Each year more than 292,000 American women face breast cancer. Today, the emotional and physical results are very different from what they were in the past. Much more is now known about breast cancer and its treatment. New kinds of treatment as well as improved reconstructive surgery mean that women who have breast cancer today have better choices.

Today, more women with breast cancer choose surgery that removes only part of the breast tissue. This may be called breast conservation surgery, lumpectomy, or segmental mastectomy. But some women have a mastectomy, which means the entire breast is removed. Many women who have a mastectomy choose reconstructive surgery to rebuild the shape and look of the breast.

If you are thinking about having reconstructive surgery, it is a good idea to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before your mastectomy. This lets the surgical teams plan the treatment that is best for you, even if you want to wait and have reconstructive surgery later.

Why have breast reconstruction?

Women choose breast reconstruction for many reasons:

• To make their chest look balanced when they are wearing a bra or swimsuit
• To permanently regain their breast shape
• So they don't have to use a form that fits inside the bra (an external prosthesis)

You will be able to see the difference between the reconstructed breast and the remaining breast when you are nude. But when you are wearing a bra, the breasts should be alike enough in size and shape that you will feel comfortable about how you look in most types of clothes.

Your body image and self-esteem may improve after your reconstruction surgery, but this is not always the case. Breast reconstruction does not fix things you were unhappy about before your surgery. Also, some women are not happy with how the reconstructed breast looks and feels after surgery. You and those close to you must know the facts about what to expect from reconstruction.

There are often many options to think about as you and your doctors talk about what is best for you. The reconstruction process often means one or more operations. Talk about the benefits and risks of reconstruction with your doctors before the surgery is planned. Give yourself plenty of time to make the best decision for you. You should decide about breast reconstruction only after you are fully informed.

Immediate or delayed breast reconstruction

Immediate breast reconstruction is done, or at least started, at the same time as the mastectomy. An advantage to this is that the chest tissues are not damaged by radiation therapy or scarring. This often means that the final result looks better. Also, immediate reconstruction means less surgery.

After the first surgery, there still may be a number of steps that are needed to complete the immediate reconstruction process. If you are planning to have immediate reconstruction, be sure to ask what will need to be done afterward and how long it will take.

Delayed breast reconstruction means that the rebuilding is started later. This may be a better choice for some women who need radiation to the chest area after the mastectomy. Radiation therapy given after breast reconstruction surgery can cause problems.

Decisions about reconstructive surgery also depend on many personal factors such as:

• Your overall health
• The stage of your breast cancer
• The size of your natural breast
• The amount of tissue available (for example, very thin women may not have enough extra body tissue to make flap grafts)
• Whether you want reconstructive surgery on both breasts
• Your insurance coverage for the unaffected breast and related costs
• The type of procedure you are thinking about
• The size of implant or reconstructed breast
• Your desire to match the look of the other breast

Other important things to think about

• Some women do not want to think about reconstruction while coping with a diagnosis of cancer. If this is the case, you may choose to wait until after your breast cancer surgery to decide about reconstruction.
• You may not want to have any more surgery than needed.
• Scarring is a natural outcome of any surgery, but cell death (called necrosis) of the breast skin, the flap, or transplanted fat can happen. Immediate reconstruction may be more likely to result in necrosis. If this happens, more surgery is needed to fix the problem and can deform the new breast shape.
• Not all surgery is a total success, and you may not like the way it looks.
• You may be concerned if you tend to bleed or scar.
• Healing may be affected by previous surgery, chemotherapy, radiation, smoking, alcohol use, diabetes, some medicines, and other factors.
• Would you prefer to have reconstruction before or after you complete your cancer treatment?
• Breast reconstruction restores the shape, but not feeling, in the breast. With time, the skin on the reconstructed breast can become more sensitive, but it will not feel the same as it did before your mastectomy.
• Surgeons may suggest you wait for one reason or another, especially if you smoke or have other health problems. Many surgeons say that you must quit smoking at least 2 months before reconstructive surgery to allow for better healing. You may not be able to have reconstruction at all if you are obese, too thin, or have blood circulation problems.
• The surgeon may offer surgery to reshape the remaining breast to match the reconstructed breast. This could include reducing or enlarging the size of the breast, or even surgically lifting the breast.
• Knowing your reconstruction options before surgery can help you prepare for a mastectomy with a more realistic outlook for the future.