Breast reconstruction

Breast reconstruction surgery is carried out on women who have had a complete or partial breast removal (mastectomy). It aims to replace the tissue removed so that your breast regains some of its original shape and appearance. This can be done immediately after a mastectomy or at a later date.

Breast reconstruction is done under general anaesthetic and can take one to three hours depending upon the method used. There are three main ways to carry out the procedure using your own tissue or a breast implant - your surgeon will discuss the best approach with you.

If a silicone breast implant is used, it is placed either directly under the skin or deeper behind the muscle on which the breast lies. An implant can be used to replace breast tissue, especially if the breast skin and nipple are preserved during the mastectomy. Once the implant has been adjusted to the correct shape and position, the skin cut is closed with stitches.

The cohesive silicone gel breast implants that we use at Circle for breast reconstruction are manufactured to the highest standards by Allergan and Nagor. The breast implants manufactured by these companies have a lifelong guarantee against the risk of leak or rupture.

If your own tissue from another part of your body is used then a procedure called Tissue Flap Reconstruction is carried out. This can be using the skin, fat and muscle from your abdomen or back and repositioning it to the chest area while keeping its connection and blood supply to the original site.

Alternatively, an area of skin and fat with or without muscle is completely removed from the abdomen, back or buttocks and transplanted to the chest area. So that the flap survives when moved to the chest, a new blood supply is created by connecting the blood vessels of the flap to the blood vessels in the chest.

Following the procedure, you will be taken from the operating theatre into the Recovery Suite where you will be looked after until you are fully awake following the anaesthetic. After this, you will return to your room, where nursing staff will check your dressings and monitor your pulse and blood pressure at regular intervals.

Your anaesthetist is likely to prescribe painkillers to reduce any potential discomfort and you should take these regularly for the first few days. Pain can slow down your recovery, so it is important to discuss any discomfort with the nursing staff.

You will have wound dressings in place and a supportive dressing around your breasts. You may also be wearing your support bra.

Until the effects of the anaesthetic have passed, you will need to rest. In the meantime, you will be visited by your surgeon who will assess your progress and answer any questions or concerns you may have.

You will need to stay in the hospital for several days although the length of your stay will depend on the extent of your surgery and how you feel afterwards.

After breast reconstruction surgery, you are likely to have some discomfort and swelling in the breast and from where the tissue flap was taken. Bruising, twinges and pain may continue for the first few weeks and it may take several months for your breast to settle into shape.

You will be left with fine but permanent visible scars on your breast and, depending on the type of operation you have, at the site where the tissue flap was taken. A reconstructed breast will not restore the feelings and sensations of a natural breast. However, in time some feeling over the skin and in the breast tissue may return.

Your surgeon will advise you as to how long you will be required to wear your support bra and whether it is to be worn day and night. You must avoid wearing an under wired bra until you are informed otherwise.

At your post-operative follow-up appointment, your surgeon will assess your progress and give advice on when you can resume your normal activities. You may need to take one to two weeks off work, depending on your type of employment

Breast reconstruction is generally a safe operation and for most women, the benefits are greater than any disadvantages. However, all surgery carries an element of risk.

Complications specific to this operation include infection, which may need to be treated with antibiotics and sometimes further surgery. There is a small risk that the alteration in the blood supply may result in the loss of part, or even all, of the breast.

With breast implants, there is a risk of capsular contracture. This is when a layer of scar tissue hardens around the implant causing the breast to feel hard. The implant may need to be removed and, if you wish, replaced with another one.

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Circle Health, 32 Welbeck St, Marylebone, London W1G 8EU