Choosing surgery when you also want reconstruction

If keeping or rebuilding the shape of your breast matters to you, it helps to think about reconstruction at the same time as choosing your cancer operation, rather than afterwards. There are two broad routes. The first is breast-conserving surgery, where only the cancer and a rim of healthy tissue are removed. For many women this already keeps a natural-looking breast, and oncoplastic techniques can reshape the remaining tissue, or borrow a little tissue from nearby, to fill the gap and improve the result. Radiotherapy usually follows. The second route is mastectomy with reconstruction, which can be done at the same operation, called immediate reconstruction, or months or years later, called delayed reconstruction. Reconstruction can use an implant, your own tissue from the tummy, back or thigh, or a combination. Some women choose mastectomy with a flat closure and no reconstruction. Your cancer decides which options are safe. Tumour size compared with breast size, whether cancer is in more than one area, whether radiotherapy is likely after mastectomy, and whether you carry a high-risk gene all shape the plan. Radiotherapy is especially important, because it can harden implants and change the look of reconstruction. Meeting both a breast surgeon and a reconstructive or oncoplastic surgeon before deciding, and asking to see realistic results, gives you the clearest picture of what each path can offer.

Lumpectomy may already preserve shape

Oncoplastic lumpectomy can keep a good breast shape without a full reconstruction.

Mastectomy offers immediate or delayed options

Reconstruction can be done at the same time or later, using implants or your own tissue.

Radiotherapy shapes the plan

Knowing whether radiotherapy is likely helps choose the type and timing of reconstruction.

Whether you will need radiotherapy is one of the most important questions when planning reconstruction.

After lumpectomy

Radiotherapy is usual. It can make the breast a little firmer or smaller over time, which surgeons plan for.

After mastectomy

It is advised for some women, such as those with larger tumours or several involved lymph nodes.

Effect on implants

Radiotherapy raises the chance of implants hardening, moving or needing removal.

Effect on flaps

Flaps usually cope better, though they can shrink or firm up if irradiated.

When radiotherapy is uncertain

Some teams place an expander first, or delay reconstruction until the need is clear.