Kerry, a nurse with dark brown hair in blue scrubs, posing for portraits at the hospital, in conversation with a patient.

Breast reconstruction toolkit

This toolkit includes many useful resources, and case studies from healthcare professionals in current practice.

We’ve created this toolkit with the collaboration of breast reconstruction nurses and breast care nurses in the UK.

The aim is to provide comprehensive research and resources that can help to improve both your practice and your patients’ experience.

The toolkit includes guidelines, research articles, reconstruction webinars and patient resources as well as examples of good practice across the UK. It also includes templates of protocols that can be adapted for use.

The toolkit is an evolving resource, and we’ll periodically update it. We hope you find it useful.

Guidance, reports and resources

Templates and pathways for clinical practice

Referral pathway example at Mersey and West Lancashire NHS Trust

MWL referral for immediate autologous reconstruction.

Download pdf (50 KB)

Resources for patients

  • Patient resources

    • Breast Cancer Now Someone Like Me
      This service can put patients in touch with a volunteer who’s had a similar experience and has been trained to help. They'll be able to use their own experiences to answer questions, offer support or simply listen.  
    • Breast Cancer Now forum
      Our online forum is available night and day. It’s a place where people affected by breast cancer and breast health concerns can learn from other people's experiences, and share their own if they wish to. 
    • Breast Cancer Now helpline
      Our helpline provides tailored information and specialist support to anyone affected by breast cancer, or with queries about breast health. It’s free and completely confidential.  
    • Breast Cancer Now Ask Our Nurses
      Our confidential Ask Our Nurses service is here for anyone who prefers to receive information in writing. People can message our nurses via email, social media or on our forum.  
    • Breast Cancer Now Moving Forward
      Our Moving Forward course is for anyone who has finished primary breast cancer treatment within 2 years. Face-to-face or online, people can connect with others and find support and information to help them move forward with their lives.
    • Keeping Abreast
      A charity that provides a forum for women with breast cancer facing the possibility of a mastectomy or reconstructive surgery. They can meet other women with similar experiences.
    • Restore
      A charity providing information, support and show and tell events for women contemplating breast reconstruction.
    • Mastectomy Tattooing Alliance  
      A charity that provides a directory of approved mastectomy tattoo artists and financial support towards the cost of mastectomy or areolar tattooing 
    • Nipple Innovation Project  
      A charity that provides education and funding for post mastectomy nipple tattoos and a directory of verified tattoo artists  

     

Case studies

  • Case study 1: Pam Golton – Queen Victoria Hospital, East Grinstead

    Tell me about your role and describe the service you work in. 

    I’m one of 3 full-time Macmillan Breast Reconstruction Clinical Nurses Specialists working at the Queen Victoria Hospital in East Grinstead. I’ve been in this post since 2011. 

    We’re a tertiary referral centre and the biggest free flap unit in the country. We’re also the sole provider of autologous reconstruction for the whole Southeast of England, including Jersey.  

    We work with 8 breast reconstruction plastic surgery consultants. We have 19 hospitals that refer to us and we do on average 363 free flaps a year over the area that we cover. In 2022, 57% of our reconstructions were immediate reconstructions, with the remainder being delayed reconstructions.  

    We undertake immediate breast reconstructions, risk reducing breast surgery and delayed breast reconstruction for patients and all symmetrising surgery. Our unit also looks after benign breast conditions, such as bilateral breast reductions, as well as looking after patients that have had cosmetic surgery done elsewhere that experience wound problems. When doing immediate breast reconstruction surgery, the referring consultant surgeon comes over and performs the mastectomy and our plastic surgeons complete the reconstruction. The logistics around this make it quite complicated.  

    What are the top 3 things that you think make your service run well, beyond having dedicated staff? 

    1. Communication

      We have two-way communication between the patients, clinicians, nurses and support staff, but also within our breast team members. We’re a small unit, undertaking many reconstructions. We work very cohesively together as a team, and we have pathways in place to ensure a smooth delivery of care. Consultants and nurses will have their own opinion on things, but we very much run the services as a group, so that we’re all singing from the same hymn sheet.

    2. Information

      As soon as we receive a referral from a patient, we send them an information pack. This means that before they come to their first consultation, they’ve been given our information on reconstruction. Having information upfront helps the consultation. If the patient wants to have reconstruction surgery, they’re fully aware of everything to expect. All patients are also invited to a Show and Tell Session.

      Show and Tell Sessions
      Our Show and Tell Sessions, run by our charity Restore, are an important part of the patient journey. During the first hour of the session, the Macmillan Breast Reconstruction Nurses explain the reconstructive pathway, what patients can expect, dos and don’ts, reasons why they might not be offered a reconstruction, what makes someone suitable for a reconstruction and things that might hinder their pathway. We discuss pre- and post-surgery expectations and recovery and answer any questions. 

