Breast Cancer in women
Breast reconstruction after breast cancer
Breast reconstruction is an operation to make a new breast shape after mastectomy (removal of a breast) or to improve the breast shape after lumpectomy (removal of part of the breast).
The National Institute for Health and Care Excellence (NICE) guidelines for mastectomy recommend that, unless there are comorbidities that rule it out, people be offered the choice to have breast reconstruction (2023), either at the time of their initial mastectomy surgery (immediate reconstruction) or afterwards (delayed reconstruction).
The aim of breast reconstruction is to make a breast that is close to the size and shape of the original breast. This can either be done by using an implant that is put under the skin and muscle that covers the chest or by using skin, fat, and sometimes muscle from another part of the body to create a breast shape (body tissue or autologous reconstruction). Sometimes a combination of these techniques is used. The surgeon advises on the type of reconstruction that’s best for them, which depends on:
- how much breast tissue has been removed
- how healthy the tissue is at the planned operation site
- whether or not a person has had or will have radiotherapy to the breast area or chest wall
- a person’s general health and body build
- a person’s personal preference
Breast reconstruction creates a smooth breast without a nipple or areola, but it is possible to recreate a nipple and areola by using own body tissue and tattooing. This recreation is often done as a separate operation once the reconstructed breast has settled into its final shape, but it may be possible for it to be done at the same time as the breast reconstruction. Not everyone chooses to have a nipple reconstruction, and stick-on nipples are available.
Some people have surgery to their opposite unaffected breast (contralateral breast surgery) to make the breasts match. People may have the other breast made bigger, smaller, or tighten it to match the shape of the new breast.
Experiences of breast reconstruction
Here women discuss their experiences of breast reconstruction. One woman, who had breast reconstruction more than 20 years before the interview, discussed her satisfaction with the surgery.
Explains that she had a reconstruction over 20 years ago that was very successful.
Explains that she had a reconstruction over 20 years ago that was very successful.
Now, I mean they're much more sophisticated now because they now do the latissimus dorsi, which is the big muscle from the back, which they divide and take through.
They do a stomach flap, and they also do the inflation one. I mean they're all three different, totally different to what I had done. And very successful I might add. I mean I can't say that mine wasn't because mine were brilliant. They really were.
Somewhere or other they've got photographs of them, so there you go. But they were, they were extremely good.
A few women had a mastectomy and reconstruction at the same time, and one of these women considered having nipple reconstruction.
Describes her experience of having a reconstruction at the same time as a mastectomy.
Describes her experience of having a reconstruction at the same time as a mastectomy.
Coming out of course I was almost in a state of euphoria because it was all over. They'd taken it, I had a new boob which I'd looked at, that was something I didn't touch on before, I was not afraid to look at it. When I looked at it I thought it was a miracle.
I thought it was amazing that they could take something from my back, put a piece in - because I wasn't small-chested, I was a D cup I think - and they'd done running stitches, they'd sewn me up very neatly with a piece let in and down to here is, down you know I can wear low dresses right down. I can wear a bikini.
You can see the scar on my back and possibly if I lift my arm because I've got the depression. But I thought it was an absolute miracle that I didn't feel. I mean it doesn't look like a boob really because I didn't have a nipple put on. But you put it in a bra and you really can't tell the difference.
So of course for me, I was so fortunate that I felt I suppose complete again. I didn't think I'd lost anything because they'd given me this wonderful new boob.
Explains that she had breast reconstruction and was considering nipple reconstruction.
Explains that she had breast reconstruction and was considering nipple reconstruction.
Which didn't worry me because as far as I was concerned it would have got rid of the cancer.
And then the doctor said to me' "We can do you a rebuild, mastectomy and a rebuild," which, when I went down to surgery, would be done at the same time.
Anyway, it was explained to me that they were going to take the muscles out of the back of my left side and just pull it across and rebuild my bust, which together with the prosthesis would have given me actually the same size as my other breast which, as I said, I didn't have any problems with. I was quite happy with it when it was finished.
And I was told afterwards that, after they inflate the prosthesis, which is done week after week after you've had the surgery, to a certain size, that they would construct a nipple as well to go on top of the bust.
Reconstructing the nipple was about, that would take about six to eight months after the first operation. That would have taken, you had to go back to hospital as a day patient for that to be done.
Gillian felt slightly rushed into deciding whether to have breast reconstruction at the same time as a mastectomy. She had only just been diagnosed with DCIS but decided to go ahead.
Gillian felt slightly rushed into deciding whether to have breast reconstruction at the same time as a mastectomy. She had only just been diagnosed with DCIS but decided to go ahead.
I was called in and they said, “Oh no, it is like cancerous. And because you’ve had it previously, you know, the recommendation this time is for a mastectomy and chemotherapy.”
So it was, I wouldn’t say, I can’t say I felt rushed, but they straightaway were talking about reconstruction. And I think it was almost, it was there and then that day to decide do you want reconstruction, sort of thing. And I think part of it was they were, they wanted to have some idea, because I mean they explained to me it means that you have to have two surgeons and the length of time you’re in the theatre, it’s you know, “And we’d rather do it sooner rather than later.”
So, as I said, I had complete faith, and the fact they said this time I’d need chemo etc, and they were recommending a mastectomy, I thought well the first time they were, you know, they were sort of very much you know what I wanted. And I felt that if they were recommending that, then I really, that’s what I should go for. So I said I would go for a reconstruction.
I hadn’t really looked into it [breast reconstruction] in any great detail. I just thought well, I didn’t know, oh they showed me some photographs. And I didn’t sort of think, “oh you know that’s definitely what I want.” But I thought as well, “If I have a reconstruction, at least when I’m dressed it looks, everything looks normal.”
