • You may have to wait longer to have your mastectomy if two teams of surgeons are involved.
  • Immediate reconstruction involves a longer operation and recovery time.
  • 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. But this is uncommon.
  • Having radiotherapy after breast reconstruction may affect the appearance of the reconstructed breast. If you need radiotherapy, your doctors may suggest delayed breast reconstruction.

Delayed reconstruction

You can have breast reconstruction after you have recovered from your other treatments. This is called delayed reconstruction. For example, if you have radiotherapy, you will usually wait about 6 to 12 months before having reconstructive surgery. This gives the skin on your chest time to recover.

There is no time limit for having delayed breast reconstruction. Some women choose to have it years after a mastectomy.

Benefits of delayed reconstruction

  • Delayed reconstruction is usually available – even years after your original surgery.
  • You will have your surgery in stages. This means that you will have a shorter recovery time after each procedure.
  • Reconstructive surgery 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 then 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 will need at least one additional operation, which requires a general anaesthetic.

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