breast reconstruction

Last edited 06/2023 and last reviewed 06/2023

Breast reconstruction is considered if the breast has not developed, there has been extensive trauma, or most commonly, after mastectomy for breast carcinoma.

Breast reconstruction aims to provide a symmetrical, lasting mound of tissue with similar shape, form, and consistency to that of the opposite breast, with or without nipple-areola reconstruction, although it is technically impossible to produce a sensate breast indistinguishable from its normal partner.

Repeated operations are usually required for the best cosmetic results. The patient should be presented with all the options and allowed to choose the timing and technique that is most preferable.

NICE state with breast reconstruction in the context of breast cancer:

• breast reconstruction should be offered to people after they have had mastectomy for breast cancer
• both should be offered breast reconstruction options to women (immediate reconstruction and delayed reconstruction), whether or not they are available locally
  • immediate breast reconstruction:
    • reconstruction is started in the same operation as the mastectomy
    • breast shape remains, which may help maintain body image and have subsequent psychological benefits
    • risks include:
      • surgical complications can occur after any breast reconstruction and will vary by type of procedure and personal risk factors. May be lower rates of:
        • tissue breakdown
        • surgery for flap removal if it cannot be used because of a complication (which may lead to delayed reconstruction and flat appearance for a period of time)
        • procedures to improve symmetry
      • complications from the mastectomy or axillary surgery can occur during the recovery period
        
        
  • delayed breast reconstruction:
    • after a mastectomy, reconstruction is done in a separate operation
    • lifestyle changes (such as losing weight and taking regular exercise) may be possible, which increase the options and lower the risks of reconstruction surgery. Procedures (and associated recovery) can be planned around other commitments
    • surgical complications can occur after any breast reconstruction and will vary by type of procedure and personal risk factors. May be lower rates of:
      • mastectomy site complications
      • flap or implant failure (which may lead to delayed reconstruction and flat appearance for a period of time)
      • capsular contracture (a scar layer around the implant that may lead to pain if severe)
      • may need to interrupt hormone therapies (tamoxifen) for further surgery
        
        
• immediate breast reconstruction should be offered to women who have been advised to have a mastectomy, including those who may need radiotherapy, unless they have comorbidities that rule out reconstructive surgery

Reference:

• NICE (June 2023).Early and locally advanced breast cancer: diagnosis and management