Differences between your breasts
Can a breast reconstruction hide a cancer?
The main operation for a breast reconstruction usually requires you to spend two to 10 days in hospital. A general anaesthetic will be used and you will feel some discomfort afterwards. If you have had a flap reconstruction, you will be sore in the area from which the muscle was taken as well as in the breast area. You can take pain relievers to control any discomfort. You will probably have a small tube inserted into the operation site to allow fluid to drain away.
You may need to be careful when moving around immediately after the operation, to help the healing process. Ask your surgeon about this.
As with all operations, recovery will take longer if problems occur. These might be related to the anaesthetic, to infection or to healing. You should be aware of possible problems and discuss them with your surgeon or breast care nurse before the operation, so that you can make the necessary arrangements for your work, home help or childcare.
Your surgeon will continue to care for you until your body has healed properly. Then your usual check-ups with your breast specialist will continue. Once healed, your reconstructed breast will not need any special care or attention.
A few problems may occur. They are not common but it may help to know about them and about the possible solutions.
Most women are very pleased with the results of their reconstruction. Remember however, that it is not possible to make an exact copy of your remaining breast. Sometimes there will be differences in the size, shape or position of the two breasts.
If your weight changes, you may find that one of your breasts changes in size while the other one stays the same.
You may also find differences in the feeling of your breasts. Your reconstructed breast may feel either numb or extremely sensitive. You may also suffer some loss of feeling if you have had surgery to your remaining breast (for example a breast reduction).
If a breast implant has been used, a capsule of fibrous tissue (scar tissue) will form around it. If this becomes thick over time it may make the reconstructed breast feel firm. This condition is called a capsular contracture. It can be uncomfortable and may change the shape of the implant. For some women, this may be very painful. Further surgery may be needed and sometimes the implant has to be removed.
Sometimes there may be healing problems within the first week or so after surgery for a breast reconstruction. These can be caused by infection, poor blood supply or problems with an implant. Any infection must be treated and, if an implant has been used, it might have to be taken out. It may be possible to have a new implant put in later on.
Sometimes, shortly after the operation, extra blood collects in or under the wound. This is called a haematoma. It causes swelling and pain and may need to be removed.
Most women who have a flap reconstruction are able to carry on their usual activities without difficulty once they have recovered from the operation. Occasionally, a breast reconstruction can result in muscle weakness. For example, women who have had a TRAM flap reconstruction may notice some weakness in bending at the middle, perhaps when getting up from a low chair. This should not be a problem after a DIEP flap.
As implants are made of a type of plastic they will not last forever. At some stage they may leak or rupture. This is due to gradual weakening of the silicone plastic envelope.
With saline implants, the implant will immediately collapse after a rupture, but replacement with a new implant is possible, usually involving day or overnight surgery. With silicone gel implants, the silicone gel is often contained within the body's capsule of scar tissue and it may not be possible even to tell if the implant is ruptured. If the silicone leaks outside the capsule it tends to cause a lump, which may be painful. It is believed that ‘cohesive gel' implants will not have this problem. Usually, if the implant is known to have ruptured, it is replaced. The average time after which an implant will rupture is thought to be around 15 years but can vary considerably.
All people heal differently and the final appearance of a scar will vary from person to person, even if the surgery is the same. Most scars have a thickened, red appearance early, which peaks at around three months and settles down over time.
Sometimes the scar stays thick for a long time and can become itchy and uncomfortable. Treatments are available to help with this. Scars may be improved surgically later on.
Many women are concerned about the possibility of a reconstruction hiding a recurrence of cancer.
This is not likely to happen because most recurrences of the cancer occur in the skin or in the tissue just under the skin. If a flap reconstruction is used, any recurrence would usually only occur in the skin that belonged to the original breast. The flap used to make the new breast would not hide this.
If a breast implant is used, it is placed beneath the chest muscle. Again it should not be difficult to detect a recurrence.
Having a reconstruction after a mastectomy for cancer does not affect your chances of long-term cure. After reconstruction, it is a good idea to examine both your breasts every month. Your surgeon will arrange to see you regularly to examine the reconstructed breast and will advise you about how often you need to have a mammogram. The mammogram will be at a hospital breast clinic or radiological practice. Mammography is generally not performed on the reconstructed breast.
Discuss any concerns you have with your general practitioner or surgeon.
Updated Sept 2005
