Reconstruction After Breast Cancer Surgery

Do I Have To Have Breast Reconstruction Surgery?

Choosing whether or not to have breast reconstruction surgery is a personal decision. Many women choose some form of reconstruction, while others decide to delay reconstruction or not pursue it at all, which is sometimes called “going flat.” Every option is valid.

Take the time to learn about your choices and make the decision that feels best for you. While this period can feel rushed and is often filled with emotion, it’s important to be comfortable in your long-term decision.

Keep in mind that breast reconstruction is considered part of breast cancer care and is typically covered by insurance. Breast cancer is not something anyone chooses, and you should never feel guilty or self-conscious about whichever path you decide to take.

When Should Breast Reconstruction Surgery Occur?

When you meet with your RMBS breast surgeon, ask about the time of reconstruction in relation to your cancer treatment. In many cases, breast cancer surgery and reconstruction are performed at the same time. This approach may improve cosmetic results and help you avoid multiple surgeries.

For some women, reconstruction may need to happen in stages. Factors like smoking, obesity, diabetes, or a history of radiation treatment may make a staged approach safer. Other parts of your treatment plan may also affect timing.

Questions you may want to ask include:

• Is it better to wait until radiation is complete before reconstruction?
• When will chemotherapy, hormone therapy, or targeted therapy begin after each surgery?
• Will reconstruction affect the timing of other treatments?

What Will The Results Look & Feel Like?

Before deciding on reconstruction, it’s natural to wonder how your breasts may look and feel afterwards. Every woman’s outcome is unique and depends on several factors, including the location of the cancer, your breast size and shape, and the type of reconstruction you choose.

Your RMBS care team can help you understand what to expect based on your individual situation. Questions you may want to ask include:

• Is it possible for my breasts to look natural?
• Will they match in size and shape?
• How will they feel?
• Will I keep my nipple?

• If not, can the nipple be reconstructed or tattooed?
• Where will the scars be located?

Reconstruction Options After A Mastectomy

For reconstruction following a mastectomy, RMBS breast surgeons and plastic surgeons work together closely to coordinate your care. Your care team will explain the benefits and potential drawbacks of each option, which may include:

• Creating a new breast with:
  • An implant filled with saline or silicone
  • Tissue from your own body, most commonly from the abdomen (called a DIEP flap procedure)
  • A combination of implants and your own tissue
• Going Flat

Implants

Some women opt to have breast reconstruction with implants because the procedure is generally less complex than a flap procedure, involving a shorter hospital stay and recovery. Your RMBS breast surgeon can help determine whether implant reconstruction is right for you and explain the difference between saline and silicone implants.

Oftentimes, implant reconstruction can begin at the time of mastectomy. During the first surgery, a tissue expander is placed beneath the skin to create space for a permanent implant. Over the following weeks or months, you will have the expander gradually filled with saline or air at regular office visits with your plastic surgeon.

Once the expander reaches the desired size, a second procedure is performed to remove the expander and place the implant. For many women, this second surgery takes place within several months of the mastectomy.

Implant reconstruction typically requires a hospital stay of one or two days. Most women can return to normal activities within four to six weeks.

Flap Procedure

Some women choose breast reconstruction using a DIEP flap procedure, which uses tissue from the abdomen to create a new breast. Because the reconstruction is made with your own tissue, it can provide a more natural look and feel.

A DIEP flap procedure can often be performed at the same time as the mastectomy. However, because the surgery involves both the breast and abdomen, it is longer and more complex than implant reconstruction.

Most women stay in the hospital for three to seven days following surgery, and recovery typically takes six to eight weeks. Ask your surgeon whether you are a good candidate for a DIEP flap procedure.

Combination or Hybrid Procedure

Some women may benefit from a combination, or hybrid, reconstruction that uses both abdominal tissue and an implant. This approach may be an option when there is not enough available tissue to rebuild the breast to the desired size or shape with a flap procedure alone.

During reconstruction, tissue from the abdomen is used to create the breast, while an implant provides additional volume and shape. Because this procedure involves two surgical sites, recovery is similar to other flap procedures and usually requires a longer hospital stay.

Oftentimes, your surgeon will recommend a second, follow-up surgery to further shape the breast and improve symmetry.

Going Flat

Not everyone chooses reconstruction after a mastectomy. Some women decide to remain flat on one or both sides, while others choose to use a breast prosthesis or bra insert to achieve their desired look without additional surgery.

If you are considering going flat, it is important to discuss the option with your surgeon. This decision can affect how the mastectomy is performed, including incision placement and closure techniques.

Reconstruction After Breast-Sparing Surgery

Although a lumpectomy removes only part of the breast, it can sometimes leave the breast looking smaller, uneven, or indented. In many cases, the RMBS breast surgeon performing your procedure can reshape the breast right away during surgery. Sometimes, the unaffected breast can also be adjusted for balance.

Not every woman who has a lumpectomy will need reconstruction. Your surgeon can help you understand what to expect based on your procedure.