Breast Reconstruction After Mastectomy

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New choices in breast cancer surgery and reconstruction

The emotional and physical results of breast cancer are very different now from what they were in the past. Much more is known about breast cancer and its treatment. New treatments, as well as improved reconstructive surgery, mean that women who have breast cancer today have more choices and better outcomes.

Today, many women with breast cancer choose surgery that removes only the tumor and an edge or margin of healthy tissue around it. This is called breast conservation surgery. (It may also be called lumpectomy, or segmental mastectomy.) But some women aren’t able to have breast conservation surgery, or they prefer to have the entire breast removed. There are different types of mastectomies, some of which save the skin and even the nipple and areola. Women who have a mastectomy may choose reconstructive surgery to rebuild the shape and look of the breast.

If you are thinking about having reconstructive surgery, it’s a good idea to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before the surgery to remove the tumor or breast. This lets the surgical teams plan the best treatment 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)
  • To be happier with their bodies and how they feel about themselves

Breast reconstruction often leaves scars that can be seen when you’re naked, but they often fade over time. Newer techniques have also reduced the amount of scarring. When you’re wearing a bra, the breasts should be alike enough in size and shape to let you feel comfortable about how you look in most types of clothes.

Breast reconstruction has been shown to improve body image and self-esteem when compared to no reconstruction. Still, some women are not happy with how the reconstructed breast looks and feels after surgery, and there may be concerns about the flap or donor sites, too. Learn as much as you can so you know what you can expect from reconstruction.

There are often many options to think about as you and your doctors talk about what’s best for you. The reconstruction process sometimes means more than one operation. 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 make your decision 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. The benefit of this is that breast skin is often preserved, which can produce better-looking results. Women also do not have to go without the shape of a breast.

While the first step in reconstruction is often the major one, many steps are often needed to get the final shape. If you’re 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 like delayed healing and scarring.

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

  • Your overall health
  • The stage of your breast cancer (how much there is and if it has spread)
  • 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 and related costs for the unaffected breast
  • The type of procedure you are thinking about having
  • The size of the implant or reconstructed breast
  • Your desire to match the look of the other breast

Other important things to think about

  • Some women don’t want to think about reconstruction while coping with cancer. If this is the case, you might choose to wait until after your breast cancer surgery to decide about reconstruction.
  • You might not want to have any more surgery than is absolutely required.
  • Not all reconstructive surgery is a total success, and the result might not look like you’d hoped.
  • The mastectomy and reconstruction surgery will leave scars on the breast and any donor areas.
  • A rebuilt breast will not have the same sensation and feeling as the natural breast, and any flap donor sites might also lose some sensation.
  • You may have extra concerns if you tend to bleed or scar more than most people.
  • Breast skin or flaps might not survive reconstructive surgery. This tissue death is called necrosis. If it happens, healing is delayed and more surgery is often needed to fix the problem.
  • Healing could be affected by previous surgery, chemotherapy, radiation, smoking, 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 won’t feel the same as it did before the mastectomy.
  • Surgeons may suggest you wait for one reason or another, especially if you smoke or have other health problems. It’s best to quit smoking at least 2 months before reconstructive surgery to allow for better healing. You might not be able to have reconstruction at all if you are obese, too thin, or have blood circulation problems.
  • The surgeon may suggest surgery to reshape the other breast to match the reconstructed breast. This could include reducing or enlarging its size, or even surgically lifting the breast.
  • Many doctors recommend that women not have immediate reconstruction if they will need radiation treatments after surgery. It can cause problems after surgery and lower the chances of success. Flap surgeries (moving tissue around) are often delayed until after radiation.

Knowing your reconstruction options before surgery can help you prepare for a mastectomy with a more realistic outlook for the outcomes.

Last Medical Review: 12/05/2014
Last Revised: 10/20/2015