Consultant Plastic Surgeon Victoria Rose (MBBS FRCSplas LLM) specialises in breast surgery and reconstruction following cancer (including complex and microsurgical cases.) She works at DRG Plastic Surgery in Harley Street and at two of London’s NHS hospital trusts.
Here she provides essential insight for women facing breast reconstruction following cancer.
1/ What are the different reconstruction processes available for women and what are their pros and cons?
Broadly speaking, women can have either implant-based reconstructions or autologous (using your own tissue) reconstructions. Autologous reconstructions use your tummy, buttocks or thighs to make a new breast. They are aesthetically superior to implant reconstructions as it is like for like, but you have to have enough tissue to spare. They also last forever so once symmetry is achieved that’s it. They will change and age in-line with the rest of your body. The downside is these procedures leave visible scars from where the tissue is borrowed. They also take slightly longer in terms of operative time and recovery time.
Implants are quicker and leave no extra scars. They don’t replace like for like though and they often need further adjustments to maintain symmetry. They are not great if you have to have radiotherapy as they tend to go hard and need changing. There is a very small risk of implant associated breast cancer with these types of reconstructions.
2/ Is there anything to bear in mind when considering reconstruction? Is it best to have it after a certain amount of time has passed? How can I decide whether reconstruction is right for me or whether I can accept my scars?
We do know that psychological well-being is improved by having your reconstruction at the same time as your mastectomy - so we always try to offer this in the NHS if we can. The surgeons and breast care nurses can help you with reconstruction choices and will be able to answer all your questions. If you opt not to have reconstructive surgery you can always opt back in to have it at a later date if you change your mind.
3/ What things do women find most difficult when approaching reconstruction and how can they manage these elements?
Timing is probably the most difficult element. Being told you have breast cancer is hard enough but to then have to make choices on what type of excision, whether chemotherapy and radiotherapy are advisable as well as what type of reconstruction can be very stressful. There are really no right or wrong decisions. Everything needs to be tailored to what suits the individual at that specific point in time. The rush is to remove the cancer and if reconstruction needs to wait the outcomes can still be exceptionally good - they just take a little longer to attain.
4/ Should women record the look and size of their breasts as a matter of course if they are both to be removed? Is there any sense in meeting with a surgeon before a double mastectomy?
Definitely meet a reconstructive surgeon before a double mastectomy. They can give you honest advice about what is achievable from breast reconstruction and in what time frames.
5/ Are there any benefits to a female surgeon conducting my breast reconstruction?
Male and female surgeons are trained in exactly the same way and have exactly the same surgical experience. Some women prefer speaking to female surgeons as they feel they have more empathy and some women find female surgeons more comfortable to discuss breast surgery with from a cultural view point. You need to trust your surgeon, understand what the options are and feel comfortable with the choices you are making. You can always ask for a second opinion!
