Breast Reconstruction After Mastectomy:
The Options


Breast cancer affects 1 in 8 women in the UK. It accounts for almost a third of cancers suffered by women, making it by far the most common. For almost half of those, a mastectomy is usually a life saving operation, but it’s also life altering. Learning to adjust to a new, different body is as much as part as the recovery from cancer as physically getting your strength back, and it’s not a journey that’s easy or that we’re prepared for.

Thankfully, there is a host of treatments available if you’ve had a mastectomy that can restore your silhouette and help you feel like the you that you know. MFMB spoke to consultant plastic surgeon and breast restoration specialist Mr Olivier Branford to lay out the options if you’re thinking of having breast reconstruction after your mastectomy.

Reconstructive implants

Implants are an obvious way to surgically restore breasts after mastectomy. Like any breast augmentation, the pear drop shape tends to give a most natural look. The upsides of this procedure is that it’s straight forward, so it’s widely available. “The problem with implants in reconstruction is that patients have very little soft tissue following mastectomy so there is little implant cover, and this can look less natural,” explains My Branford.

How natural an implant reconstruction looks will depend on the shape of your breasts to begin with. We all know what breast implants look like – they sit higher on the chest than natural breasts and tend to stay put when you lie down. So, how symmetrical an implant will look next to your natural breast is really your call. If you’ve had a double mastectomy, though, implants will look symmetrical. Another advantage to having implants is the down time and recovery is usually less than with a tissue replacement. However, they carry a risk of complications like capsular contracture (which is where the scar tissue that forms around the implant can tighten and harden), which might need follow up operations further down the line to correct.

Tissue replacement

Breast reconstruction using your own tissue is another option. Known as a “free flap” procedure, it’s more specialist and uses tissue taken from somewhere else on your body, say your tummy, thighs or buttocks. “Not all units have the facility to offer this surgery,” explains Mr Brandford. “However all patients have the right to ask their doctor to see a plastic surgeon if they would like reconstruction using their own tissue.”

According to Mr Branford, this type of surgery is most likely to leave a natural looking result. You might also hear reference to the DIEP-Flap technique, a specific type of free flap surgery. “It uses the abdominal tissue that would normally be discarded in a tummy tuck,” Mr Branford says. “It’s been described as the gold standard for breast reconstruction as it provides a breast that can look and feel very natural.”

Of course there are some risks: the main risk of this surgery is flap failure, where the blood supply to part or all of the transferred tissue is damaged. “This is usually down to technical reasons and can sometimes be corrected,”explains Mr Branford. But, he says, a good surgeon should have a success rate of close to 100{19761799e1353b7a6a49a5f02d3172230495afcde52b198895f8f3ba7ac759cb} with this procedure, and you shouldn’t be afraid to ask his or her success rate.

Nipple saving mastectomy

“There has been a move towards sparing the nipple during mastectomy,” says Mr Branford. “It does not compromise cancer treatment.” This option isn’t available to everyone – if the cancer is too large or too close to the nipple, it might not be possible to avoid removing the nipple. However if that can be done, Mr Branford explains, the result can look very similar to the original breast, and usually leaving only a small scar.

If a nipple sparing procedure is not an option, there are plenty of micro pigmentation specialists that can tattoo a new nipple.

Whatever you decide is right for you, don’t rush your decision.“Most reconstructions require more than one stage and adjustments to one or both sides, so it’s a journey, not a single operation,” adds Mr Branford.

Olivier Branford is a London-based plastic surgeon specialising in breast augmentation and in particular breast reconstruction. He is regularly published in a number of peer-reviewed medical journals and is a pioneer in the field of breast reconstruction.