Women who have surgery to treat their breast cancer may choose breast reconstruction surgery to rebuild the shape and look of the breast.
There are several types of reconstructive surgery available, and the reconstruction process sometimes means more than one operation. One should make their decision about breast reconstruction only after they are fully informed.
Two main types of operations can be done to reconstruct the shape of your breast or breasts:
Sometimes a combination of an implant and flap procedure is used to get the best result
Here are some things one might want to consider while making a decision about breast reconstruction:
Breast reconstruction can be done at different times, depending on what works best for your situation:
At the same time as mastectomy surgery. This is called immediate reconstruction.
As soon as the breast is removed by the breast cancer surgeon, the plastic surgeon reconstructs the breast either with tissue from another location on your body or with an implant (and sometimes both). Nearly all of the work is done during one operation, and you wake up with a rebuilt breast (or breasts). This approach requires co-ordination of both the breast cancer surgery and plastic surgery teams. Immediate reconstruction may not always be possible if you need additional treatments such as chemotherapy or radiation therapy. In some cases, a surgeon will recommend waiting until after these treatments are finished before starting reconstruction. Or, depending on your situation, a surgeon may recommend doing part of the reconstruction immediately and then finishing the reconstruction after chemotherapy and/or radiation therapy are done. You and your surgeon can discuss your particular situation and needs. If you’re having prophylactic mastectomy — mastectomy to reduce a high risk of breast cancer — then reconstruction is always done immediately.
After mastectomy or lumpectomy surgery, as well as after radiation therapy, chemotherapy, or targeted therapies that are given. This is called delayed reconstruction.
Treatments such as radiation therapy and sometimes chemotherapy given after surgery can cause the reconstructed breast to lose volume and change color, texture, and appearance. Radiation therapy in particular is known to cause undesirable changes to an implant reconstruction. Cancers that are larger than 5 centimeters and that have spread to the lymph nodes are more likely to need radiation therapy after surgery.
Reconstruction also can be done years later if desired. Some women aren’t ready to have the surgery sooner, or they change their minds about their initial decision to “go flat” or wear a prosthesis.
As a staged approach, involving some reconstructive surgery during mastectomy or lumpectomy and more reconstructive surgery after any additional treatments. This is also called delayed-immediate reconstruction.
In delayed-immediate reconstruction, a tissue expander or ordinary breast implant is inserted under the chest muscle and preserved breast skin after the breast is removed. Temporarily placing an expander or implant will preserve the shape of the breast and breast skin during the upcoming radiation treatments and allow for the final benefit of a skin-sparing mastectomy technique.
The timing of breast reconstruction is one of the most discussed topics in reconstruction research. It's important that the entire team of doctors — breast surgeon, plastic surgeon, radiation oncologist, medical oncologist, and other caregivers — meet as a group and discuss the situation. Ideally, this group should meet before you make your decision about mastectomy or lumpectomy because the type of breast surgery you have can affect the reconstruction outcome. For example, some women may opt to have mastectomy instead of lumpectomy because the plastic surgeon advises that reconstruction after mastectomy offers better cosmetic results. Because each breast cancer is unique, each reconstruction surgery and its timing are unique. Together, you and your team can decide on an approach that is best for you.
A number of factors influence the timing of your reconstruction:
Cancer stage: In general, women diagnosed with stage I or some stage II breast cancers who choose mastectomy based on a biopsy are less likely to need radiation or other treatments after mastectomy and are often good candidates for immediate reconstruction. This is their best option because it combines the mastectomy and reconstruction into one surgical procedure. However, if there’s a good chance that radiation will be needed, the staged approach may be used instead. Your surgeon will help you choose the timing that is right for you.
Women diagnosed with stage III or stage IV cancers almost always need radiation therapy or other treatments after mastectomy because of the size of the cancer or the number of lymph nodes involved. In this case, some doctors recommend delaying reconstruction until all other breast cancer treatments are completed. Reconstruction may require extra healing time that could delay radiation and chemotherapy.
In some cases, though, immediate reconstruction may be appropriate. For example, if you have chemotherapy as your first treatment to shrink the breast cancer, this may allow for a downstaging of your tumor. You may then be eligible for skin-sparing mastectomy, which preserves as much of the breast skin as possible. While radiation may still be necessary, your doctor may be comfortable with its potential effects on an immediate flap reconstruction. Or, your doctor may suggest the staged reconstruction with a tissue expander or saline implant to maintain a breast pocket throughout your treatments. You and your doctor can discuss what makes the most sense for you.
Women might choose breast reconstruction for many reasons:
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.
Knowing your reconstruction options before surgery can help you prepare with a more realistic outlook expectations for the outcomes.
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.
Many women decide that breast reconstruction is not right for them. Or they might not be able to have more surgery. If you do not 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.
If you’ve decided to have breast reconstruction, you’ll still have many things to think about as you and your doctors talk about what type of reconstruction might be best for you. Some of the factors you and your doctors will need to take into account when considering your options include:
Your surgeon will review your medical history and overall health, and will explain which reconstructive options might be best for you based on your age, health, body type, lifestyle, goals, and other factors. Talk with your surgeon openly about your preferences. Be sure to voice any concerns and priorities you have for the reconstruction, and find a surgeon that you feel comfortable with. Your surgeon should explain the limits, risks, and benefits of each option.
You may have a choice between having breast reconstruction at the same time as the surgery to treat the cancer (immediate reconstruction) or at a later time (delayed reconstruction).
Immediate breast reconstruction is done, or at least started, at the same time as the surgery to treat the cancer. 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. You might choose to delay breast reconstruction if:
As you prepare for breast reconstruction surgery, your surgeon will help you answer questions about what to expect. Breast reconstruction 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, 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.
Your surgeon (or other doctors involved) would explain the details of your surgery, including:
It’s important to have an idea of what to expect after breast reconstruction surgery, including the possible risks and side effects. The time it takes you to recover from surgery will vary depending on the type of reconstruction you have. Most women begin to feel better in a couple of weeks and can return to normal activities in a couple of months. Be sure you understand how to take care of your surgery sites and how to follow up with your breast care, including regular mammograms.
There are certain risks from any type of surgery, and breast reconstruction may pose certain unique problems for some women. Even though many of these are not common, it’s important to have an idea of the possible risks and side effects.
Infection can happen with any surgery, most often in the first couple of weeks after surgery. If an implant has been placed, it might have to be removed until the infection clears. A new implant can be put in later. If you have a tissue flap, surgery may be needed to clean the wound.
The most common problem with breast implants is capsular contracture. A scar (or capsule) can form around the soft implant. As it tightens, it can start to squeeze the implant, making the breast feel hard. Capsular contracture can be treated. Sometimes surgery can remove the scar tissue, or the implant can be removed or replaced.
Using tobacco narrows blood vessels and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can cause more noticeable scars and a longer recovery time. Sometimes these problems are bad enough that a second operation is needed to fix them. You may be asked to quit smoking a few weeks or months before surgery to reduce these risks. This can be hard to do, so ask your doctor for help.
You’re likely to feel tired and sore for a week or 2 after implant surgery, or longer after a flap procedure (which will leave you with 2 surgical wounds). Your doctor will give you medicines to help control pain and other discomfort.
Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a little hollow ball that you’ll learn how to empty before you leave the hospital. Follow your doctor’s instructions on wound and drain care and also seek advice on the kind of support garments you should wear.
Most women can start to get back to normal activities within about 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind: