Firstly, it's important to really emphasise what is the aim of breast reconstruction.
And that is twofold. Firstly, to recreate and replace volume and then to achieve symmetry
to the other breast. And both of those are equally important. One can do this either
by using an implant and an implant-based reconstruction, or using your own tissue which is called an
autologous reconstruction.
So, an implant-based reconstruction, firstly,
it must be said it's the most popular or common type of reconstruction performed in the UK
with about 90% of ladies choosing to have it and the majority of them choosing to have
it at the same time as their mastectomy for their cancer surgery. Implant based reconstruction
can replace the volume and also give a very definitive shape to the breast. That shape
that can be delivered is usually quite a pert breast appearance. When you look at all the
different reconstruction strategies, an implant-based strategy is the least complex with the least
time in theatre with many ladies going home the next day or even the same day after this
surgery. Recovery also is shorter with many ladies back to normal activities within about
four weeks. The major downside or potential disadvantages of implant-based reconstruction
are firstly the lifespan of the implant. So, this idea of natural wear and tear and rupture.
But actually, the modern-day implants may last you a lifetime with less than one in
ten potentially rupturing at ten years. The next major potential risk is the risk that
the implant has to be removed within three months of surgery. And that's usually because
of an infection. Now, infection rates are low and your surgeon will know how often they
are required to remove their implant in the reconstruction setting. And for me that is
less than one in twenty occasions. The next risk is the risk of something called capsular
contracture, which is actually your body's immune response to the implant. Your body's
immune response recognises the implant as something foreign and it walls it off. That
wall can be thought of as a capsule which is paper-thin such as cling film. Now the
problem here is that for some ladies that cling film capsule can thicken and harden
over time causing a miss shape of the implant and ultimately pain. The only way really to
deal with that is a repeat operation to remove that capsule. However, the risk of capsular
contracture is low and less than 1 in 20 ladies does develop it at 10 years. The last risk
is something we're learning more about which is a type of lymphoma called ALCL. Now this
is very rare but can develop in a capsule around implants. Once detected though, it
is very treatable and removing the capsule will cure you of that disease.
So, a flap-based reconstruction means using your own tissue to recreate breast volume
and also to try to achieve that symmetry. Using your own tissue can recreate volume
and that can be done at the same time as your cancer surgery or at a later date. Many women
believe that actually using your own tissue gives them a more natural feel compared to
the other type of reconstruction which is an implant based. Though, it is one that less
women choose. And this may be because it's more complex surgery and can often take a
longer time in theatre and a longer recovery time with some ladies needing to spend up
to a week in hospital afterwards particularly if you use the fat from your tummy for the
reconstruction. The advantages of using your own tissue though is that it may naturally
change as your normal breast tissue would change. So, you may get that normal natural
droop that happens as women age which you would not get with an implant-based reconstruction.
The other advantage is that in the long term it is a stable reconstruction, whereas with
the use of implants you may get complications as time goes by. Therefore, then the flipside
the disadvantages really, I believe are when the operation is done because it is more complex,
because it does require a lot longer for patients to recover from and so that must really be
balanced when patients make a choice about what type of reconstruction is best suited
for them.
So, this comes back to the importance and
role of breast reconstruction which is not only to replace volume but also to achieve
symmetry. So, when one does a mastectomy and reconstruction, we look to achieve a particular
shape as well as volume. For many women who have a natural droop to their breasts, this
may create a difference from that side to the reconstructed breast. And so quite often
I'm recommending to ladies a breast reduction or a breast uplift so that you get that symmetry.
Whether the nipple is removed or not as part of your mastectomy, in part depends on the
cancer that we are dealing with. If the nipple is removed, there is the option of nipple
reconstruction as well as tattooing of the nipple and areola at a later date. Those options
are always offered to ladies but it is the lady's choice whether they wish to have that
or not. This will involve a small operation at a later point and tattooing can be done
as an outpatient procedure. In my experience, the nipple reconstruction and tattooing adds
a lot to the final cosmetic appearance of the breast and also to patient satisfaction.