Breast Reconstruction
Reconstructing the breast after mastectomy using an approach tailored to cancer treatment, anatomy and individual priorities.
Breast reconstruction may be performed at the time of mastectomy or as a later operation. Depending on the clinical circumstances, reconstruction may use an implant, the patient's own tissue, or a combination of techniques.
The reconstructive plan needs to sit within the wider breast-cancer pathway, including the type of mastectomy, radiotherapy, previous surgery and treatment still to come.
There is no single breast reconstruction
The appropriate operation depends on more than breast size or a preferred technique. Cancer treatment, body shape, available donor tissue, previous abdominal or breast surgery, the opposite breast and the patient's priorities all influence the decision.
For some patients an implant-based reconstruction is the most appropriate option. For others, reconstruction with their own tissue offers important advantages. The role of consultation is to work through those trade-offs clearly.
Timing of reconstruction
Immediate reconstruction
Reconstruction can often begin at the same operation as mastectomy. This allows the breast skin envelope to be considered as part of the reconstructive plan and avoids a period without a breast mound.
Delayed reconstruction
Reconstruction can also be performed after completion of the initial cancer treatment. This may be appropriate by choice or because oncological treatment, previous complications or individual circumstances favour a staged approach.
Immediate-delayed pathways
In selected situations reconstruction may be deliberately staged so that the breast envelope is preserved while subsequent treatment or the definitive reconstructive plan becomes clearer.
Revision reconstruction
Patients with an existing reconstruction may seek treatment for implant problems, asymmetry, contour concerns or the consequences of radiotherapy and previous surgery.
Choosing the reconstructive technique
Implant-based reconstruction
Implant reconstruction can provide an effective breast mound without a distant tissue donor site and generally involves a shorter initial operation than free-tissue reconstruction. It may be performed as a direct-to-implant reconstruction in selected patients or through a staged expander-to-implant pathway.
Because implants are prosthetic devices, the reconstruction needs to be considered as a long-term process rather than necessarily a single permanent operation.
Reconstruction using your own tissue
Autologous reconstruction uses tissue from another part of the body to create a soft, living breast mound. In microsurgical reconstruction, that tissue is transferred together with its blood supply and the vessels are reconnected in the chest under magnification.
Abdominal tissue is commonly used, while other donor sites may be considered when the abdomen is unsuitable or another option better fits the patient's anatomy. This is a longer and more complex operation than implant reconstruction, with recovery from both the chest and donor site, but it avoids relying on an implant for the reconstructed volume.
Radiotherapy changes the discussion
Before reconstruction
Previous radiotherapy can alter skin and soft-tissue quality and may influence whether implant-based or autologous reconstruction is likely to provide the more reliable result.
After reconstruction
When post-mastectomy radiotherapy is anticipated, its potential effects on the reconstructed breast need to be incorporated into the timing and choice of reconstruction.
Implants
Radiotherapy can increase problems such as firmness, capsular contracture and distortion around an implant reconstruction.
Living tissue
Autologous tissue can be particularly useful when reconstruction requires healthy vascularised tissue in an area affected by previous surgery or radiotherapy.
The whole breast matters
Breast envelope
The mastectomy pattern, skin quality and whether the nipple can be preserved all influence the shape and possibilities of reconstruction.
Volume & proportion
The reconstructed breast is planned in relation to chest dimensions, available tissue and the opposite breast rather than as an isolated mound.
Symmetry
In some patients, surgery to the opposite breast may be considered to improve balance. This is discussed as part of the overall reconstructive strategy rather than assumed to be necessary.
Refinement
Fat grafting, scar revision, nipple reconstruction or other secondary procedures can sometimes refine contour and symmetry after the principal reconstruction has healed.