The decision about what type of risk reducing surgery is a very important one and one that you will make in discussion with your breast surgeon and breast care nurse.
Is risk reducing surgery (RRS) right for you at this time?
You need to be 100% sure that this is the right decision at this time of your life. Do you have a good understanding about the level of risk at your age and how that risk will change over the next 5-10 years? Have you had the opportunity to talk with a clinical psychologist and explore how you will feel about the change in how your body will look and feel?
Consider your family responsibilities and what help and support you will have from family and friends after surgery, especially if you have young children. Have you a history of depression or anxiety and do you feel emotional resilient enough to cope with life changing surgery. How important is the reduction in your risk of breast cancer to you and your family?
Are you thinking about immediate reconstruction?
Most women wish to have immediate reconstruction but other women may prefer a simpler operation and may decide to wear breast prosthesis in their bra. Your decision may be influenced by your body size and shape, your general health, your lifestyle and relationships. Breast reconstruction should be viewed as a process, rather than as only one operation. It may take a number of operations to get the desired result or to treat complications that develop. Over time further surgery may be considered if there are changes in your weight or with the reconstruction or implants. The aim of breast reconstruction is to provide breasts that will look natural when wearing a bra but the breasts will look and feel very different after surgery.
What type of surgery would you like?
Implant based reconstruction has the advantages of having a quicker recovery time with no additional scars to those on the breasts but it is more likely that you will require additional surgery in the future. Within the first three months following surgery up to 10% of women may need to have the implant removed due to complications and the risks are higher in women who have had radiotherapy to the breast, are smokers or are overweight.
Tissue flaps (autologous breast reconstructions) are more complex operations and involve a longer recovery. Breasts made from your own living tissue feel soft and move more like your natural breasts. Like your own breasts, they fluctuate as you loss or gain weight and tend to age more gracefully.
LD Flap using the latissimus dorsi muscle from your back, with or without an implant. This may be recommended if you are having surgery on one breast after breast cancer and then will have the other breast removed at a later date. LD flap reconstruction will result in an additional scar on our back which is usually hidden by your bra strap and the volume of the reconstructed breast may reduce over the next few years. TRAM (transverse rectus abdominis myocutaneous) flap involves lifting a flap of abdominal fatty tissue and muscle which is tunneled under the skin to the chest and shaped into a breast. This gives the bonus of a tummy tuck but removing the main abdominal muscle can leave permanent weakness. This makes it more difficult to sit up or get out of bed and sit-up exercises are not recommended.
DIEP (deep inferior epigastric perforator) flap uses only the abdominal fatty tissue so full abdominal muscle strength is retained and recovery is easier. This is more complex surgery performed by a plastic surgeon that requires the surgeon to extract the blood vessels from the tummy muscle and then reconnect them in the chest.
What cosmetic result are you expecting?
Surveys have shown that 80% of patients who had breast reconstruction were happy with their appearance when wearing a bra but this means that 20% of women were disappointed.
It is simply not possible to reconstruct a breast that is as good or as natural as one’s own breast. Surgeons aim to make a reconstructed breast that looks symmetrical with the other breast when wearing a bra. However out of a bra, it may be obvious that the breast has undergone major surgery and a reconstruction.
In general, the reconstructed breast sits higher on the chest wall, is firmer to touch, the skin may feel numb and much less mobile. A reconstructed breast does not necessarily look, move or feel like a normal breast.