A cancer diagnosis is a huge thing to take onboard. With breast cancer, your cancer surgeon may recommend you have a mastectomy (removal of the breast) to treat the cancer. This can have a significant impact on an individual’s confidence, self-esteem and sexual well-being.
Breast reconstruction offers the opportunity to create a new breast. For anyone who has done any reading on the topic, it’s likely that the number of options mentioned can make the decision seem daunting. Terms like DIEP, autologous, TRAM, expander, TUG etc. add to the confusion. Here I’ll give you my simplified overview to try and help you towards making that decision.
Reconstruction isn’t compulsory:
The first thing to say is that breast reconstruction isn’t compulsory. With the speed at which appointments and scans start coming at you following a new cancer diagnosis, the discussion about breast reconstruction at the time of your mastectomy (an ‘immediate’ reconstruction’) can sometimes make it feel like the the reconstruction has to be done at this time to help cure the cancer. This isn’t the case - it won’t improve the outcome from the cancer itself and, rarely, can delay any other treatments you may need for the cancer if there is a wound healing problem. If you’re not sure at this stage, ask for another appointment to discuss the reconstruction again, or come back to it once the cancer has been treated.
Their are two key decisions you’ll need to make when thinking about a breast reconstruction:
Do you want the reconstruction at the time of the mastectomy (‘immediate’ reconstruction), or would you rather wait till all the cancer treatment is complete (‘delayed’ reconstruction)?
Do you want to use an implant or your own tissue to rebuild your breast?
Immediate vs delayed reconstruction:
When everything goes to plan, it’s more likely that an immediate reconstruction will give you the best possible cosmetic result in the long-term. Using the breast skin left behind at the time of the mastectomy allows the surgeon the best opportunity to create a breast that has similar shape and position to the one removed. It also means that you wake up with a mound resembling a breast that can avoid the period of time being flat-chested on one side.
That being said, an immediate reconstruction does introduce other surgical risks that can lengthen your recovery at a time when you may be needing to prepare for other important cancer treatments, such as radiotherapy or chemotherapy. It also introduces more decisions for you to make at a time when you may be feeling overwhelmed by everything you’re needing to process. Interestingly, although surgeons would judge the final result of an immediate reconstruction as better than that achieved with a delayed approach, patient surveys often find those having a delayed reconstruction are happier with the final result. Whether this is to do with those having a delayed reconstruction comparing their new breast to a flat chest, compared to those having an immediate approach comparing their new breast to their old breast, is unclear.
Implant vs own tissue (autologous):
Broadly speaking, a breast can be rebuilt with either an implant or your own tissue. Each has its pros and cons. I’ll try to simplify the pros and cons in this article to help guide you:
Pros = Shorter surgery and hospital stay, quicker return to normal activities
Cons = Higher risk of later complications and further surgery at later stage
Best candidates = Smaller breasted patient, pert breasts, keen to avoid scars elsewhere
Autologous (usually the tummy skin from a tummy-tuck)
Pros = Natural feel, changes shape and size with you, once surgery complete gives lifelong result
Cons = Longer surgery and hospital stay, slower return to normal activities, extra scars elsewhere
Best candidates = Larger volume breasts with a degree of drooping, enough skin and fat elsewhere to use, going to need (or had) radiotherapy for breast cancer treatment, wants lifelong result.
To summarise: Implants offer short-term gains, but long-term problems, where as using your own tissue demands more of you in the short-term, but gives a life-long result.
Reconstruction is a journey:
Getting you the best possible final result often requires 1-2 additional procedures after the initial procedure. These operations are generally shorter and often focus on refining the shape and volume of your new breast, whilst also changing the position and size of your remaining breast (if you had a single-sided mastectomy).
If you lost your nipple at the time of your mastectomy, there are special surgical techniques to rebuild this. You can also have tattooing to restore an areola to the new breast.
Breast reconstruction is a journey. I always use the analogy of reconstruction being like a tourist bus tour around a city. You don’t have to get on the bus at all if you don’t want to. If you do get on the bus, you can get off the bus whenever your want. What this means is that, after the first operation of your reconstruction, you can push on and have all the other steps done as soon as your surgeon is happy to offer each step. Alternatively, you can get off the bus and take extra time between each step to help it fit around you individual needs and circumstances. The reconstruction doesn’t have the same urgency as your cancer treatment, so make it work for you.
Finally, ask around amongst friends to see whether any of them have been through the process. Breast cancer affects 1 in 8 women, so there’s a high chance that someone you know may have been through this decision making process before. Their experiences may help you in your decision.
I hope you found this useful.
If you want to meet to discuss your breast reconstruction options, please contact my team at the Da Vinci Clinic, Tauranga to book in to see me.