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Breast reconstruction surgery

Breast reconstruction surgery is an operation to restore the shape and appearance of your breasts after having complete or partial breast removal surgery (mastectomy).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Breast reconstruction surgery can be done at the same time as a complete or partial breast removal (in the same operation). Alternatively, you can have the procedure at a later date.

There are a number of different ways your surgeon can make a new breast shape. However, most fall into two main types of surgery.

  • Implants. Your surgeon may remove just your breast tissue, but leave your skin. He or she will then insert an implant. This is usually made of silicone.
  • Flaps. During flap reconstruction, your surgeon will take tissue from other parts of your body to create your new breast. This may be from your abdomen (tummy) or back, or your buttocks or thighs.

Your surgeon may use a combination of these types of surgery to restore the shape of your breast. He or she may also inject your own fat cells during a breast reconstruction operation, in what is called lipomodelling. This can help to make your breast smoother or enlarge your breast.

You may need to have more than one operation to get the best breast shape and appearance. You may also need further treatment to uplift or reduce your other breast so that they match as well as possible.

Before surgery you will have the opportunity to discuss the different types of breast reconstruction operations with various specialists. They will explain all the options so you can make a decision on what option is best for you. It's important to understand that the timing of the operation may also depend on other treatment you may be having, such as chemotherapy. Ask your surgeon for more information.

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Details

  • Preparation Preparing for breast reconstruction surgery

    Your surgeon will explain how to prepare for your breast reconstruction surgery. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

    You may need to stay in hospital for around four days but this will depend on the type of operation you have. Breast reconstruction surgery will be done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You will be asked to sign a consent form.

    Your surgeon will measure your breasts, and look at their shape and the position of your nipple. He or she may make some marks on your breast using a special pen. Your surgeon may also take photographs so that the results of your surgery can be compared with your original appearance.

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  • Alternatives What are the alternatives to breast reconstruction surgery?

    Alternatives to breast reconstruction surgery include wearing a lightweight foam bra insert or a soft plastic (silicone) false breast inside your bra.

  • The procedure What happens during breast reconstruction surgery?

    The time breast reconstruction takes will depend on the method your surgeon uses. It may be anything between one and 10 hours. You may be able to have a breast reconstruction in just one operation, or your surgeon may do it in stages. This will depend on a number of things, such as the size of your breast and whether or not your nipple was removed. Ask your surgeon for more information.

    Implant-based reconstruction

    If your skin is saved when your breast is removed, you may be able to have an implant. Your surgeon will place the implant under your chest muscle, under your skin.

    If your surgeon removed skin from your breast when you had it removed, you may have an expandable implant (an expander) inserted under your muscle. Your surgeon will then gradually inflate it with salt water (saline), which will gently stretch the skin and muscle over your breast area. The expander can be replaced with an implant at a later date.

    Tissue flap reconstruction

    In this type of operation, your surgeon will take tissue from another part of your body and use this to reconstruct your breast. There are a number of different tissue flap reconstruction operations. The type of operation you have will depend on a number of factors, such as your body shape. Ask your surgeon to explain the options available to you. There are three main types of tissue flaps.

    • Latissimus dorsi flap reconstruction. In this operation, your surgeon will take tissue from your back, including the latissimus dorsi muscle that lies below your shoulder and behind your armpit.
    • Transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Your surgeon will take tissue from your abdomen. This will consist of a portion of transverse rectus abdominis muscle and skin and fat from your lower abdomen, along with the veins and arteries. Your surgeon may leave the veins and arteries intact in what's called a pedicle flap technique. Alternatively he or she will join the ones in the flap to those in your chest to restore its blood supply.
    • Deep inferior epigastric perforator (DIEP) flap reconstruction. In this operation, your surgeon will take skin and fat from your abdomen, along with its blood supply but leave the muscle behind. As with some TRAM flap techniques, a DIEP involves microsurgery to restore the blood supply to the flap.

    Your surgeon will explain the differences between these and other types of procedure.

    When your breast reconstruction is complete, your surgeon will close the cuts with stitches, which may be dissolvable. He or she will wrap your breasts in a special supportive dressing.

    Lipomodelling

    Lipomodelling can be done on its own or as part of another operation to reconstruct your breast. Your surgeon will use a syringe to take some fat from your abdomen, side or outer thigh. The fat cells will be prepared and then your surgeon will inject them into your breast to smooth the shape or enlarge your breast. You may need to have a number of injections in separate visits.

