What are my options for breast reconstruction if I have a mastectomy?
The options for reconstruction can be divided into three general categories:
- Implant only
- Using your own body tissue only
- Implant combined with using your own body tissue
All reconstructive options will require multiple surgeries and take time to achieve the final result.
Which method may be best for me?
The best method for you depends on many factors, including your:
- Body shape
- Past surgeries
- Current health
- Treatment needs
- Personal preferences
During your consultation, the surgeon will discuss your reconstructive options, including the risks, benefits and choices for each procedure. You will also discuss the expected outcomes from reconstruction.
Do I have to have breast reconstruction?
No. Some patients decide that they are not ready to have reconstruction for various reasons, or do not want to undergo any further surgeries. Many breast cancer patients may choose to wear a prosthesis (artificial breast) to allow better fit in clothing and minimize the lopsided feeling that the missing breast tissue or breast may create for some patients after cancer surgery. Living a long cancer-free life is our goal, but retaining your femininity is just as important.
How long is the reconstruction process?
The timeline for completing breast reconstruction varies, depending on how many surgeries are done and the need for other cancer treatments. The reconstruction process takes 6 months to one year, no matter what procedures are chosen, and if no further cancer treatment is necessary. Many patients may choose to not have a nipple reconstructed or may require multiple surgeries to make the reconstructed breast look like the remaining natural breast. Here's a general reconstruction timeline:
Step 1: First surgery to create breast. Wait about three months for healing. Increase this time if you need chemotherapy or radiation treatment.
Step 2: Surgery to make any changes to refine or balance the reconstructed breast. Wait about two to three months for healing. This step may be repeated as needed.
Step 3: Surgery to add nipple and areola.
Are there risks associated with breast reconstruction?
Yes. As with any surgery, there are risks. The plastic surgeon will review these risks during your clinic visits and answer any questions. Risks of breast reconstruction surgery may include:
- Wound healing problems
- Changes in sensation
- Fluid build up (such as hematomas and seromas)
- Implant failure/rippling/extrusion
- Partial or complete loss of flaps
- Failure or loss of implants
- Asymmetry (lopsidedness)
- Poor cosmetic results
What questions should I ask my reconstructive surgeon?
- Can breast reconstruction be done in my case?
- When can I have reconstruction done?
- What types of reconstruction are possible for me?
- What type of reconstruction do you think would be best for me? Why?
- How many of these procedures have you done?
- Will the reconstructed breast match my remaining breast and if not, what can be done?
- How will my reconstructed breast feel and will I have any sensation?
- What possible complications should I know about?
- How long will the surgery take and how long will I be in the hospital?
- Will I need blood transfusions? If so, can I donate my own blood?
- How long is the recovery time?
- How much help will I need at home to take care of my drain (tube that lets fluid out) and wound?
- When can I start my exercises and return to normal activity such as driving and working?
- Can I talk with other women who have had the same surgery?
- Will reconstruction interfere with chemotherapy or radiation therapy?
- How long will the implant last?
- What happens if I gain or lose weight?
What if my natural breast does not match my reconstructed breast?
The ultimate goal of reconstruction is to create a breast that is symmetrical with the remaining natural breast. Sometimes, getting the reconstructed and natural breasts to match is difficult unless surgery is performed on the natural breast, too. For some patients, this may involve placing an implant in the natural breast to make it larger (augmentation); making the natural breast smaller or less droopy by reducing the tissue (reduction), or lifting the breast skin (mastopexy). Your surgeon will discuss these options during your consultation. This “balancing procedure” is often done 3-6 months after your first surgery, to make sure the reconstructed breast has healed and is the desired size and shape.
What if I may need chemotherapy?
Breast reconstruction should not delay chemotherapy treatments. Usually your medical oncologist will wait until you have healed from your mastectomy and reconstruction before starting chemotherapy. If you have complications such as wound healing problems or infection, chemotherapy may be delayed.
If you are undergoing tissue expansion at the time of chemotherapy, the surgeon may need to take blood. This is to make sure that your body can fight bacteria that may be introduced from your skin during the expansion process. Once chemotherapy is complete, your surgeon will usually wait at least a month before considering further reconstructive surgery.
What if I may need radiation?
You may want to delay breast reconstruction until you are finished with radiation therapy. Radiation may damage your reconstruction and affect your final cosmetic result. If you require radiation, your surgeons may recommend that you use your own tissue for delayed reconstruction, either alone or with an implant. Implant-only reconstruction is not recommended, since radiation often results in implant complications, including:
- Severe capsular contracture (scar tissue around the implant causes hardening of the breast)
- Fluid buildup
- Poor cosmetic result
If you may need radiation treatment, a tissue expander can be placed during the mastectomy to preserve the skin "pocket." It provides a breast mound while you are waiting to hear if you need radiation.
If you do not need radiation, you and your surgeon can plan the final reconstruction. If you do need radiation, the tissue expander can be left in place. However, at MD Anderson, the tissue expander must be deflated while you are receiving radiation, which usually takes 6-8 weeks. The tissue expander is then re-inflated 2 weeks after radiation is complete. A delayed reconstruction is planned with your surgeon. Not all surgeons will recommend this option because there is an increased risk of complications by having a tissue expander in place during radiation treatment.
Does reconstruction change the risk of my cancer returning? Does it make cancer detection harder?
The risk of breast cancer recurrence depends on the stage of disease, biologic characteristics of the cancer and additional breast cancer treatments. Reconstructive surgery has not been shown to increase the risk of the cancer returning or make it harder to detect if cancer does return. The methods or tests used to screen for recurrence will be decided by your cancer care team.
Who pays for my reconstruction?
In October of 1998, Congress passed the “Women’s Health and Cancer Rights Act,” which requires group health and individual health insurance coverage for reconstructive surgery following a mastectomy. In general, the law states that these plans should cover:
- Reconstruction of the breast on which the mastectomy was performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- prosthesis (artificial breast) and treatment of physical complications at all stages of the mastectomy
Check with your insurance company or the MD Anderson business office to confirm that coverage for your surgery is being provided by your insurance company.
What if I am considering a lumpectomy or breast conservation instead of mastectomy?
If you are considering breast conservation rather than a mastectomy, reconstructive options may be available to improve the cosmetic result. Breast conservation surgery usually involves removing a portion of breast tissue where the cancer is located, followed by radiation therapy. The removal of breast tissue can often leave an indentation or dimple on the breast. This dimple may not be seen until after radiation treatment.
To prevent this, your plastic surgeon may be able to “re-arrange” the remaining breast tissue at the time of the cancer removal. This may leave you with a smaller breast or further scarring. These procedures are referred to as oncoplastic surgery. If this is not an option at the time of your cancer surgery, delayed reconstructive options may be used, such as the latissimus dorsi flap, local tissue flaps and fat grafting.