After your implant reconstruction, you’ll be followed up until surgery is completed on the reconstructed side. As with other breast recon - struction techniques, it’s often helpful to consider surgery to the other breast to gain the best match in size and shape. An over-large breast can be reduced in size (breast reduction), an excessively droopy breast can be uplifted (mastopexy), and a very small breast can be enlarged (augmentation), using the same techniques as used in purely cosmetic surgery (see pp. 130–136).
Your reconstructed breast will need to match your other side in shape and volume, and implants with valves have the advantage that they are very easy to enlarge or reduce in volume. Finally, you may want to have a new nipple and areola created: there are specific surgical techniques for this, with tattooing to restore colour match. These techniques can be applied to all forms of breast reconstruction surgery. Many women are, however, content just to have a nicely matching breast in a bra, even if the breasts are not an exact match in the nude. There is no need for you to have any more surgery once you are content with the way you look. Some women are happy to look normal in clothing, whilst some others do want to sunbathe topless, and happily, surgery can offer reconstructive procedures across the whole spectrum of patients’ wishes.
Follow-up
Follow-up visits will continue after completion of all surgical pro - cedures. They give your surgeon the opportunity to ensure that all is well after your breast cancer treatment, and also with the recon - struction. These check-ups are also a regular opportunity to make sure that the implant used in your reconstruction remains problem free. As well as clinical examination, which is adequate in the vast majority of patients, the integrity of the implant can also be confirmed by scans and x-rays if there are any concerns.
I was 62 and it was nearly 11 years since my mastectomy. I asked the Breast Care Sister whether it was too late to have reconstruction and she thought not. I saw the surgeon and he asked me why I wanted reconstruction. It was really the fact that I
had gone from an ordinary prosthesis to a self-adhesive one, which had made me feel much more whole and natural. Having
had to give that up, reconstruction presented itself to me as a good option. As I was small, it was suggested that I should have
just a tissue expander, rather than anything more major. I was pleased about that.
Preparation for the operation was easy because it was my choice and there was none of the worry of the mastectomy or whether the cancer had spread. I felt more buoyant to cope with it than
people who were having first time round operations. After the operation, it was a bit sore but I only had the painkillers
for a couple of days. After that, it was only uncomfortable if I moved. I got up and around the day after the operation and was
in hospital for four days. The breast was covered and quite bruised. I looked at it when the dressings were taken off and was
very pleased with it because it had been done through the same scar. I had been told what it would look like and that it would take two or more months to settle down, so I wasn’t anxiously
expecting results at that time.
Because I was 62 and the other breast had lost condition, the surgeon operated on it at the same time, lifting it to match the reconstructed one. It did mean that I had twinges in both breasts
at once but that was quite acceptable and also saved another operation.
When I went home, I could do light duties and it was about three weeks before I drove again. It was a month or two before I could
do what I wanted in the garden.
The tissue expansion was no problem. It felt a bit tight after each time but I didn’t need painkillers. The expanded breast came higher up the chest than I would have liked and to get better parity with the other breast, we had to try inflating and deflating
it a couple of times. It is still slightly smaller than the other one because to fill it sufficiently would have caused an imbalance
higher up the chest. I am quite happy with it.
I chose to have a mastectomy, rather than lumpectomy and radiotherapy. Immediate breast reconstruction was not offered in
1988. My lifeline after the mastectomy was knowing that I was going to have a reconstruction. I had been widowed five years before that and there was a new male friend on the horizon. I thought that starting a new relationship might be the time to go for reconstruction. I have always been big-breasted and I wanted a big reconstruction. I wanted to look the same as I had done
before.
The reconstruction was not as uncomfortable as I had thought it would be. The worst thing about it was the pressure on my chest, particularly at night. I felt as though I was struggling to
breathe because of it. I was told that as time goes by, gravity helps and it is better to stand or sit up rather than lie down. I had to do quite a lot for myself when I got home but I did have
some help.
The tissue expansion was done every two weeks. It took ten days after each expansion for the breast to feel reasonable again and
then they would add more saline. It was a long and gradual process. The pressure on the chest was uncomfortable and it did help to see someone else who had had it. She was able to tell me that the pressure would pass. The process of expansion took nine months altogether. It is important to allow adequate time and
then you can feel confident and put your life together again.
“
I had to cope with the difference in size between both breasts for a few months. I either wore a scarf, or edge-to-edge jackets, without buttons. The size difference spoils the line of buttoned
jackets. If you wear anything with a horizontal line, your eye is drawn to it. I also wore a little bit more make-up to take the eye
away from my breasts.
I have the same tissue expander that was inserted in 1988 and the reconstruction is nearly as soft as it was originally. I have good
skin sensation, although there is no sensation or erection in the nipple. I find lifting a weight above my head or using a hand- whisk with constant repetition difficult but apart from those two
things, I can do everything that I want to.
I am very glad that I had the reconstruction done. Although I did not have a choice of which type, I am perfectly happy with it. It
made it easier for me in my relationship. I wanted to make the best of myself and it gave me confidence. I definitely turned the
corner psychologically when the reconstruction started. It is in your hands to make the most of life. If reconstruction is part of
that, go for it but think carefully about it first.
I didn’t cope very well with the mastectomy and prosthesis but part of that may have been because I knew that I was going to have a breast reconstruction. I was 51 at the time. Immediate
breast reconstruction was not available.
I was offered a tissue expander for breast reconstruction. It was very helpful to meet someone who had had one before me. She showed me hers and told me quite a lot about it. The decision to have breast reconstruction has to be the person’s own decision. It is
very useful to know how long the whole process is going to take. Afterwards, there was a very tight sensation across my chest and it felt very heavy and hard at first. The drains were taken out and I
left hospital after five days.
