Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

We help you to find the best breast reconstruction technique to help you recover

Breast Reconstruction Overview
We understand that deciding on whether to have breast reconstruction or not can be a difficult process, especially when you are dealing with your diagnosis and treatment. Whilst we can guide and support you as much as possible, ultimately the decision is yours and should be made on what is best for you and your health. Although all woman having a mastectomy should have breast reconstruction discussed there is no right or wrong about choosing it for you as an individual.

Breast reconstruction can be performed at the time of the mastectomy (known as primary or immediate reconstruction) or at a later date (secondary or delayed reconstruction). If in doubt you can always have reconstruction at a later date. In general terms a breast can be reconstructed using an implant or tissue from the patient’s own body (back, tummy, bottom or thigh). Sometimes a combination of the two procedures can be used, but the type of procedure used will really depend on what is best for the patient and can be discussed with Stephen McCulley during a consultation.

Further information about breast reconstruction is below. Please do not hesitate to contact us if you have any questions or would like to obtain costs.

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Why and When

Breast reconstruction is an option and never an essential part of your treatment, however the option of breast reconstruction should be offered to every woman that has a mastectomy.

If you are looking to have reconstruction, it is important to consider the added surgery and potential complications reconstruction will add to your recovery process. Great advances in reconstruction techniques now allow for some excellent outcomes with breast reconstruction following cancer.

The decision on when to have the reconstruction surgery will be driven by the patient's choice, along with advice from Stephen McCulley. When patients require other treatments, especially radiotherapy, it might be considered better to delay reconstruction. Nipple reconstruction can be performed at the time of the reconstruction or usually later.

For further information we would recommend taking a look at breastcancercare.org with useful links offering support and information to those affected by breast cancer as well as macmillan.org.uk

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Immediate Reconstruction

This is when the reconstruction is done at the same time as the surgery for your breast cancer. There are advantages and potential disadvantages to planning an immediate reconstruction. It must always be remembered that a reconstruction can still be performed on the majority of patients at a later date after all of the cancer treatment is completed.

Advantages Of Immediate Reconstruction

  • As there is no delay between cancer treatment and reconstruction, for some patients this means that the psychological effects of having a mastectomy and therefore losing a breast is reduced.
  • A reconstruction using the patient's own tissue will only involve one operation, and therefore recovery should be quicker.
  • An immediate reconstruction can result in a far more natural result for the patient, especially if the mastectomy is carried out through the nipple. This means that all of the breast skin can be saved and used for the reconstruction giving a more natural cosmetic result.
  • Stephen McCulley can sometimes build a nipple at the same time as a mastectomy. This is true of the reconstructions using the tummy or back but not with implant based reconstruction.

Disadvantages Of Immediate Reconstruction

  • Understanding the surgical process of a breast reconstruction and deciding to have immediate treatment, that may lengthen your hospital stay, will inevitably add further pressure at an already difficult time.
  • You may have complications from your additional surgery at a time when you are awaiting other treatments for your cancer such as radiotherapy and chemotherapy. This does not mean that your cancer treatment will be affected, but could mean additional surgery to ensure that complications are treated quickly if they occur.
  • If you unexpectedly need radiotherapy this can affect the result of your reconstruction. Indeed, if we know you will definitely need radiotherapy after surgery then we may recommend delaying reconstruction.
  • The complication rate of immediate reconstruction is slightly higher than delayed reconstruction.
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Delayed Reconstruction

This is when breast reconstruction is performed after all of the cancer treatment has finished, and may be months or years later. There is no time or specific age limit, and should only be carried out when the patient is ready, both physically and mentally, for further surgery.

Some patients choose to have a delayed reconstruction, others are recommended it and some patients who did not initially want to have a reconstruction sometimes decide after a period of time that they are ready to have surgery.

Advantages Of Delayed Reconstruction

  • It will avoid the strain of being treated for any possible complications following reconstruction surgery at the same time as undergoing cancer treatment, such as radiotherapy or chemotherapy.
  • Avoids the possible effects of radiotherapy (firmness, shrinking and deformity) impacting on the reconstruction. The cosmetic result of immediate reconstruction can be superior to delayed reconstruction. However, if you add radiotherapy to an immediate reconstruction it will have the opposite effect.
  • You will not have to deal with the surgery or any decisions relating to the reconstruction at the time of cancer diagnosis and treatment.
  • This form of surgery has a slightly lower complication rate than compared to immediate reconstruction.

Disadvantages Of Delayed Reconstruction

  • You will need to live with the effects of the mastectomy until the reconstruction is performed. This can be for a number of months or up to a year, depending on the individual case.
  • The cosmetic result is potentially not as good. This is because an immediate reconstruction the skin of the breast is often kept and used to cover the reconstruction giving a more natural result. If a delayed reconstruction is performed using your own body tissue then skin needs to be added to the breast from the back or tummy. This skin does have slightly different appearance and the scars on the reconstructed breast will be longer.
  • The skin difference is less obvious in delayed implant based reconstruction as the skin is stretched with the inflatable balloon device first (just as with immediate reconstruction).
  • If you have had radiotherapy it is unlikely you will be offered implant type reconstruction, as the complications are too high. You will need some tissue from the back or tummy moved to help reconstruct the breast.

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Radiotherapy and Breast Reconstruction

Radiotherapy is a very important part of the treatment for certain breast cancer patients, usually those who only have part of the breast removed (breast conserving surgery), as it has been shown to reduce the chances of breast cancer recurring in the remaining breast tissue. There is also evidence to show that the combined efforts of breast conserving surgery and radiotherapy can be as effective as a mastectomy.

However, certain patients that have a mastectomy have also been shown to benefit from radiotherapy. It’s likely use can be predicted in some patients but it will often only be known if radiotherapy is needed after the mastectomy is performed and the cancer analysed.

When carried out, radiotherapy can damage normal tissue as well as cancer cells. It can result in changes to the patient's skin colour and cause firmness and shrinkage in healthy breast tissue. It can also have the same effects in tissues that have been used to reconstruct a breast. If a silicone implant is present then it can cause an alarming rise in potential complications of capsule formation (firmness from scar tissue) or infection.

The problems associated with having radiotherapy can impact on when to have a breast reconstruction and the particular method to use.

  • If radiotherapy is planned or has already been given then implant reconstruction should be avoided in the majority of cases.
  • When radiotherapy is almost certainly planned you may be recommended to delay reconstruction until all of your treatment is completed. There is nothing more disappointing for the patient and Stephen McCulley to see a good reconstruction be adversely affected by radiotherapy.
  • If radiotherapy is a possibility then it is acceptable to take either the cautious route of delayed reconstruction or proceed with an immediate reconstruction and deal with radiotherapy problems if they occur.
  • It must be emphasized that not all patients get strong adverse affects from radiotherapy. This can make definitive advice difficult, however Stephen McCulley will guide you as much as possible on the best course of treatment for you, based on your individual case.

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Reconstruction Techniques Overview

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