Deciding whether or not to have breast reconstruction can be a stressful experience, as you will need to take in complex information at what is already a difficult time for you. It is impossible to know exactly how a reconstructed breast will look and feel in the future.

Many women find that breast reconstruction offers many psychological benefits including improved quality of life, body image, confidence and self-esteem, and a restored sense of wholeness and femininity. However, the personal impact of the surgery varies from one woman to another and it isn’t a complete remedy for the distress associated with breast cancer and mastectomy. Regardless of whether or not you have reconstructive surgery, feelings of anxiety and depression typically improve during the first year after diagnosis. 

Women who choose reconstruction will need to adjust to changes in the appearance and sensation of their reconstructed breast(s) and, depending on the type of procedure carried out, may also be faced with changes to other parts of their body (for example scarring on their back or abdomen). It is not unusual for this process of adjusting to an altered appearance to take a year or more.

Some women feel self-conscious about their reconstructed breast. It is not uncommon to feel anxious about how other people (especially a partner) will respond, and to worry whether intimate relationships will be affected. Partners may also have concerns about this and will be going through a period of adjustment themselves.

Some women also worry whether the cancer could return in the reconstructed breast and how this would be detected. Ultimately, most women report being satisfied with their choice about whether or not to have reconstructive surgery and those who do choose it are typically pleased with the outcome. On some occasions, however, reconstructive surgery does not meet a woman’s expectations. This can lead to feelings of regret, anger and disappointment, and frustration at any need for further surgery.

Overall, women who are most satisfied with their decision and the outcome of surgery tend to be those who have taken time to carefully consider the options. Make sure you:

•  Read all the information about the options that are available to you
•  Weigh up the pros and cons in relation to your own personal values and priorities
•  Have clear and realistic expectations of the likely outcome
•  Discuss your options with your breast care team and people who you are close to

Remember: ultimately, you must make the decision for yourself and not for anyone else.

What is involved in the surgery?

The detail of the process varies depending on the technique used. This will be
discussed with you before the operation so you will know what to expect.

•  Once you have decided to proceed with surgery you will have a preadmission
assessment and clinical photographs
•  All breast reconstruction surgery is done under general anaesthesia
•  When you come round you will have some dressings and drains which remove excess fluid from the wounds
•  Various techniques are used to make the process as painless as possible
•  With free flap breast reconstruction you will have a period of careful monitoring for the first day or so after the operation to make sure that the blood is flowing freely into and out of the tissues; but you will then be allowed gradually to get up and about

Will it be painful?

Whilst you are in hospital you will be given medication and possibly also nerve blocks for pain control. We know that patients recover better after surgery if their pain control is good. Everything possible will be done to make the process as comfortable as possible.

What is the recovery and aftercare?

Once you go home from hospital you will feel very tired initially, and should have someone around to help you. The recovery period depends on which of the operations you have had done – as a general rule:

•  After the first week you should be starting to look after yourself and begin to resume normal activities
•  A few weeks after the operation you will be seen again in a clinic to check how you are doing and make sure all your wounds are healing well
•  You will then be seen a few months later to assess the outcome and decide if any adjustments are needed and when they should be carried out

Will there be scars?

All operations result in scarring of some sort and the position and size of scars after breast reconstruction depends entirely on the technique used.

In general, implant techniques give shorter scars confined only to the breast, whereas flap techniques give longer scars which will be on the breast and where the tissue has been taken from (back, tummy etc.). All scars can be expected to be lumpy at first and will go through a period of being pink, red and raised. They will usually then gradually become flat and pale. This process can take as long as two years to happen

In some people scars will not remain narrow, but will stretch and widen. In some people scars will remain red and raised and not become pale or flat. 

The exact type of scar any individual gets is not always possible to predict and can depend on your skin type

What complications might occur?

With any operation there are some risks although of course steps are always taken to minimise these. The most frequent problem is delayed wound healing:

•  This risk is greatest in some of the larger flap operations where the incisions are longer
•  If there is a wound problem it is usually minor, but more major wound healing problems can occur such as infection, skin loss, and wound separation, and may require re-operation
•  Very occasionally, soon after the surgery, bleeding can occur which may necessitate a return to the operating theatre to stop it
•  Sometimes patients can collect fluid beneath the operation site (a “seroma”), and this may need to be drained off in a clinic Other more general problems can include:
•  If an implant is used there are some specific complications that can happen such as deflation of the implant, infection, hardening around the implant, visible folds and ripples
•  In some abdominal flap surgery there is a risk of abdominal muscle weakness or perhaps even a bulge or hernia
•  There is a slight risk of blood clots after the operation occurring in the legs or lungs (venous thrombosis), and steps will be taken before, during and after the operation to minimise this risk.

Specifically, with regards to free flap surgery there is a risk that the circulation to the flap may become blocked:
•  If this occurs, it is usually in the first day or so
•  You will be monitored carefully to spot this and if it occurs you will need to go back to the operating theatre to remedy the problem
•  The microsurgery may need to be redone, if so circulation will usually be restored. However there is a slight risk that it cannot and the flap will need to be removed 

The chances of these various complications varies between operations and the likelihood of them happening in your operation will be discussed with you.

There is not much that you can do to minimise any of these risks, but in delayed reconstruction, patients may be advised to try to lose weight before the operation, and all patients should stop smoking for as long as possible prior to surgery.

Read More

Introduction to breast reconstruction
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 
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