Reconstruction

Breast reconstruction is an important aspect of breast cancer treatment, and can form part of the process of ‘closing the loop’ for cancer treatment. According to the Scottish Intercollegiate Guidelines Network, patients who have either immediate or delayed reconstruction report a feeling of being whole again, better psychological and social adjustments to their cancer and mastectomy, a more positive body image, better sexual adjustment, less depression and feeling more comfortable without a prosthesis.

Breast reconstruction does not appear to be associated with an increased risk of local recurrence, or the ability to detect a cancer recurrence.

Breast reconstruction aims to rebuild the shape of the breast after mastectomy or breast-conserving surgery. The resulting breast ‘mound’ usually has no nipple (unless the patient has undergone a nipple-sparing mastectomy) and has no sensation. The reconstruction process can involve several surgeries.

Before mastectomy, women should be informed about the option for breast reconstruction, and have a chance to discuss their options pre-surgery. Referral pathways should be in place for reconstruction methods that cannot be performed locally.

Immediate reconstruction is performed at the same time as breast surgery (mastectomy or breast-conserving surgery). If performed in the adjuvant setting, complications arising from immediate reconstruction may occasionally delay further treatment (neo-adjuvant chemotherapy avoids this possibility). Immediate reconstruction is associated with better cosmetic outcomes, however, chest wall radiation therapy may significantly reduce these outcomes.

Delayed reconstruction may be recommended if:

• there is an urgency for chemotherapy post-surgery.
• patient requires radiation therapy. Radiation therapy can have adverse effects on cosmetic outcomes, particularly for implant reconstruction. Note, practice is changing in this area, with reconstruction increasingly considered prior to radiation therapy.
• patient presents with risk factors such as smoking, diabetes or obesity, which can increase the risk of complications including infection and poor wound healing.
• patient preference.

Procedures used in breast reconstruction:

• implant reconstruction
• autologous (also called autogenous) reconstruction
• further procedures, e.g nipple reconstruction.
• factors that determine procedure choice for breast reconstruction include the:patient’s health
• impact on the patient’s lifestyle and responsibilities
• amount of tissue available at potential donor sites
• likelihood of radiation therapy being required
• length and complexity of various procedures and recovery time
• desired cosmetic outcome
• preference of patient and surgeon.