Surgery to remove all or part of your breast as part of breast cancer treatment can have an impact on your sense of self, your body image, and your sexuality.
Some women find they cope better with these issues after breast reconstruction surgery. This involves the surgical reconstruction of the breast tissue to create a body shape similar to your pre-surgery shape. However, a reconstructed breast will never look or feel the same as your own breast.
Breast reconstruction surgery is optional and many women never have this surgery. It is an individual choice so take the time to think about this carefully. For many women reconstruction aids recovery and helps them feel better about themselves. However, it is not the right choice for everyone and it may not be appropriate for you. Discuss your options with your surgeon.
Breast reconstruction can be carried out at the same time as your initial surgery - known as immediate reconstruction. Alternatively, you may prefer to wait until your cancer treatment is over before you consider reconstructive options – this is known as delayed reconstruction. This may also be the advice of your surgeons and is often the case if your surgeon prefers to wait until you have recovered from chemotherapy and/or radiotherapy before having further surgery. However, in some parts of New Zealand, there can be long waits for delayed breast reconstruction surgery, so make sure you discuss this issue thoroughly with your surgeon.
There are different kinds of reconstruction surgery avaialable so think about these carefully and make sure you are happy with your medical team. Some questions you might like to ask your surgeon include:
- what types of reconstructive surgery to you perform?
- how many times have you performed these different procedures?
- have you had special training to perform these types of surgery?
- can I view your album of previous results?
There are three commonly used methods of reconstruction and these are listed below.
This method usually involves two stages. At the first operation a tissue expander is placed under the muscle of the chest wall. Sometimes it may be placed under the skin only, rather than the muscle - speak to your surgeon about the option that's best for you. The tissue expander is expanded over time by an injection of saline. At a second operation the tissue expander is removed and replaced with a silicone gel implant. This technique gives good size balance. As your body changes with time further surgery may be required.
Latissimus dorsi flap, often with an implant
Skin and muscle from the back is brought forward onto the chest to reconstruct the breast. Usually a tissue expander and implant is also needed to achieve size and shape match. This approach often achieves a more natural breast shape. It will leave a scar on the back, your shoulder strength will take some months to recover and overall recovery is longer than implant reconstruction alone.
Abdominal tissue reconstruction
There are several techniques for moving skin and fat from your abdomen to reconstruct your breast. The blood supply to that tissue can be left intact - this is called a pedicled TRAM flap. Alternatively, microsurgery is used to re-establish the blood supply - this is called a free TRAM flap. Often this approach gives enough tissue to enable the surgeon to create a natural breast shape without the need for an implant. However, this kind of surgery is extensive. It can result in weakness and bulging in the abdominal area and has a longer recovery period.
Often further surgery is required to achieve a better balance. This may require surgery to the other breast such as a lift or reduction. The reconstructed breast may often require further adjustment as well.
Finally, you may wish to consider reconstruction of a nipple and areola. This surgery is usually many months after the initial breast reconstruction.
Recommendations on breast reconstruction:
Clinicians should follow the recommendations of the New Zealand Guidelines on the Management of Early Breast Cancer on breast reconstruction. These state:
A woman being prepared for a mastectomy should be informed of the option of breast reconstruction and, if appropriate, should discuss the option with a surgeon trained in reconstructive techniques prior to the surgery.
The use of immediate or delayed breast reconstruction is an important means of enhancing body image and self-confidence after mastectomy and both options should be available to women in the public and private sectors in New Zealand.