Breast reconstruction is a topic that is on my mind a lot this week as I prepare for reconstructive surgery. Or more precisely a mastectomy followed by an on table reconstruction. This is something a lot of you will have been through or will be facing at some point.
In the Past
We are lucky, things have come on a lot since the late nineteenth century and the early twentieth century when pioneering surgeons were trying all sorts of techniques. Flap implants (see below) were being invented and trialled but faced all sorts of complications and the first silicone breast implant was introduced in 1963. Both of these types of reconstruction were usually carried out after a delay following mastectomy.
Breast Reconstruction Today
Nowadays we are faced by a lot of choice. Which means a lot of decisions – for most of us this comes at a time when the menu in a restaurant is difficult to narrow down. So, how do you choose what to go for? and how do you know what the best choice for you will be?
The more you talk to people with breast cancer the more you realise how different peoples’ diagnosis, experience and choices are. Your options for reconstruction including the timing of the surgery may vary depending on your diagnosis and where you are geographically.
Reconstruction may not be the option for you at all. You may, like me, not have thought about how you would feel losing a breast (why would you?) until it was imminent. There are plenty of women who make the decision to not undergo reconstruction. Only you know how you would feel. There is no wrong or right. I would say do a bit of reading, talk to people and decide for yourself.
Most women who have had a mastectomy will be suitable for a reconstruction but may not be suitable for reconstruction at the same time as their mastectomy. This depends on various factors. One of these factors is whether or not you need radiotherapy. This is something your breast surgeon or oncologist will discuss with you.
Is Breast Reconstruction for Me?
Only you will be able to make this decision but you do need to be armed with all the facts and be happy with your choice.
The Options for Reconstructive Surgery
The types of breast reconstruction fall into two main categories:
- Implant reconstruction
- Flap (autologous) reconstruction
An implant reconstruction uses an implant that is filled with either silicone gel or salt water (or sometimes both).
Flap reconstruction uses tissue from another part of your body which is grafted into position. The tissue can be taken from your tummy, thigh or back. Sometimes an implant is used at the same time.
Flap Reconstructions seem to be getting more and more complicated and technical but all with a view to giving you a better result.
Which type of Breast Reconstruction do you choose and why?
As with a lot of these things there are pros and cons to both types of reconstruction. I would advise talking to anyone you know who has been through this for a brief ‘User’s View’ (it turns out there are an awful lot of people out here who have and most are willing to talk about it!).
By all means familiarise yourself with the pros and cons of reconstruction but also listen to what your specialist has to say – there at be particular reasons why you should choose one type over the other.
The Pros and Cons of Implant Reconstruction
So, what are the good things about implant reconstruction?
- The actual operation is shorter.
- If you are thin you may not have enough tissue on your body to use to rebuild the breast.
- Less scarring – the mastectomy incision can be used to insert the implant and there is no need to make incisions elsewhere on your body.
- The implant breast will stay the same no matter whether you lose or gain weight.
And the not so good?
- The breast with the implant may not move or feel as natural as your breast would.
- Sometimes surgery is needed to match up the other side.
- The implant won’t last a lifetime.
- There can be problems with implants – eg. rupture or deflation.
- Having an implant will depend whether or not you need radiotherapy or have had it.
The Pros and Cons of Flap Reconstruction
What are the Pros?
- It usually lasts a lifetime.
- The tissue that is taken from elsewhere on your body is very similar to breast tissue which means the breast will move and feel a lot more like your breast would.
- As you lose or gain weight so will your breast.
- If you need radiotherapy then a flap reconstruction will tolerate it better than an implant (neither is ideal).
And the Cons?
- The actual surgery takes longer.
- You will have at least two wounds healing after surgery.
But its not as simple as that…..
There are many types of flap reconstruction. What you may be offered will vary depending on the expertise of the surgeons at your local centres.
Flap surgery often requires specialist nursing teams to keep a very close eye on the reconstruction in the hours and days which follow the operation. Flap surgery can require a night in the Intensive Care Unit for very close monitoring – these are long operations and can take a toll on the rest of the body if you are not at your fittest (which a lot of us won’t be) at the time of surgery.
There really is no substitute for speaking to your surgeon about you but there are some good online resources (I particularly like the breastcancer.org section on this) to give you more information. It is worth having a read before discussing things with your specialist to make sure you understand what you may be letting yourself in for.
If you feel overwhelmed at the prospect of making the decision now after all you may have been through ask to delay the reconstruction. You can wear a prosthesis in your bra or have a special bra made if you would feel more comfortable in the meantime.
A breast prosthesis is usually made from silicone gel and is breast shaped and fits into the cup of your bra or a bra pocket in the case of post mastectomy bras. These can be worn long term if you have decided not to have a reconstruction at all.
Either type of reconstruction can leave you with a smooth breast.
So the next decision is how you feel about not having a nipple and what you want to do about it. You may be quite happy without a nipple, but plastic surgery is amazing these days and nipples can be recreated using skin from elsewhere on your body or by gathering the skin on the breast into a nipple shape. These procedures are usually carried out 6 months down the line.
You may then decide to opt for a nipple tattoo. Medical tattooists are really clever and the tattooes they create so realistic.
Another choice is a stick on nipple. A mould is made based on your other nipple and then a stick on nipple is made from latex. You need to glue it on every day and one disadvantage can be that it may move around but at least you avoid any more surgery.
A Matching Pair
Although at the time of the initial surgery your mind may be more occupied with getting rid of this dreaded cancer there may come a time when you become more focussed on life after cancer and want to get your body back – preferably better than before!
Plastic surgeons can even up the breasts and make your remaining breast match your reconstructed one once things have settled down. This may mean adding an implant, taking tissue away or just getting rid of the droopiness…..
Just bear in mind this will result in scarring but they will try and minimise it and you will probably get a better outline in clothes.
I have decided to go for a TUG reconstruction in a few days time. This means the Transverse Upper Gracilis muscle from the inside of the top of my thigh (a muscle which is used to move your leg back towards your body) will be removed from its own blood supply and attached to vessels on the chest wall. The surgery itself takes 8 hours. The immediate recovery period is quite intense and the graft needs to be checked every 30 minutes postoperatively for the first night to make sure it has taken.
I chose this option as it suited my body type. This followed a few long chats, debating all the pros and cons with my plastic surgeon.
By the time I had made my decision I had had all my questions answered and felt confident in my choice and also the team operating on me which is obviously really important.