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  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

    You may have a catheter to drain urine from your bladder into a bag. This will usually be removed when you’re ready to get out of bed and walk around. You may also have fine tubes called drains running out from the wound. These drain fluid into another bag and are usually removed after a few days. However, you may go home with the drains still in place.

    On the first day, you may have to wear special pads, attached to a pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent deep vein thrombosis (DVT). You may also need to wear compression stockings on your legs for the same reasons.

    A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will guide you through exercises designed to help your recovery.

    Your nurse will give you some advice about caring for your surgical wound before you go home. You may be given a date for a follow-up appointment.

    You will need to arrange for someone to take you home.

    The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in about two weeks. If you have non-dissolvable stitches, ask your surgeon when you will have these taken out.

  • Recovery Recovering from breast reconstruction surgery

    It usually takes several weeks to make a full recovery from breast reconstruction surgery, but this depends on the type of surgery you have. It can also vary between individuals, so it’s important to follow your surgeon’s advice.

    Ask your surgeon for advice about wearing a bra after your operation. It might be better not to wear one at first or you may need to wear a support bra.

    Your breasts will feel sore and you will have swelling for a few months. If your surgeon moved tissue from your back or abdomen during your operation, these wounds may be uncomfortable. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    At your follow-up appointment, your surgeon will give you advice about when you can go back to your usual activities and return to work. It’s best not to drive for at least a few weeks but follow your surgeon’s advice.

    It may take several months before your reconstructed breast settles into its new shape.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with breast reconstruction surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

    Side-effects of breast reconstruction surgery include:

    • soreness, swelling and bruising – this can last up to a month
    • scars – you will have permanent scars on your breast and other areas that your surgeon took tissue from but these will fade

    Complications

    Complications are when problems occur during or after the operation. Complications of breast reconstruction surgery can include:

    • an infection
    • bleeding under your skin (haematoma), which may require further surgery to stop the bleeding and drain the area
    • a change in sensation both in your breast and the site where your surgeon took tissue from in flap operations – this can be permanent
    • an unevenness in size and shape – your reconstructed breast may look different to your natural breast
    • loss of part or all of your reconstruction – transplanted tissue may die, and complications with implants can lead to implant loss
    • build-up of scar tissue around an implant (capsular contracture)
    • build-up of fluid around the implant or where your surgeon removed tissue (seroma)

    It's possible that you may not be completely satisfied with your appearance after the operation.

  • FAQs FAQs

    How soon can I have my nipple reconstructed?

    Answer

    A nipple reconstruction is usually done about three months after you have a breast reconstruction.

    Explanation

    If your nipple was removed during breast removal surgery, you can have a nipple reconstruction after a breast reconstruction operation. You will need to give your breast time to heal and settle into shape. Your surgeon can then position the new nipple accurately in line with the one on your other breast.

    There are a number of ways to reconstruct a nipple. Your surgeon may reconstruct a nipple by folding skin on your new breast into a nipple shape, for example. Alternatively he or she may take part of your nipple on your natural breast and place it on your new breast. This is called a nipple sharing graft. Most procedures are done under a local anaesthetic and you should be able to go home the same day.

    You may need further treatment, such as a tattoo on your nipple and areola, to give it the right colour. This is usually done a few months after a nipple reconstruction.

    Your reconstructed nipple may look slightly different to your natural nipple. It won’t respond in the same way to temperature changes or touch, or have the same sensation as a natural nipple. It will also often flatten out over time.

    What are the different types of implants available for breast reconstruction and could they hide a new cancer?

    Answer

    There are two main types of implant available in the UK. They are usually filled with silicone gel but saline (salt water) implants are available too. The implants won’t hide breast cancer.

    Explanation

    All synthetic breast implants are surrounded by a firm elastic shell that may be smooth or textured. Silicone gel-filled implants are the most commonly used. The silicone filler can either be a soft, fluid-like gel or a firmer gel. The firmer gel has the advantage of keeping its shape if the implant shell ruptures. However, the softer silicone gel is less prone to wrinkling, and has a more natural feel than other implants. If you choose a firmer gel implant, you may have a slightly larger scar.