      During the second part of the session, male partners go to another room and talk about how they can support their partners with an ex-patients’ partner and an ex-patient. The women are left with 6 or 7 ex-patient ‘models’, who’ll take their clothes off, show their scars and talk about their reconstructive experiences. This provides women with an opportunity to ask questions to women who’ve been through the process, and ask any medical questions to the Macmillan Breast Reconstruction Nurses. 

      Once the models are dressed, the partners come back in, and everyone has the opportunity to talk to the models individually if they felt they have a personal connection with someone.

    3. Shared decision-making

      Within our unit, we all respect each other. Our consultants are happy for the Macmillan Breast Reconstruction Nurses to make decisions on their behalf, include us in the decision-making process and respect our opinion. We’re trusted to be autonomous, which helps the patient pathway to run more smoothly and more efficiently. We involve the patient in all decisions and believe shared decision-making works both ways.  

    What do you need to help your service work better?

    There are a number of things that would improve our service, including more operating space, more surgeons, more Macmillan Breast Reconstruction Nurses, better funding, better patient administration systems and less bureaucracy. 

    If I could put one of those at the top of the list, it would be theatre capacity. Despite having 13 theatres, there are often times when surgeons don’t have an operating room to work in because it’s allocated for something else. More theatre space, combined with more surgeons to do the operations, would help us do more reconstructions on the women who have been waiting for considerably increasing waiting times.  

  • Case study 2: Rieka Taghizadeh – Mersey and West Lancashire Trust

    Tell me about your role and describe the service you work in. 

    I’m a consultant plastic surgeon with a special interest in microsurgical breast reconstruction. I’m the clinical lead for microsurgical breast reconstruction and the current BAPRAS Chair for the Breast Special Interest Group. We’re a 4-consultant microsurgical breast reconstruction group who do a high volume of reconstructions and work closely with our oncoplastic colleagues. 

    When I first joined, the unit was mostly working on delayed reconstruction patients, but I helped change this to an immediate reconstruction service. This meant we could collaborate and do a mastectomy at the same time as the reconstruction, which is recognised as a much better option for physical and mental wellbeing for women. 

    I worked to change some of the barriers and goal posts of breast reconstruction. Initially, the unit had a strict no radiotherapy policy, so that any patient having a DIEP reconstruction was never going to be offered an immediate DIEP. I helped change this by collaborating closely with the radiology oncologists. We created a prospective group of women who could have a DIEP and we altered and modified their radiotherapy to be DIEP friendly.  

    The unit also had a very strict BMI cut off, so that even if patients had a slightly higher than average BMI, we didn’t accept them. I helped changed that so that patients could come in as long as they were physiologically fit, and we still offered them reconstruction. The range and complexity of reconstruction started growing, and this helped us show other units where it’s possible to stretch boundaries.  

    What do you think helps makes your service run well? 

    We’ve been very selective in choosing who works on the unit, and we’ve been lucky enough to have people who are extremely good at what they do in their individual roles. There is never any shortcoming from a surgical side, an anaesthetic side, from our breast reconstruction nurses and so on. People who are in individual designated roles as part of our team are very good at what they do, and that comes from both selection and training. 

    What do you need to help your service work better? 

    Despite being chosen as trust of the year and repeatedly giving 5-star care, the number of patients is overwhelming. We have more and more patients coming through, but we only have a limited number of surgeons.  

    We have a number of selectively chosen surgeons who have gone through the training scheme, who we know are capable and can be made better and better. However, it comes down to passing on the baton of what we do to the younger generation of surgeons. It would be great to have trainees who are dedicated to learning breast reconstruction to come under our umbrella, so we can train them as the next generation of microsurgeons.  

    We have a team that is already exemplary, but we’d like to pass that on by having fellows, by having more capacity and hopefully more microsurgeons to add to our unit.  

Further reading, international resources and support garments

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Join the Breast Reconstruction Nursing Network

This networking group provides a space for breast reconstruction nurses to regularly meet for networking and education.

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We'd love your feedback

We'd love to know what you think of this toolkit. If you have any resources you think we should add, let us know. And please tell us if you use the toolkit to adapt your service so we can share your experience with others.

Get in touch

With thanks to our reviewers 

  • Pam Golton 
    Macmillan Breast Reconstruction Nurse Specialist
    Queen Victoria Hospital NHS Foundation Trust
  • Tina Gallagher 
    Breast Reconstruction Nurse 
    Mersey and West Lancashire NHS Trust 
  • Linda Hammel
    Breast Clinical Nurse Specialist
    NHS Lothian 
  • Anna Maulson
    Breast Reconstruction Nurse Specialist
    Oxford University NHS Trust
  • Rowena Jackson 
    Breast Reconstruction Nurse Specialist
    Barts Health NHS Trust