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Implants or tissue reconstruction
The type of reconstructive surgery a woman chooses depends on the location of the breast tumour, the size and shape of the breast that is being replaced, age, wellbeing and the availability of autologous tissue.
 
Techniques to reconstruct breast include: implant-only reconstruction, autologous reconstruction using the patient's own tissue and a combination of both.
 
Implants and tissue reconstruction
Breast implants are usually a two-stage procedure. First, an expander is placed under the chest muscle and slowly filled with saline solution during visits to the doctor after surgery. Second, after the chest tissue has relaxed and healed, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant six to 24 weeks after mastectomy.
 
Tissue reconstruction involves moving a flap of skin, muscle and fat from a patient's back or abdomen to the breast area, while keeping intact a pedicle or tube of tissue containing its supplying arteries and veins.
 
Free flap reconstruction involves tissue being detached from a donor site before it is moved. Microsurgical techniques are then used to rejoin its arteries and veins to those in the breast area. An advantage of this procedure is that tissue can be harvested from areas of a patient's body not adjacent to the breast, such as the buttock or thigh.

Harvesting fat from one part of the body and re-introducing it to help reconstruct breast tissue is challenging because the body may reabsorb between 20 to 90% of the harvested fat, which then results in further interventions and unreliable outcomes.
 
According to Anne Wilson, a RAFT Surgical Research Fellow working on a project with Professors Peter Butler and Alexander Seifalian from University College London, "The introduction of stem cells into the fat-transfer procedure may reduce or eliminate the problem of the body reabsorbing the fatty tissue. For a woman undergoing breast reconstruction this would be significant as it would mean fewer visits to the operating room and better aesthetics".
 
Same time or delayed reconstruction
Another important choice women face with breast reconstruction is whether to have reconstruction at the same time as the mastectomy. Immediate breast reconstruction usually means less surgery, the chest tissue is not damaged by radiotherapy or scarring and this often means that the final result looks better.
 
Delayed breast reconstruction may be a better choice for some women who need radiotherapy to the chest area after a mastectomy and this can cause delayed healing and scarring. Sometimes, a woman may not know whether she needs radiotherapy until after her mastectomy. This can make planning ahead for an immediate reconstruction difficult.
 
Takeaway
Each year, some 18,000 mastectomies are performed in England alone. About 40 to 50% of these have breast reconstruction surgery. According to a recent survey by the British Association of Plastic, Reconstructive and Aesthetic Surgeons, more than 33% of respondents said that the risks and benefits of reconstructive surgery were never discussed.