If you want to have breast reconstruction it is best to discuss this with your doctor as soon as you realise you need a mastectomy, although, breast reconstruction can be done months to years after a mastectomy or immediately after mastectomy as part of the same operation.
There are two main types, one in which muscle and/or skin are taken from another part of your body (the back, stomach or other breast) and one using implants. The surgeon will often recommend which is best for you based on your breast size and personal preferences. You may also be given a choice where either may suit.
It is useful to do the research on this and look at photos and videos, both in relation to the type of operation and to your choice of surgeon.
Depending what you prefer, your nipple and aureola may or may not
be added to the reconstructed breast. Reconstruction of the nipple
is often deferred until after the breast reconstruction to allow
for better placement of the nipple.
Women undertake breast reconstruction for a number of reasons including:
- Maintenance of self-esteem and confidence
- Body image reinforcement
- Sexual attractiveness
- Appearance for professional reasons
- To avoid the inconvenience of a mammary prosthesis which may be uncomfortable in hot weather, especially if the woman plays active sports and swims.
In Australia more younger women opt for breast reconstruction, but it is equally available to women of all ages who desire it for any of the above reasons.
Ideally your GP or surgeon will initiate a discussion about reconstruction, but all mastectomy patients should feel free to request this option. It is a legitimate request, not a matter of vanity.
Questions most women ask:
What are the different types of reconstruction available and how are they done?
Several options are available for breast reconstruction:
- Using either the stomach or back muscle
- Using Breast Implants (sometimes with tissue expanders)
Can I have a nipple reconstruction? How are the nipples created?
What sort of implants can be used?
Saline or silicone, or a combination of both.
Will my breasts look the same?
Your surgeon will try to closely match your own breast, but usually it will not match exactly. If you are not happy with the result, you may be able to improve it by having an operation on your other breast. Or the implant may be replaced with one that is larger, smaller or positioned differently.
When you are naked you may notice differences in terms of fullness and droopiness, with your reconstructed breast often being less droopy. Your surgeon will try to make sure these differences are not too great.
Will they feel the same?
Your reconstructed breast will feel soft to touch but slightly firmer than your own breast.
What will the scars look like?
It depends on what type of reconstruction you have.
Will I have any feeling or sensation in my breasts after reconstruction?
Most women have very little feeling in their reconstructed breast. Occasionally there may be sensation in the skin, but often not. If you have a nipple reconstructed, it won't have any sensation. You may experience phantom nipple sensations, but these disappear with time.
Is breast reconstruction covered by Medicare?
Yes, but only partly.
Are there any costs involved? What are they?
Surgical, anaesthetist, assistants, hospital and implant costs. These will depend on one's health insurance.
Do I still need to have breast screening? Will breast reconstruction interfere with breast screening?
Research has shown that this is not the case.
How will I feel afterwards?
You are likely to experience
some degree of discomfort following your breast reconstruction,
as you would after any operation. Some women experience more pain
than others, and they may need painkilling injections for a day
or so after the operation. However, many women have less pain than
they expected.
Is it possible for me to have a breast reconstruction?
Breast reconstruction is possible for most women who have had all or part of their breast removed. Providing you are well enough, you can have a breast reconstruction at any age.
Which approach would you recommend for me and why?
The choice will depend on for example, the size of your breast and whether you are having one breast or both reconstructed. It will also depend on whether or not you have had previous radiotherapy.
Can I pick the reconstruction size?
Yes, this should be possible. If it is not possible, ask why.
Can I see any pictures of before and after reconstruction?
Yes, your surgeon should be able to show you these.
Are there any costs involved? What are they?
Surgical, anaesthetist, assistants, hospital and implant costs. These will depend on one's health insurance.
Can mammography damage a breast implant?
Yes, but this would be very unusual.
If I do get breast cancer, could it be concealed by the scar tissue or breast reconstruction?
Generally this will not be the case, but do ask.
How long will I have to wait before having the operation? Can I have it while I am having the mastectomy?
Sometimes breast reconstruction may be performed at the same time as surgery for breast cancer. Later adjustments are often necessary. In this case. Some doctors still recommend a delay, particularly if you are advised to have chemotherapy or radiotherapy. There may be a waiting list.
Factors in choosing the best procedure for you
Discuss the following with the surgeon in deciding what will work best for you:
- Your normal breast anatomy, shape, and texture
- Your wishes regarding the technique and aesthetic outcome
- Your wishes regarding the timing of the procedure
- The likely impact of each method on your social, sexual and physical functioning
- The number of visits and procedures you will require
- Your overall health.
Risk-impact of lifestyle and history
There are reports that the incidence of complications following surgery is higher in:
- Smokers
- Obese women
- Women with diabetes, cardiovascular disease, or respiratory disease Women with previous exposure to radiotherapy
- Women with an abdominal scar.