    Your surgeon can insert empty saline implants and fill them once they are in place.

    You can still examine yourself for breast cancer and have breast imaging if you have an implant. However, tell your doctor or radiographer that you have breast implants before having a breast examination, so that they can take special measures.

    What does a reconstructed breast look like?

    Answer

    Your reconstructed breast may look different from your natural breast but you shouldn’t notice any difference when you wear clothes.

    Explanation

    Your reconstructed breast will usually have a scar. If you have a nipple reconstruction, this may also look slightly different to your natural breast. You might choose to have a tattoo after a nipple reconstruction to create the illusion of an areola. This is the area of dark tissue that normally surrounds your nipple. This can also look slightly different in shape or colour to your normal areola. However, these differences shouldn’t be noticeable when you wear clothes.

    Although implants are quite firm, they should feel similar to your remaining breast. Most women who have breast removal and reconstruction don’t have much, or even any, sensation in their breasts. This can happen if your surgeon needs to cut the nerves to the skin on your breast during your operation.

    If your breasts don’t match in shape, size or outline, your surgeon may suggest you have an operation on your natural breast to give a more balanced appearance. The most common procedures are breast reduction, breast enlargement or lifting of your natural breast.

    Will I have permanent scars after a breast reconstruction?

    Answer

    Yes, you will have some scarring around your breast. If skin, fat or muscle is used from your abdomen (tummy), back or buttocks, you will have scars in that area too.

    Explanation

    The scars you will be left with after your breast reconstruction will be permanent but they should fade. Where your scars are will depend on the technique your surgeon uses. Ask your surgeon about how he or she plans to do the operation and the likely position of scars.

    The scars will be noticeable at first and perhaps look lumpy and red. However, they normally fade over several months to two years and become close to your natural skin colour. If you smoke, the scars may be more noticeable. This is because the toxins in cigarettes can stop your tissue from healing properly. If you smoke, your surgeon will suggest that you stop before your operation.

    You may decide that the benefits of the operation outweigh any scarring. For example, breast reconstruction may help restore your self-confidence and feelings of femininity, attractiveness and sexuality. You won’t need to wear an artificial breast (prosthesis). When you’re wearing clothes your appearance will be closer to the way it was before your breast removal. However, it’s your choice. Discuss your options with your surgeon.

  • Resources Resources

    Further information


    Sources

    • Oncoplastic breast reconstruction. British Association of Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, published November 2012
    • Breast cancer quality standard. National Institute for Health and Care Excellence (NICE), September 2011. www.nice.org.uk
    • Surgical treatment of breast cancer. Medscape. www.emedicine.medscape.com, published 7 April 2014
    • Breast reconstruction using lipomodelling after breast cancer treatment. National Institute for Health and Care Excellence (NICE), January 2012. www.nice.org.uk
    • Your guide to breast reconstruction. British Association of Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, published 2010
    • The second all breast cancer report. National Cancer Intelligence Network. www.ncin.org.uk, published June 2011
    • Breast reconstruction – patient information guide. British Association of Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, published 22 April 2014
    • Breast reconstruction. Breast Cancer Care. www.breastcancercare.org.uk, published April 2012
    • Breast reconstruction after mastectomy. American Cancer Society. www.cancer.org, published 12 June 2013
    • Early-stage breast cancer treatment fact sheet. Womenshealth.Gov. www.womenshealth.gov, published 16 July 2012
    • Breast reconstruction after mastectomy. National Cancer Institute. www.cancer.gov, published 12 February 2013
    • Breast reconstruction risks and safety information. American Society of Plastic Surgeons. www.plasticsurgery.org, accessed 23 April 2014
    • Smoking and its effects on the skin. Dermnet NZ. www.dermnetnz.org, published 8 April 2014
    • Breast implants. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, published November 2012
    • 5 things to know about breast implants. US Food and Drug Administration (FDA). www.fda.gov, published 20 February 2013
    • Nipple-areola reconstruction treatment and management. Medscape. www.emedicine.medscape.com, published 11 July 2013
    • Gahm J, Hanssonb P, Brandberg Y, et al. Breast sensibility after bilateral risk-reducing mastectomy and immediate breast reconstruction: a prospective study. J Plast Reconstr Aesthet Surg 2013; 66(11):1521–27. doi: 10.1016/j.bjps.2013.06.054
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, June 2014.

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