Breast Reconstruction After Mastectomy

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Should I have breast reconstruction?

Women who have surgery to treat their breast cancer may choose breast reconstruction surgery to rebuild the shape and look of the breast. If you are thinking about having reconstructive surgery, 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.

Benefits of 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 after a mastectomy can make you feel better about how you look and renew your self-confidence. But keep in mind that the reconstructed breast will not be a perfect match or substitute for your natural breast. If tissue from your tummy, shoulder, or buttocks will be used as part of the reconstruction, those areas will also look different after surgery. Talk with your surgeon about surgical scars and changes in shape or contour. Ask where they will be, and how they will look and feel after they heal.

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 cancer surgery and reconstruction surgery will leave scars on the breast and any areas where tissue was moved to create the new breast mound.
  • 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. With time, the skin can become more sensitive, but it won’t feel the same as it did before the surgery.
  • 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, or radiation therapy. It can also be affected by smoking, diabetes, some medicines, and other factors.
  • You might have a choice between having breast reconstruction at the same time as the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction).
  • Surgeons may suggest you wait to have reconstruction, 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 with a more realistic outlook for the outcomes.

Can breast reconstruction hide cancer or make it come back?

Studies show that reconstruction does not make breast cancer come back. If the cancer does come back, reconstructed breasts should not cause problems with chemotherapy or radiation treatment.

If you are thinking about breast reconstruction, either with an implant or flap, you need to know that reconstruction rarely, if ever, hides a return of breast cancer. You should not consider this a big risk when deciding to have breast reconstruction.

Some early research has found that breast implants may be linked to a rare kind of cancer, known as anaplastic large cell lymphoma (ALCL). This is mainly based on a few small studies, but other studies so far have not shown any significant link. ALCL has been noted between 1 and 23 years after implants, and usually responds well to treatment. It can show up as a lump or as a collection of fluid near the implant. More careful studies are needed to find out what link, if any, there is between this rare cancer and breast implants.

What if I choose not to have breast reconstruction?

Many women decide that breast reconstruction is not right for them. Or they might not be able to have more surgery. If you choose not to have breast reconstruction, you can use breast forms or prosthetics that simulate the look and feel of a natural breast. But you can also decide not to use a breast form. Learn more in “Breast reconstruction alternatives.”

Talk to someone who’s been there

If you would like to talk with someone who has had your type of surgery, ask about our Reach To Recovery program. Reach To Recovery volunteers are breast cancer survivors trained to support others facing breast cancer, as well as those who are thinking about breast reconstruction. Ask your doctor or nurse to refer you to a volunteer in your area, or call us at 1-800-227-2345.

Last Medical Review: 12/05/2014
Last Revised: 09/13/2016