As a plastic surgeon, I meet many women who have bravely battled with breast cancer and want to undergo reconstructive surgery in order to restore both their body shape and self-confidence. But while there are in excess of 50,000 breast cancer diagnoses in the UK every year, the most recent National Audit of Mastectomy shows that less than 21% of women in England and Wales undergo immediate reconstruction.
While there may sometimes be good oncological reasons for delaying reconstruction such as certain tumour types - the majority of women are suitable candidates for post-treatment reconstruction without delay. So why aren't they being offered this option as standard?
Advice and trends
Unfortunately, despite recommendations by the National Institute for Health and Clinical Excellence (NICE) that immediate reconstruction should be discussed with and offered to patients at the outset, the worrying trend for low take-up figures just doesn't align with this.
Perhaps even more sadly, when patients are not offered immediate reconstruction and are told they could have a reconstruction later on, over half these patients fail to follow this up - leaving them with more than just physical scars to contend with.
Types of reconstructive surgery
Depending on the nature, extent and treatment of the diseased area, there are four main types of reconstructive breast surgery available in increasing order of complexity:
• A tissue expander or implant placed directly under the breast skin
• An implant or expander covered by a pedicled flap from the back
• A pedicled flap without the use of an implant or expander
• Free (autologous) tissue transfer from abdomen, thigh or buttock
While the types of reconstruction may differ, they have one crucial factor in common: they all offer a better aesthetic outcome when performed during the same operation as the mastectomy, compared to a delayed reconstruction.
Why immediate reconstruction should be standard
Aside from the above, there are many compelling reasons for immediate reconstruction - one study puts patient satisfaction rates at a disparate 95% for those undergoing reconstruction straight away, compared with 76% of women undergoing a delayed procedure who stated they would have preferred a speedier treatment.
Other reasons that immediate reconstruction should become the norm (where appropriate) include:
• Reduced rates of anxiety and depression
• Improved self-confidence, self-esteem and body image
• Increased success in recreating the natural size, symmetry and contour
• Improved social and sex life
As surgeons, we have a responsibility to provide high quality care to our patients, and this is even more important when a lack of advice on available options leads to an increased risk to the patient's physiological welfare.
Personally, I would like to see the offer of immediate breast reconstruction become standard, as recommended by the National Institute for Health and Clinical Excellence, regardless of budgetary pressures and postcode. While there may be concerns of overloading patients with information following an upsetting cancer diagnosis, by providing hope at this early stage and access to reconstructive treatment, we would certainly see a significant improvement in post-mastectomy mental health outcomes.
My advice to any women facing a breast tumour removal is to ask your surgeon about your options for reconstruction at the earliest stage possible, so that you have the guidance and support you need to speed your physical and psychological recovery.