And I thought, the reason I decided in the end I’d go for the reconstruction was because I thought if I don’t have the reconstruction now, you know because they explain if I have it now they would keep the actual, a lot of the skin they would keep, whereas with afterwards it would be a bit more of a job to do things. And I thought, “If I don’t have it done now, even if I’m really unhappy, would I choose to undergo quite extreme surgery again?” And I wasn’t sure that I would. So that, in the end, decided me to go for the reconstruction.
And they did explain to me that it could fail, that with the reconstruction it needed a really good blood supply. Because I had the one where they pull it round from your back. And they said it needs a really good blood supply. So they can fail. But I thought, “No, we’ll go for it sort of thing.”
One woman described having two reconstructive operations due to complications but explained that this was uncommon.
Explains why she had to have two reconstructive operations.
Explains why she had to have two reconstructive operations.
But once I got out of bed I was fine, it was good. And then I think I started realising that things were not maybe as good as they should be because the breast was, looked incredibly bruised and I now know it was necrosis, but at the time I didn't know. And I must admit they did absolutely everything in their power to save it but it was just, it was just useless.
The plastic surgeon who'd helped in the TRAM flap, he did the LD flap. And the breast side of it was fine but unfortunately my back split open and I had a huge hole in my back.
So I was actually in the ward for four weeks at that time which was actually longer than I'd been there having my mastectomy. So my back was sewn back up and that was the end of that stage of the surgery. I was working very full time and looking forward to my last surgery which was planned for about the September.
And this was to get the, I was going to have a Becker, which is again a concession to me not wanting the silicone. It's a prosthesis which is put in and they fill it with saline and it stays put.
You don't have to have another operation to take that out and put, so it's a tissue-expander-come-prosthesis.
And the doctor who had done the LD flap did this surgery. Unfortunately he put it in the wrong place. So when I was being expanded instead of coming out that way I was going out that way. And it was extremely painful, extremely painful.
So I eventually saw [name] and he, he decided that he would expand it some more and would try and improve things. So he expanded it as much as he possibly could but he eventually had to admit yes it was in the wrong position. It had to come out.
So he had to take that out, put in a conventional tissue expander, expand me again, take that out, and put a silicone prosthesis in. So I had gone completely full circle.
I don't know whether I would do it again. Knowing me, probably yes. I would probably go for the TRAM flap again because I think it's such a marvellous idea of using your own body tissue to reconstruct something that's been taken away.
Ingrid was happy with her reconstruction but has had discomfort in her shoulder since having radiotherapy. Lymph drainage massage has helped.
Ingrid was happy with her reconstruction but has had discomfort in her shoulder since having radiotherapy. Lymph drainage massage has helped.
I have to say that the surgery was fine. And for the first weeks after the surgery and during the chemotherapy, I had no problems with my shoulder. But post radiotherapy I do. And my shoulder is uncomfortable and there’s one certain point that really hurts. And I have mentioned it every time I’ve gone to doctors here in the UK. But nobody’s picked up on it or followed through with it in any shape or form. So I’ve taken control and I go to a physiotherapist in Germany who does, you know, is qualified and trained to do lymph drainage. And I have to say, although I’ve only had a few, it is making a huge difference. And I was mentioning it to a friend, a colleague who is a cancer nurse. And I said, “I’m having lymph drainage treatment in Germany whenever I can get over there.” And she said, she immediately said, “Oh have you got lymphodoema?” I said, “No. No I haven’t.”
But just having the drainage has made a huge difference. And I’m sure it’s not purely coincidental. My fingers are getting better, definitely on the right hand. My shoulder is more comfortable, I’m not saying it’s perfect, I don’t think it ever will be. I know there’s a certain level of discomfort that I’ve got to learn to live with, but it is definitely, the lymph drainage is, having that is improving. I could only start doing that when I, because I knew I’d be in Germany quite regularly these last few months, and that is making a difference. And I will continue in that.
Some women had a partial reconstruction following a lumpectomy.
Women also commented on the care they received from hospital staff, and support from friends and family. Some women advised taking time to recover from the operations before resuming work or driving.
A few women talked about their reasons for wanting breast reconstruction, although they had not yet had reconstructive surgery. One woman explained that she was considering reconstruction but had not yet made a final decision.
Explains why she wants breast reconstruction.
Explains why she wants breast reconstruction.
But because I'm such an active person, I'm quite a sporty person, I just thought' "I actually don't want to have this, you know, false boob, you know, stuffed in my bra all the time."
It's inconvenient. Basically that's why I'm having it. It's inconvenient. And that's the main reason.
And vanity as well obviously, because you can't wear, you've got to watch what clothes you wear. And you can't have anything too low, and even with your sleeves, you know, on a tee-shirt, you know, we've had warm weather.
I've had to go and look at tee-shirts, put them on' "Can you see the scar under my arm? Is my bra showing?" All that sort of stuff.
And I can laugh about it now but at the time it was very serious. It was very' "No. I've got this, it's got to happen," you know. So yeah, but no I'm having reconstruction surgery. I'm not going to have it until, they said there's a six month waiting list.
Discusses her reasons for wanting reconstruction.
Discusses her reasons for wanting reconstruction.
Well I was told that it will take a couple of years before I can have that if I want it.
I've decided I was not going to, but now, after carrying that thing on my left side, it's a bit heavy to carry for your whole life.So I think after a couple of years I'll go, see if I can have it done. But they said that it can be done.
And you'd like to have it done in a couple of years?
Yes, I've thought about it and I'd like to have it done.
More experiences of breast reconstruction can be found on our DCIS website.
Last reviewed November 2024.
Last updated November 2024.
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