Prosthetic reconstruction
Many women choose to have a breast reconstruction after mastectomy. Prosthetic reconstruction uses breast implants or expanders to replace the breast tissue. You will keep your own breast skin and your nipple can usually be preserved.

Expanders are usually used to reconstruct larger breasts and can be filled up over time in the clinic before being replaced with an implant at a separate surgery. Small to medium breasts can often go direct to implant.

It may also be possible to use expanders and implants for delayed breast reconstruction (ie spending a period of time "flat").
Key points
  • Uses an implant or expander to replace the breast tissue
  • Usually 1-2 nights in hospital
  • Drain for about a week
  • Supportive bra night and day for 6 weeks
  • Faster recovery than autologous reconstruction
  • Expect maintenance or revision surgery in future
Alternatives

You can choose to go flat and wear a prosthesis in your bra. You may also prefer to use your own tissue to reconstruct your breast, often tissue from your tummy or back (autologous reconstruction). You can also discuss your options with a Plastic Surgeon.

Modern breast surgery techniques can be used to remove larger cancers than previously possible without needing a mastectomy. These include therapeutic mammoplasty and local flap reconstruction such as LICAP. Depending on your cancer and breast size and shape, these may be alternative options for you.

Potential problems
  • Bleeding, including a pocket of blood under the skin (haematoma) (5%)
  • Seroma (fluid build up around the implant)
  • Wound infection
  • Revisional surgery
  • Implant rippling/wrinkling
  • Implant rupture/silicone bleed
  • Implant loss
  • Skin necrosis - may involve nipple
  • Breast cancer recurrence (1% per year)
  • Blood clots (DVT/PE) (<1%)
  • Risk of anaesthesia (low)
  • Breast implant illness
  • Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) (rare)
Associated treatment
If you are having risk reducing surgery, you may not need any other treatments, but don't forget the risk of ovarian cancer for BRCA mutation carriers.

Most women having mastectomy will also require surgery to the lymph glands in the arm pit, usually a sentinel node biopsy. If cancer is found in the lymph glands before surgery, you may need an axillary dissection. 

Some women having mastectomy will be advised to have radiotherapy. This reduces the risk of any breast cancer recurring in the chest wall area but may increase the risk of problems with a prosthetic reconstruction. 

Many women with breast cancer are recommended to take hormonal therapy for several years. Some women are recommended to have chemotherapy or targeted therapy for several months. This depends on the biology of your tumour and you will discuss this in detail with your medical oncologist if needed.
On the day of surgery
You will need to fast for 6 hours before surgery. You can take any medications as normal and continue to drink water until 2 hours before surgery.
You should shower and wash well in the morning. Bring something to do as there will be a lot of waiting.
When you arrive you will be checked in by the nurses and change into a gown and stockings ready for the operation.
In the holding bay
You will see your surgeon and anaesthetist, have a drip put in and have the operative site marked. You might also be given premedication.
In recovery
After surgery you will go to recovery. You will be watched closely until you are alert and well enough to return to the ward. You might be given medication for any sickness or pain.
After surgery
Swelling or bruising is common and usually settles on its own. It is important to wear a good post-operative bra night and day for 6 weeks.
You will probably have a drain (plastic tube) to prevent fluid building up in the wound. This is usually removed after about a week. You can shower carefully straight away. Try not to soak your dressings and pat them dry afterwards.
Pain and discomfort can usually be managed with simple painkiller tablets.
Eat healthily and try to exercise a little every day. You will probably find your movement restricted for several weeks. The exercises given to you by your breast care nurse will help to minimise stiffness.
If you have any concerns call the team - we would rather know about it and you are never wasting our time! We can always arrange for you to come to the clinic if needed and if you are unwell out of hours you can always attend the emergency department.
Driving
You need to be able to concentrate properly and perform an emergency stop without any distracting pain. You will probably need to avoid driving for 1-2 weeks, but check with your insurance company.
Work
Getting back to work can be necessary or helpful for many women, but you will probably need to wait at least until you get your results and can plan any further surgery or treatment. 
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