At home, I wasn’t really restricted too much. I didn’t do housework and took things easily. I went back to work part-time
after four weeks and was full-time after three or four months.
”
“
My expander was fully expanded at surgery and then adjusted later. This was started after three months and was very gradual. At that
time, the breast was large and quite high up on my chest. I felt quite good about that because I had always wanted to be larger. I bought a big bra and put the comfy that I had after the mastectomy
into the other side to even it out. I always wore loose tops and it didn’t really show. The whole process of stretching and deflating took a year. I was left the size that I am now for the last month to see that I was happy with it before they took the injection port out.
I did find the injection port uncomfortable sometimes. The final match was very good and I was pleased with it.
The reconstructed breast is quite firm and if I am undressed, my natural breast is slightly lower. It is fine in a bra. I can wear any
type of bra. I wouldn’t hesitate to change in a communal changing room now.
I think that I had the best type of reconstruction for me because I don’t take anaesthetics well and don’t think that I could have coped
with the other options. Mine was probably the easiest option.
I was 46 when it was recommended that I should have bilateral mastectomies. I did not have the option of immediate breast reconstruction, although it was being done at other hospitals. I got through the mastectomies quite well physically and did the
Run for Life five months afterwards. However, I hated the prostheses. I had been quite a large cup size before the surgery
but because I had both breasts removed chose to have much smaller prostheses. I didn’t want to draw attention to myself any more. The crunch came when we were on holiday in Crete. It was
hot and I got fed up with the prostheses, particularly in the swimming pool. It affected my confidence and I decided that I
didn’t want to go through that again.
I saw a plastic surgeon about breast reconstruction and agonised about the choices but didn’t really have a lot of information. He only suggested that I should have a Becker tissue expander. I felt that I wanted to keep the surgery to a minimum, so came to
terms with his suggestion.
”
“
In retrospect, I think that I would have liked to have seen people who had the other reconstructive operations as well. Recently, three of us who had had different reconstructions were showing
another lady who was deciding, and when I saw the other options, they looked better than mine. They had all recovered so
well from their more complicated operations and their breasts looked so natural.
Initially, the reconstruction felt very painful. I don’t think that I had expected that and should have taken the painkillers on offer.
Because the expander had been almost fully expanded before it was put in, I felt as though I had a concrete block sitting on my chest. I had two lots of drains and they were manageable. I went
home after a few days.
When I first looked at my new breasts, they looked as I had expected for that stage. They were very high, large and solid. I found that it took me longer to get over the reconstruction than
it did for the mastectomy. Getting some arm movements back was a gradual process.
After six months, I had to have the muscle around one implant cut to release a capsule that had formed and that worked. With tissue expansion, I was a funny shape for some time during the expansion and it was lucky for me that it happened over the
winter because I could disguise it with baggy clothes. If it is possible to choose the time, it’s worth opting for winter when it
is not so hot and uncomfortable.
I used to do a lot of gardening but am still careful with what I do. I am so pleased that I had the reconstruction, regardless of
this.
I think that the breasts have become softer in the three years since the operation and one side has changed shape slightly. I wear really soft underwired bras. The reconstructions are quite flat and don’t droop, so I can’t fill out some bras. Other types of
reconstructions seem more natural. It was very difficult with clothes before reconstruction. I still find some hard but am more
It may be easier to accept mastectomies and reconstructions when both sides are involved because I have nothing left to remind me of what I had. It was traumatic at the time but easier
later. The reconstructions have given me so much confidence, which I didn’t think I would get back after the mastectomies.
Even if there are a few drawbacks at the time of surgery, reconstruction changes your attitude to everything.
Because of the type of cancer that I had and the risk of recurrence in the other breast, I was offered the jackpot of double
mastectomies and breast reconstruction. My treatment until then had been long-winded and I decided to have this to get it over
and done with. Because I had lost a lot of weight after chemotherapy, they could not use the tummy muscle. I had no tummy and even less on my back. It was recommended that I had
tissue expanders for the reconstruction.
I found the surgery very painful. The first set of implants was very painful, so they were swapped for something softer. I think that
things might have felt tight because I am so slim. As far as the shape of the reconstructions is concerned, if anything, there has been a slight drooping of the breasts. The tightness has always been there. The breasts match quite well
because they were done at the same time. The main thing that I would advise others is to get help for tightness, if it occurs, as soon as possible, rather than think that it
will go away. My friends who have had breast reconstruction did not find it painful. They are all larger breasted and this makes
quite a difference.
I am glad that I had the reconstructions because they have given me shape. I don’t have to worry or feel embarrassed in shops or
on a hot day.
”
”
“
G LD reconstruction is a very reliable and popular technique. G It can sometimes be done without using an implant or
expander.
G It’s used for both immediate and for delayed breast reconstruction.
G Your reconstructed breast will look and feel very natural. G It requires major surgery.
G Recovery takes about six to eight weeks.
U
sing live tissue from another part of your body to reconstruct your breast has been a major new development in breast reconstruction over the last twenty years. In fact, it’s quite remarkable that tissue will heal into place when it’s been moved from one part of your body to another. Most tissue that can be moved like this is made from muscle, fatty tissue and skin, and these structures are called myocutaneous flaps. The use of living tissue to reconstruct a lost breast is a major advance. The new breast is made of soft, warm, living tissue, which can be shaped to look like your original breast.Two different approaches are used by surgeons to make sure a myocutaneous flap has a good enough blood supply to remain healthy and to heal into place once it’s been moved. The first approach is to leave the flap attached to its blood supply or ‘pedicle’. The pedicle is rather like an umbilical cord, with the ‘mother’s end’ of the pedicle remaining attached to the place where the flap tissue was taken from – the ‘donor site’. The second approach is to divide the pedicle or umbilical cord