Understanding Your Options for Breast Reconstruction

Just as breast cancer treatment has become more individualized, so have the ways to make you feel more comfortable with your body once treatment is over. For some women with breast cancer, this means breast reconstruction after mastectomy or, in some cases, lumpectomy. Breast reconstruction is a personal choice – and although it may not be the choice for every woman, it is certainly a choice every woman should know about. 

When it comes to breast reconstruction, there are several options available, which involve both the timing and the type of breast reconstruction. If you are thinking about breast reconstruction, it is important to understand that what is right for one woman may not be right for another. Talking with your breast cancer oncologist, who will often work with the cancer surgeon and a plastic surgeon, can help you make the best decision based on your personal situation.   

Immediate vs. Delayed Reconstruction after Breast Cancer Treatment

Breast reconstruction can be done at different times, depending on what works best for your situation. 

For many women, breast reconstruction can take place at the same time or just after the mastectomy surgery. This approach is called immediate reconstruction. Although immediate reconstruction has become the standard of care for most patients, there are times when it may not be possible. 

Women who need additional breast cancer treatment, such as radiation or chemotherapy, may be advised by their breast cancer doctor to wait until all necessary treatment is finished. This is called delayed reconstruction. Depending on your situation, this delay can occur many months or even years after your mastectomy. 

Types of Breast Reconstruction Procedures

There are several different reconstruction techniques available, which sometimes require more than one operation. You should talk with your breast cancer oncologist and visit with the plastic surgeon who will perform the reconstruction to discuss what would be best for you.

Generally, breast reconstruction falls into two categories: 

• Implant reconstruction, which uses silicone or saline breast inserts known as breast implants to help form a new breast. 
• Autologous or “flap” reconstruction, which uses the patient’s own tissue from another part of the body (such as your belly, thigh, or back) to form a new breast. 

There are pros and cons to consider when thinking about either procedure. For example, implant reconstruction is a relatively short procedure, but implants don’t hold up as well as using your own tissue. This means that you will likely need another surgery to remove and/or replace your implant later on. According to The American Cancer Society, implant removals, modifications, or replacements are usually necessary within 10 years. 

The autologous procedure, on the other hand, is a longer operation. However, because you are using your own tissue, it should last a lifetime.

If you have had both breasts removed in a bilateral mastectomy, then implants are an easier option because they will both be the same size and shape. If only one breast needs to be reconstructed, then a flap surgery may make it possible to better match the shape and size of the other breast. There are some situations in which the surgeon will recommend altering the second breast, even if it was not included in the mastectomy surgery, to make them look similar.

You can also choose whether or not to reconstruct your nipple. Nipple reconstruction options include nipple/areola tattooing and fat grafting. Although the reconstructed nipple and areola do not have any sensation, it can help the reconstructed breast look more like the original breast.

Choosing What’s Best for You

Remember, what is right for one woman may not be right for another. Be sure to talk with your breast cancer oncologist about your preferences and/or any concerns you may have. After some careful thinking, you can decide what is most suitable for you and your lifestyle.