Deciding about breast reconstruction

Most people focus on removing the cancer. It can feel overwhelming to have to make a decision about having a reconstruction as well.

Deciding whether to have breast reconstruction or when to have it will depend on your individual situation. You can discuss it with your surgeon and breast care nurse. You can also talk about it with a relative or friend you trust. You might want to contact an organisation such as Breast Cancer Now.

Breast reconstruction is available on the NHS. National guidelines say that anyone having a mastectomy should be offered the choice of either immediate or delayed reconstruction. This is unless there is a medical reason why someone cannot have reconstructive surgery.

There are different breast reconstruction options available. The guidelines also say you should have access to all types of breast reconstruction. Some options may not be available at your local hospital. If the option most suitable for you is not available locally, you may need to go to another breast surgery unit.

Download comparison table for breast reconstruction [PDF, 30.5KB]

It is important to discuss your options for breast reconstruction before you have a mastectomy. You do not have to make a decision about it at this stage. But it will help the surgeon to plan your first surgery.

Breast reconstruction does not increase the chance of a cancer developing in the breast or coming back in the breast (recurrence). Reconstruction does not make it harder for your doctor to diagnose a possible recurrence. They can still check any changes in the breast area.

Some people choose not to have reconstruction and not to have a prosthesis. Others may plan to have breast reconstruction, but then decide not to. For some people, losing their breast is something they feel they can adapt to in time. Or you may not feel ready to have breast reconstruction until a while after surgery for breast cancer.

It is important to have realistic expectations about breast reconstruction. 

Your reconstructed breast will not look or feel the same as the breast that has been removed. It may be a slightly different size and shape and will not have as much sensation. It may also not move as well as your natural breast did.

If you are having 1 breast reconstructed, your surgeon will try to match it to your other breast. But there may be differences in the size, shape or position of the 2 breasts. Most people are pleased with the results of their surgery, but some may be disappointed.

Breast reconstruction usually involves more than 1 operation. There are usually several months between these operations. The reconstruction process can take 12 to 18 months to complete.

Other factors may also affect your decisions about reconstruction. These may include:

• your general health
• relationships
• your commitments and priorities.

You have an immediate reconstruction at the same time as a mastectomy. It is usually possible for the surgeon to leave most of the skin that covers the breasts when they remove the breast tissue. Doctors call this a skin-sparing mastectomy.

Skin-sparing mastectomy leaves less scarring than a delayed reconstruction. This is because less skin is removed.

During this operation, the surgeon sometimes removes:

• the nipple
• the dark area around the nipple (areola)
• a small circle of skin around the areola.

This depends on how close the cancer is to the nipple.

Sometimes it is possible to leave the nipple in place attached to the breast skin. Doctors call this a nipple-sparing mastectomy. Sometimes the nipple is removed and then put back on (grafted) to the reconstructed breast.

• Immediate reconstruction usually gives a better appearance than delayed reconstruction. This is because it is easier to keep more of the breast skin.
• There is less scarring than with delayed reconstruction.
• You will not be without a breast shape at any time.

• Immediate reconstruction involves a longer operation and recovery time than just having the breast removed.
• If you need chemotherapy or radiotherapy after surgery, this could be slightly delayed. For example, this might happen if problems such as infection slow your recovery. This is uncommon.
• Having radiotherapy after breast reconstruction may affect the look of the reconstructed breast. If you need radiotherapy, your doctors may suggest delayed breast reconstruction.
• You may have a slightly longer wait for surgery, especially if 2 teams of surgeons are involved. This is not likely to affect the success of the surgery.

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