A diagnosis of breast cancer can be life-changing, and for most patients, surgery forms an important part of treatment. This may involve a lumpectomy (breast conserving surgery) or a mastectomy.
For those undergoing mastectomy, breast reconstruction after cancer can play an important role in restoring both physical form and confidence.
Modern reconstructive techniques offer a range of options, including implant-based reconstruction and autologous (natural tissue) reconstruction, each tailored to your body, lifestyle, and personal goals. Understanding these options can help you make an informed and confident decision.
Breast Cancer and Mastectomy: Understanding Your Surgery
Breast cancer is one of the most common cancers affecting UK women, with around 55,000 new cases diagnosed each year and around 1 in 8 women affected in their lifetime. Surgical treatment is typically required to remove the breast cancer. Additional treatments, such as chemotherapy and radiotherapy, may also be required before or after surgery, alongside longer-term treatments such as hormone therapies and some of the newer treatments called targeted or immunotherapy.
Types of mastectomy include:
- Simple mastectomy – removal of the breast with the overlying skin and nipple / areola area
- Skin-sparing mastectomy – preserving most of the breast skin, but removing the nipple and areola. This can also sometimes include skin tightening to facilitate a better reconstructive outcome.
- Nipple-sparing mastectomy – preserving the nipple and skin overlying the breast
The type of mastectomy will be determined by the size, position, and characteristics of the breast cancer, and will influence your breast reconstruction options and outcome.
Reconstruction can be performed:
- Immediately (at the same time as mastectomy)
- Delayed (typically at least 6-12 months following completion of cancer treatment)
Breast Reconstruction Options After Mastectomy
There are two main types of breast reconstruction surgery:
Implant-Based Breast Reconstruction
Implant-based reconstruction involves placing a silicone implant to recreate the breast shape. This may be combined with a product called an acellular dermal matrix which can be used to support the position of the implant. Implants vary in size and shape, and choices need to be individualised. It is important to remember that implant based reconstruction is very different from breast augmentation, as in a reconstructive setting there is no breast tissue to cover or disguise the implant.
Benefits:
- Shorter operation time
- Faster initial recovery
- No additional donor site scars
Considerations:
- Implants may feel firmer and less natural
- Implants will require replacement and ‘maintenance surgery’ over time
- Results can be impacted significantly by radiotherapy, with a high risk of capsular contracture
- Implants may rotate, rupture, and the implant edge or implant rippling may be visible
- There is a risk of implant infection or implant loss following reconstruction
- It can be more difficult to create natural symmetry with an implant-based reconstruction
Autologous Breast Reconstruction (Using Your Own Tissue)
Autologous breast reconstruction uses your own tissue to recreate the breast, offering a more natural look and feel.
Benefits:
- Natural softness and warmth
- Long-lasting results that will change naturally as your body ages or your weight fluctuates
- It is easier to provide symmetry with your natural breast
- Once your reconstructive journey is complete, ‘maintenance surgery’ is not required
- The risk of reconstructive failure is lower
- The reconstruction is usually able to withstand radiotherapy with much less of a long-term impact
Considerations:
- Longer surgery and recovery
- Additional scars at the donor site
- Common donor areas include the abdomen and thighs, depending on your anatomy and suitability. Some patients will benefit from contour improvement the donor site, particularly on the lower abdomen following weight changes, caesarean section, or childbirth.
Common donor areas include the abdomen and thighs, depending on your anatomy and suitability. Some patients will benefit from contour improvement the donor site, particularly on the lower abdomen following weight changes, caesarean section, or childbirth.
DIEP Flap Breast Reconstruction
The DIEP flap (Deep Inferior Epigastric Perforator flap) is one of the most advanced forms of natural breast reconstruction, known as a free flap. This means performing a tissue transplant operation within the same patient, moving the skin and fat from the lower abdomen to recreate a breast.
This technique:
- Uses skin and fat from the lower abdomen
- Preserves the abdominal muscles
- Reconnects blood vessels using microsurgery
DIEP flap surgery is often considered the gold standard in breast reconstruction, as it provides:
- A natural look and feel
- Improved abdominal contour
- Reduced risk of muscle weakness compared to more traditional techniques such as the TRAM flap
- A suitable volume tissue with a reliable blood supply for breast reconstruction
- A low risk of significant complications
Thigh Flap Breast Reconstruction (TUG, DUG & PAP flaps)
For patients who are not suitable for abdominal-based reconstruction, thigh flap breast reconstruction is an excellent alternative.
Common techniques include:
- TUG flap (Transverse Upper Gracilis)
- DUG flap (Diagonal Upper Gracilis)
- PAP flap (Profunda Artery Perforator)
These procedures use tissue from the inner or upper thigh to reconstruct the breast.
Advantages:
- Ideal for slimmer patients
- Natural tissue reconstruction
- Alternative when DIEP flap is not suitable
Implants vs Autologous Reconstruction: Which is Best?
Choosing between breast implants and natural tissue reconstruction depends on several factors:
- Body shape and available tissue
- Previous surgeries
- Planned or previous cancer treatment
- Lifestyle and recovery preferences
- Desired aesthetic outcome
Implants offer a faster recovery and may be preferable for patients having immediate reconstruction and who have young children (or who have not completed their family), risk reducing patients with a genetic change, and patients who will not require radiotherapy. Autologous reconstruction provides more natural, long-term results and is often suited to cancer patients undergoing immediate reconstruction, patients who are seeking a delayed reconstruction, and patients who wish to avoid the use of implants or who have had implants previously and wish to convert their reconstruction to one using their own tissue.
Helpful Resources
For more information on breast reconstruction, the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) is the leading professional body in the UK dedicated to advancing safety, education, and best practice in reconstructive surgery. Their patient information pages provide clear, reliable, and up-to-date guidance on breast reconstruction options, including implant-based and autologous techniques, as well as what to expect before and after surgery.
You can explore these resources directly on the BAPRAS website: Breast Reconstruction | BAPRAS
A Personalised Approach to Breast Reconstruction
Every patient’s journey after breast cancer is unique. Breast reconstruction is not simply about restoring appearance; it is about helping you feel comfortable, confident, and supported.
A detailed consultation allows us to:
- Understand your goals
- Assess your suitability for different techniques
- Discuss risks, recovery and outcomes
- Create a personalised surgical plan
If you would like to learn more about breast reconstruction after cancer, I’m here to guide you through your options and help you make an informed decision. For further information or to arrange a consultation, please call 0161 260 0131 or contact us here.