Breast reconstruction
Reconstruction is a series of decisions, not a single procedure.
Breast reconstruction may be performed during mastectomy or after cancer treatment has been completed.
It may use an implant, the patient's own tissue or a staged combination of methods. More than one operation may be required.
The purpose of reconstruction is to create a breast contour. It cannot restore the original breast, normal sensation or eliminate the effects of cancer treatment.
The first decision: timing
Immediate reconstruction
Immediate reconstruction begins during the same operation as mastectomy.
It may preserve more of the breast skin and avoid a period without a breast mound. However, the initial operation is longer, complications may affect recovery and the final need for radiotherapy may not be known before surgery.
Delayed reconstruction
Delayed reconstruction is performed after mastectomy at a later stage.
It may be appropriate when radiotherapy is expected, when medical conditions increase surgical risk or when the patient needs more time to consider reconstruction.
Delayed-immediate reconstruction
Some treatment plans use a temporary expander or staged approach while the need for radiotherapy is clarified.
The terminology and exact method vary by institution.
The second decision: method
Implant-based reconstruction
Implant-based reconstruction uses a temporary tissue expander, a permanent implant or a staged combination.
It generally avoids surgery at a distant donor site, but the implant remains a medical device. Infection, capsular contracture, implant displacement, implant loss and future replacement or revision should be discussed.
Autologous reconstruction
Autologous reconstruction uses tissue transferred from another part of the body, most commonly the abdomen.
It involves a longer and more complex operation and creates a donor-site scar. It may provide a more natural change in shape and softness over time, but donor-site complications and partial or total tissue loss are possible.
Combined or staged reconstruction
Some patients undergo more than one method or change methods because of radiotherapy, complications, implant problems or changing preferences.
Factors that may affect the recommendation
- Cancer stage and treatment sequence
- Likelihood of radiotherapy
- Previous radiotherapy
- General health and anesthetic risk
- Smoking
- Diabetes and vascular disease
- Body habitus
- Previous abdominal operations
- Breast size and shape
- Availability of donor tissue
- Recovery time
- Ability to attend long-term follow-up
- Patient priorities and risk tolerance
What reconstruction cannot guarantee
Breast reconstruction can create a breast contour, but it cannot guarantee any of the following:
- Normal sensation
- Perfect symmetry
- A permanent result without revision
- Absence of scars
- Freedom from complications
- Avoidance of radiotherapy
- Improved cancer survival
- A specific cosmetic result
Questions for the reconstructive surgeon
- Why is this reconstructive method being recommended?
- What reasonable alternatives are available?
- How could radiotherapy affect the result?
- How many stages are likely?
- What are the donor-site risks?
- What happens if the reconstruction fails?
- Could a complication delay cancer treatment?
- What revisions are commonly required?
- Who will manage complications after I return home?