Why do people have breast reconstruction?
Reconstruction surgery is usually carried out following the removal of a breast due to cancer. It is important to remember that it is a complex operation and you should discuss all the potential options with your surgeon prior to agreeing to surgery. For a variety of medical reasons it is not for everyone and much will depend on your individual circumstances.

Realistic expectations
As reconstruction is usually undertaken following a mastectomy it is important to be as confident as possible that the cancer has been eliminated. There are other considerations to also bear in mind. Many women do not want to undergo more surgery than is absolutely necessary after a mastectomy. Some are devastated by the impact of having cancer and require time to weigh up all their options before deciding on reconstruction. This is a highly emotional decision to make.

In other cases the surgery options may be particularly complex or a woman may be suffering from medical conditions that could complicate surgery such as high blood pressure or obesity. You must have realistic expectations about what breast reconstruction can achieve for you and thoroughly discuss your hopes with your surgeon.

What happens during consultation?
The surgeon will examine your medical history and discuss what reconstruction options are available in your circumstances. This will depend on your age, skin elasticity and general health factors. Ideally these discussions will take place in collaboration with the medical team who have treated your cancer.

During the consultation the surgeon will discuss the procedures before, during and after surgery and explain what can be realistically achieved. He or she will point out that great improvements can be made but there may be individual circumstances that will impact on the final results.

Getting the most out of your consultancy
Often in cases where clients are unhappy with the results of surgery it is because they did not discuss their expectations thoroughly or were afraid to talk about the outcome or risks.

You have to make an informed decision before signing the consent form so ask plenty of questions. You want to feel relaxed and confident and completely understand what will happen during surgery.

You may want to know:

• About the surgeon’s qualifications.
• How many operations of your procedure are carried out each year.
• How you prepare for the surgery.
• What realistic results can be expected and when.
• How long the results will last.
• About the side-effects and possible complications.
• How long it will take to recover.
• About the extent of scarring and how it will change in time.
• What happens if anything goes wrong.

Preparation for surgery

• Avoid alcohol, aspirin, garlic and food oils a least a week before surgery as they can cause excessive bleeding.
• Do not eat or drink anything six hours before your general anaesthetic.
• The surgeon and anaesthetist need to know your medical history.
• You will be advised of any health checks or X-rays required before your procedure.
• Prior to surgery you will be met by your surgeon who will assess you and discuss your queries.

What happens during breast reconstruction surgery?
Breast reconstruction is complex and will require more than one operation. Your surgeon will recommend the most appropriate action in your case.

Implants and expansion
In most reconstruction cases a ‘balloon’ expander is inserted under the skin and chest muscle. During a series of surgery visits this is gradually filled with a salt-water solution. Depending on the advice of the surgeon the expander will remain as a final reconstruction or a silicon implant may be inserted later. The nipple area is completely reconstructed at a later date. For some women a silicon implant may be inserted from the beginning.

Tissue reconstruction
Another way of reconstructing a breast is to use tissue from other parts of the body such as the buttocks or stomach. This is a complicated operation that requires considerable skill. Tissue, featuring skin, fat and muscle, is taken from the donor area and transplanted to the chest. Blood vessels are then reconnected in the new site. The result can be the complete recreation of the breast mound or an effective new site for an implant. In this case it is important to remember that considerable scarring will take place in both the donor and breast areas.

In both types of surgery it is likely that you will have a series of follow-up operations. These will include the reconstruction of a nipple and the areola, the area surrounding the nipple. Additionally reconstruction or uplift operations may have to be carried out on the breast that does not require surgery to create symmetry.

After surgery

• Your first day is likely to be spent in a recovery room bed being cared for by nursing staff. Your surgeon will visit you and advise you when you can leave.
• The reshaped breast will have to be dressed and may have to be drained after surgery to speed up the healing process.
• Enjoy plenty of rest (you will feel more comfortable sleeping on your back) and avoid any energetic activities that raise your blood pressure.
• If you have had a drainage tube inserted it will be removed within two days. Bandages are normally taken off after one to five days.
• Avoid alcohol, aspirin, garlic, food oils and smoking. All of these can interfere with the body’s healing processes.
• Any discomfort, bruising or swelling should be treated with prescribed medication..

Road to recovery

• The reconstructed area is likely to look different to your other breast, however many women believe that the enhanced quality of life they enjoy is worth the operation.
• It can take several weeks to recover from breast reconstruction, particularly if it has been combined with a mastectomy.
• The extent of the recovery time will depend on whether implants have been inserted or tissue reconstruction has taken place.
• Your surgeon will tell you when you can return to normal activities and advise you to begin mild exercises.
• Scars may initially appear noticeable. In time they will take on a more normal skin colour but will not disappear completely.
• You must contact your doctor if you suffer from an abnormally high temperature, severe pain that is not treated with Paracetamol or if you experience severe bleeding.
• Reconstruction cannot return full feeling to the treated area.
• You must speak to your surgeon about any postoperative effects.

All surgery carries an element of risk
Most people believe that the benefits of breast reconstruction far outweigh the risk. However before you sign the surgery consent form you should be aware of any possible complications and side effects.

For example, there may be a period of emotional readjustment. Losing a breast is a harrowing experience for a woman and it may take time to adapt to that loss and also come to terms with the reconstructed area.

Physical complications associated with any type of surgery include problems healing, the danger of infection and the potential formation of clots that may be life-threatening. Excessive bleeding or bleeding under the skin, known as a haematoma, may require a return visit to the surgery. Some patients may also have an allergic reaction to anaesthesia. In a minority of cases there may be a problem with fluid loss or an excessive build up of fluid that needs to be drained.

Other considerations

• There will be scars left by the incisions. Scars fade but do not disappear completely. This depends on your skin type.
• In some cases scars may be irritable and red for several months.
• Infection of the breast may require the temporary removal of the implant to allow the area to heal.
• Healing tissue may put pressure on the implant and cause some pain. In rare cases you may require further surgery.
• Occasionally implants leak. This can be caused, for example, by an injury. If a leak occurs the implant will deflate over a period of hours and the implant’s saline (salt water) will be absorbed by the body harmlessly.
• There is no evidence that implants cause cancer, affect fertility or your ability to breast-feed.

Complications are rare and depend on individual circumstances such as a person’s health and the extent of the procedure. Your surgeon will be able to explain how the risks apply in your circumstances.