Image of a breast being marked for immediate reconstruction

Immediate reconstruction

The benefits of immediate reconstruction are:

  • It requires one hospitalization, anaesthetic, operation and recovery period
  • Your native breast skin is preserved and used rather than bringing skin from other areas of body which may not match with skin of your other breast
  • The cosmetic results are usually better
  • Less scars on the breast
  • You will not be without a breast any time

In immediate reconstruction mastectomy is done keeping the breast skin intact. This is done by scooping the breast tissue out through a small incision saving whole skin with or without nipple. If the cancer is close to nipple then it is not safe to keep nipple otherwise nipple can be preserved. This will be discussed with you before the surgery.

There are two main ways to do immediate reconstruction. These are ***implant reconstruction, and reconstruction with your own tissues.  Reconstruction with your own tissues is done mainly with flap from your back (Latissimus Dorsi or LD flap) or flap from your abdomen (DIEP flap). If you are likely to need radiotherapy after the surgery, immediate reconstruction with your own tissue is generally not advisable because radiotherapy can have detrimental effect on the reconstruction. Radiotherapy can have similar impact on implant reconstruction but if that happens implant can be changed or removed and reconstruction done with your own tissue after your cancer treatment finishes.

“***if you want reconstruction with implant, it’s to better have immediate reconstruction as delayed reconstruction with implant only is usually not feasible”.

If you are unlikely to need radiotherapy you can choose to have reconstruction with either implant or your own tissue. Sometimes there is only one type of procedure that can be recommended, but usually you will have a choice to make. This depends on how much of the breast skin and volume needs to be replaced after the cancer is removed and how much spare tissue is available in the various areas of the body it can be taken from. It also depends on your life style and your preferences. Sometimes you would need surgery to the unaffected breast to adjust it, either by lifting it or making it smaller. This also will be considered at the time of decision making.

Nipple Reconstruction

In spite of the breast mound being there, you may not think it looks like a breast until there is a nipple reconstructed and some tattoo around it. Nipple reconstruction is usually done at a later stage. If you are having any radiotherapy, then I usually allow at least 9-12 months from the time of completion of this before performing the nipple reconstruction.  Flaps of tissue are raised up on the reconstructed breast and sewn together to make a nipple shape. It will restore the look, but not the feel or sensation of the nipple. The nipple which is reconstructed usually flattens over a period of time but continues to give impression of nipple. It is normally done under local anaesthetic and takes about 20-30 minutes to do. Healing takes about 3 weeks. Rare complication of new nipple completely dying off is possible. If you choose not to have a nipple, you can use a stick-on nipple prosthesis made from silicone rubber, closely matched to the other side.

What about not having any Reconstruction?

You may choose not to have your breast reconstructed at all. Many women feel radically changed by their cancer experience, and some feel that a flat chest is constant reminder of cancer to them. Others are very satisfied choosing to wear a prosthetic breast in their bra rather than have to undergo more surgery, although some women find it restricts their choice of clothing. Talking to other women who have undergone treatment can often help you decide whether or not breast reconstruction is the right option for you.

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