What you need to know about immediate breast reconstruction
Written in association with:
Published: 23/12/2024
Edited by: Jessica Wise
In order to treat breast cancer and stop it from further metastasising, a mastectomy (removal of the breast or breasts) is sometimes necessitated. However, some patients can struggle with their self-image and confidence after a mastectomy due to the dramatic change in their body and silhouette. They may choose to get a breast reconstruction or augmentation surgery further down the line, but this means undergoing several major procedures, which can be tiring or even dangerous. An alternative for those who are undergoing a mastectomy but would like to maintain the breast shape is an immediate breast reconstruction, which is a surgery that combines a mastectomy with a reconstructive procedure at the same time. In this article, a consultant breast and oncoplastic surgeon explains this procedure, its benefits, and possible disadvantages.
What is a mastectomy?
A mastectomy is the recommended method of treatment when there is cancer in a larger swath of breast tissue, and if it or projected to be spreading. Sometimes, patients may opt to have a mastectomy as a preventative measure.
The typical procedure involves the removal of all breast tissue, and in most cases, the skin around the area (including the nipple) is removed as well. The surgeon will make an incision across the chest, through which they can remove the tissue and skin as needed. The incision is sealed with stitches, and will scar.
What is immediate breast reconstruction?
Not all patients will be suitable for immediate breast construction. It will depend on the severity of their cancer, their physical condition, if they will need any additional therapies (such as radiotherapy), and their personal preference.
During an immediate breast construction, however, instead of simply removing the tissue and closing the incision, the skin around the breast is preserved. The nipple may also still be removed, but this depends on how close the cancerous cells were to the nipple and areola. The remaining skin, once excised of the diseased tissue, is then refilled with skin, fat, or muscle taken from other parts of the body, or silicone implants. One technique takes a muscle specifically from the back called the latissimus dorsi, as well as some of the skin and fat around it, and another takes tissue from the abdomen, a muscle called the rectus abdominis along with the fat and skin.
The surgeon will try to match the appearance of the reconstructed breast to that of the remaining breast, when applicable. If the nipple and areola had to be taken out during the surgery, they may be reconstructed at a later date.
What are the benefits of immediate breast reconstruction?
One of the greatest advantages of immediate breast reconstruction is that the patient does not need to go ‘under the knife’ more than once, so they need not have to recover from the side effects of anaesthesia twice, and the recovery periods for a mastectomy and a breast construction are combined into one, instead of two separate periods. Having cancer is already difficult for mental health, so being able to preserve the body as much as possible can help the patient adjust and prevent emotional or social hardship that they may struggle with. Reconstructions that are done after a mastectomy (delayed reconstruction) have less skin to work with, so the aesthetic result may not be as desirable as compared to an immediate reconstruction. A delayed reconstruction also means more incisions and more scars, whereas the scar with an immediate reconstruction – although still a big scar, possibly bigger than that of a mastectomy – will have a more intentional placement so that it isn’t noticeable, and the overall cosmetic results are better.
What are the disadvantages of immediate breast reconstruction?
The surgery is longer, and recovery time is longer overall at around eight weeks. Those who are to undergo further radio- or chemotherapy would have to wait longer after an immediate breast reconstruction as they cannot undergo these therapies while actively healing from major surgery, and radiotherapy may even interfere with the reconstructed breast and distort it.
If you’re considering reconstructive or preventative breast surgery, you can consult with a specialist via Top Doctors.