Every woman having treatment for breast cancer, and for whom reconstruction is an option, should have the opportunity to discuss reconstruction with a plastic surgeon even if it means going to another hospital to have it.
So that women are fully informed of their reconstructive options before undergoing mastectomy, BAPRAS has produced a free, comprehensive guide to breast reconstruction. The guide is produced here, but is also available to download as a PDF (click here to download) or a hard copy, available by emailing firstname.lastname@example.org
This guide is for women looking for more information about breast reconstruction – either before or at the time of cancer treatment. It aims to give an overview of the options and provides pointers to further sources of information on the internet. It can be used by women and their families, and by any healthcare professional in contact with the patient throughout her treatment.
What is breast reconstruction?
If you need to have surgery to remove a breast cancer, reconstructive surgery aims to rebuild your breast, either wholly or partially, to match the normal breast in both shape and size. It also aims to improve your body image and self-esteem, helping the process of recovery on a physical, emotional and psychological level.
According to the National Institute for Health and Clinical Excellence (NICE), all women should be offered the chance of high quality breast reconstruction at the same time as their mastectomy – this is known as “immediate reconstruction”. Current evidence suggests that breast reconstruction, either at the same time or after cancer treatment, does not in any way increase the chances of the cancer recurring.
There are several surgical ways to reconstruct a breast, some relatively simple, some quite complicated. It is essential that you are assessed and informed of the technique that would be best for you by someone who knows about all the options. You should be able to choose your preferred option, even if it means travelling to another hospital to have it carried out. As awareness of the range of choices and benefits of breast reconstruction grows, there is more demand for it: as a result, plastic surgeons have become an integral part of the teams treating women with breast cancer
What causes breast cancer?
Breast cancer is the most common form of cancer affecting women in the UK, with 40,000 new cases diagnosed every year.
Cancers occur when normal cells stop responding to the control systems used to co-ordinate the function of cells.
These rogue cells start to multiply faster than they should, forming cancerous tumours. Why this happens is the subject of much research and debate, but is probably a combination of environmental, lifestyle and genetic factors.
The treatment of breast cancer is based on the elimination of these cells, whether through surgical removal or by killing them with radiotherapy and/or chemotherapy.
The type of treatment you will be offered depends on the exact type of breast cancer you have, and if any cancerous cells have spread within and beyond the breast.
Your breast surgeon or breast care nurse will discuss the treatment options available for you and will help guide your decision.
What is a mastectomy?
This is the surgical removal of the entire breast. About 40% of women diagnosed with breast cancer require or choose to undergo mastectomy.
The breast is positioned between the skin of the chest and the chest wall muscles, and consists of milk ducts, glands, fat and some connective tissue holding all of these components together. The glands produce milk, which runs via the ducts to the nipple.
As the nipple is connected to the entire breast and the cancer can involve the ducts, the nipple must usually be removed as part of the mastectomy surgery.
Mastectomy is still the best treatment for women with certain types of breast cancer. Your breast cancer surgeon will discuss this with you, but generally a mastectomy is recommended if:
• Cancer is present in two or more areas of the breast
• The breast has been treated in the past with radiotherapy
• A large tumour is found in a small breast
• The tumour is likely to recur.
On discovering cancer within one breast, many women prefer to have that entire breast, or even both breasts, removed to reduce the risk of getting another breast cancer in the future.
What is my next step?
Sometimes there is really 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. Other factors are also taken into consideration, such as:
• Your general fitness
• Preferences in terms of risk, outcome and scarring
• Any possible impact with other treatments you might need
Another important consideration is whether your other breast can be matched as it is or if it would be better to adjust it, perhaps by lifting it or making it smaller. All of these things will be taken into account by the plastic surgeon before a decision can be made as to what options are available for you to choose from.
When to have breast reconstruction
Operations to make a new breast
Further operations and nipple reconstruction
Reconstruction in other situations
Where can you have breast reconstruction?
Other questions and where to get more information
Editors: David Coleman & Hamish Laing
Contributors: Vik Devaraj, Fazel Fatah, Eric Freedlander, Mary Gay, Joe O'Donoghue, Eva Weiler-Mithoff, Diana Harcourt (Centre for Appearance Research, UWE)