If you decide to proceed with a mastectomy, your surgeon will discuss breast reconstruction with you. You do not have to have reconstruction, and some women opt to be flat chested. Some women may wish to wear a breast prosthesis, which gives the appearance of a natural breast under clothing.
Breast reconstruction is the process of re-creating a breast, either with an implant, your own tissue (autologous), or a combination of both. It is a very personal subject. There are many things to consider when choosing this surgery, and your surgeon and breast care nurse will spend as much time as you require discussing suitable options with you.
Immediate vs Delayed
A reconstruction that is carried out at the same time as cancer surgery is termed an “immediate reconstruction”. During this type of reconstruction, native breast skin is preserved, whilst the breast volume is re-created with an implant, your own tissue, or both. Advise against this due to the type or stage of your breast cancer will be given. Many women choose not to undergo an immediate reconstruction, and opt for a “delayed reconstruction”. Sometimes having to deal with reconstruction options as well as a breast cancer can be too much to process, therefore having a delayed reconstruction can reduce this stress.
Implant vs Autologous
Implant based reconstruction is the commonest form of breast reconstruction practiced in the UK. Implants can be fixed volume or variable volume. The implant is often used in combination with a biological mesh which acts as an internal bra to support the implant. The mesh may originate from pig or cow skin. Synthetic meshes are also available.
Autologous reconstructions utilise a persons own tissues to re-create the breast volume. Tissue may be transferred from other parts of the body, such as the back or tummy, which will leave scars at these donor sites. These are more complex operations relative to implant based reconstructions, but a more natural feeling breast is created. The autologous reconstruction will age naturally and is much less likely to require revisional surgery.