Mastectomy and breast reconstruction – knowing your options

By Mr Massimiliano Cariati, consultant oncoplastic breast surgeon at The Wellington Hospital Breast Unit

Even in a time of minimally invasive surgery mastectomy remains a very frequent surgical procedure.

About one third of women diagnosed with breast cancer undergo mastectomy following the recommendation of their surgeon and others elect for it over breast conservation for treatment. Others choose to undergo the procedure to reduce their risk of developing breast cancer in the future.

Whatever your age, relationship status and individual circumstances, it is difficult to predict how one will feel in response to the loss of one or both breasts. Since puberty they have will have been a significant part of the image and identity for a number of women.

How you choose to navigate this journey is frequently your choice. You should be offered the chance of considering breast reconstruction, either immediate or at a later stage. Some careful thinking is required to decide whether breast reconstruction is for you and, if so, what type of reconstruction may suit you best. And it is always important to consider what the alternatives to reconstruction are.

1. How important is it to you to rebuild your breast?
2. Is a reconstructed breast going to help you feel whole again?
3. Are you more concerned about the way your body looks dressed or also undressed?
4. How do you feel about undergoing more extensive or further surgery and about a longer recovery?

 

If you chose to not undergo a reconstruction, it is important to know external prostheses are available and can be tailored to your size and shape. So when wearing a bra and clothes it would be unlikely anyone would be aware you have undergone a mastectomy.

The option of undergoing a reconstruction may still be available at a later stage (delayed), but it is important to understand a reconstruction performed at the same time as your mastectomy (immediate) is likely to provide a better cosmetic outcome.

If you feel reconstruction is likely to be right for you, it is important you are aware there are two main approaches. This is in terms of the timing of the procedure (immediate or delayed) and two different types of reconstruction (implant-based or using tissue from another part of your body – autologous flap).

It is also important to know while reconstruction restores the shape of your breast, it will not maintain the feeling to your breast skin or nipple (if this has been preserved – which depends on individual factors and circumstances). It is possible a degree of sensation will recover over time, but it will feel different than before surgery.

As mentioned there are two main ways of reconstructing a breast. Either using an implant (filled with silicone gel, or saline, or a combination of the two) or using tissue from another part of your body (most frequently your tummy fat or the fat and muscle from your back).

The approach which suits you best depends on your shape and size (implants work best for small to moderate size breast with little or no droop; tissue flaps work for all sizes and shapes), your general level of fitness, and your preference.

Implant reconstruction is easier on the front end: a much shorter surgery (three hours), one set of scars only, a shorter hospital stay, and relatively quicker recovery time.

Tissue flaps take much longer to perform (six-12 hours), come with multiple scars, a longer hospital stay and recovery time.

As time goes by, however, implants are more likely to require revision and further surgery to correct any issues that might occur. While tissue flaps perform well in the long term and usually require limited revision over the course of a lifetime.

It is also important to realise, when making this decision, a conversion is possible over time. A cautious strategy, when suitable, could be the performing an implant-based reconstruction at the time of mastectomy, to allow for the advantages of a more straightforward surgery at the time of cancer treatment. Consideration should then be given to a revision to a flap further down the line, should the implant fail or not achieve the desired results (this approach is sometimes referred to as immediate-delayed).

Whichever your preference or choice, it is important to consider all your options and to take time to make the correct decision for you with the help of your surgeon and breast care nurse.



Book an appointment with Mr Massimiliano Cariati at The Wellington Hospital.