When the consultant plastic surgeon Elaine Sassoon first arrived at Norfolk and Norwich University Hospital, charged with setting up a breast-reconstruction unit, a kindly colleague pulled her aside for a quiet word. There wasn’t going to be much of a call on her kind of expertise around there, he said. Norfolk women were “down-to-earth farming types” and had better things to think about than getting a new breast. Sassoon listened, unconvinced. Ten years down the road, the landscape for breast reconstruction in this country has been transformed – in no small part thanks to Sassoon’s efforts in constantly adopting and pioneering the most challenging breast-reconstruction techniques, so that she can offer patients the choice she feels that they need to get a breast rebuilt as close to the original as possible.

The idea for a coffee-table book with pictures of the “gorgeous, funny women” she sees at post-reconstruction follow-ups – one calls her tattooed rebuilt nipple her “tittoo” – had been germinating in Sassoon’s mind for ages, partly inspired by a seminal American book along these lines. She knew, as with this forerunner, that she needed to show women nude. Women considering reconstruction are routinely given sheaves of clinical photographs of chests before and after various types of reconstruction to pore over – useful to a point, but leading-edge reconstruction surgery is often not about breasts in isolation, because the tissue for rebuilding the breast is taken from elsewhere, leaving a scar at the “harvest” site too.

This is particularly true of the surgery Sassoon has championed. She was one of the first in the UK to adopt perforator flap reconstructions – complex, microsurgical techniques that involve filleting out spare skin and fat with its own blood supply (the free flap) from the woman’s body where she has a surplus, then reconnecting the vessels to those in the chest, where the tissue is fashioned into the new breast. Sassoon refers to these operations – one is the DIEP flap, in which tissue is taken from the bikini line – as the “gold standard” in breast reconstruction. But these procedures won’t be right for everyone: this is major surgery, which means a longer recovery time, and an additional scar, even if it is hidden in the bikini line or the bottom crease (as with the IGAP flap, which Sassoon introduced here a few years ago). Sassoon firmly believes in “giving the right reconstruction to the right person”, and for some patients the simplest solution, and one offered nationwide, is implants, particularly for younger women with smaller breasts. But these will have to be surgically replaced at intervals in the future, and safety issues might bother some. Getting the right reconstruction can also mean having the right postcode. So women living close to one of the leading breast units are likely to get their first breast-cancer treatment – often combined mastectomy and immediate reconstruction – within the Department of Health’s 31-day target from diagnosis. Those living further afield are just as likely to get the combined operations within the delivery timescale – but their choice may be restricted to one or two of the simpler reconstruction techniques.

Women unhappy with limited options in their area for immediate reconstruction are entitled to a second opinion at a centre of excellence offering the full range of breast-reconstruction choices, but they might have to go out of their area for it, and wait longer. Some women elect to delay reconstruction to take some pressure off short-term. And it will have to be deferred anyway if radiotherapy is necessary after surgery. Different oncologists will advise a different waiting period before recommending women for reconstruction, so delayed reconstruction can unfortunately be very delayed. “Also,” says Antonia Dean of Breast Cancer Care, “resources aren’t evenly distributed around the country, so women who have delayed reconstruction might have to wait quite a long time. We’ve spoken to women who have waited 18 months.”

Sassoon encourages women to explore all the options, and, to help them decide, breast-care nurses give them before-and-after photographs. Her resolve to provide shots of former patients – most of them striking, some with scars and none airbrushed or disguised in any way – became the imperative for The Boudica Within. From the moment she started exploring the idea of a book, in December 2004, she knew that she wanted to show the women as “sexy and powerful”. But the book had a spluttering start, relegated by work pressure. When one of her former patients, Chrystèle Ganivet, agreed to oversee the project, it started clicking into place. Last November, Sassoon carried out a breast reconstruction on Andrea O’Hare – as it transpired, an award-winning photographer. By January, Andrea had been enlisted as the photographer for the book, and another patient, Bronwen, had secured a farm with beautiful gardens and a country pile for the photo session.

Sassoon allotted three hours in her diary to phone the 90 patients who had provisionally agreed to be photographed; within half that time the first 23 had signed up to reveal all for posterity on a Norfolk beach. The photo session had a therapeutic effect, she feels: “Being perceived as a beautiful woman is very liberating, and a lot of these women started seeing themselves in an entirely new light because of that.”

By the time each patient’s personal story and the selected pictures were with the publishers, Chrystèle Ganivet was five months pregnant. The spirited Frenchwoman was 32 when she was diagnosed with breast cancer three years ago, just shortly after telling her husband, Neil, that she was ready to try for a baby. She took the medication the doctors gave her to temporarily “put her ovaries to sleep”, to protect them while on chemotherapy, aware that they might never wake up again. After her reconstruction, her oncologist told her to wait before trying for a baby, to be sure she was clear of the chemotherapy. Last year he gave her the all-clear and in two months she was pregnant. The birth of Chrystèle’s baby, against seemingly insurmountable odds, coincides with the book’s publication. Her view – “never, ever give up” – runs like a mantra through its remarkable pages.

The Boudica Within by Elaine Sassoon (Erskine Press, £14.95) is available at the BooksFirst price of £14.95, including postage and packing. Tel: 0870 165 8585. All profits will go to cancer charities

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