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If you’re having or have had a mastectomy to treat breast cancer, your doctor has likely talked to you about breast reconstruction surgery, including the option of implants. As of 2016, more than 40 percent of women in the U.S. who had a mastectomy also chose to have breast reconstruction surgery. More than 4,400 members of MyBCTeam have shared that they’ve had reconstruction, both with and without implants.
The decision to get implants after breast cancer surgery is entirely yours. Many people consider the pros and cons of additional surgery. If you’re considering implants, you’ll have to take into account your health, appearance, and whether you’ll need additional breast cancer treatment in future. If you choose reconstruction, you can decide between using your own tissue, getting implants, or a combination of both.
It’s important to talk openly with your doctor and care team about your feelings and options for reconstruction. Understanding your reconstruction options, including implants, is an important part of your decision process, so you should know all the choices available to you.
Deciding whether to undergo breast reconstruction can be hard. There are several factors to think about. Your oncology team may offer to do reconstruction during a lumpectomy — removing a portion of a breast — or a mastectomy — removing the entire breast. Alternatively, you can choose to have the reconstruction later, after you’ve healed from surgery and other treatments. If you are having or have had a single or double mastectomy, think about whether you want one or both breasts reconstructed. Some people choose to have both done after a single mastectomy so their breasts will have a similar appearance. This is known as symmetrization.
Some MyBCTeam members have shared their experiences with breast reconstruction and how it has affected their self-esteem. One member said, “I can’t explain it, but I do feel a different confidence now that I’ve had reconstruction.”
Another member added, “I, too, was very happy that I chose reconstruction. It looks different, and I still have to wear small inserts in my bra, but it was a great boost to my self-esteem.”
If you choose not to have reconstruction, you can choose to wear a breast prosthesis that looks similar to a natural breast. This can be a foam or silicone prosthesis that you can put in your bra or bathing suit top.
When deciding when to have reconstruction surgery, there are a few factors to consider. These include follow-up treatments after surgery, the type of breast cancer you have, and your personal preferences.
Immediate reconstruction is done right after the mastectomy. Most people prefer immediate reconstruction. This option is chosen for about 75 percent of reconstructions in the U.S.
Potential benefits of immediate reconstruction include:
However, not everyone is a candidate for immediate reconstruction.
Delayed reconstruction can occur weeks, months, or even years after your initial breast cancer surgery. This gives your body time to heal and gives you time to finish any adjuvant treatments (additional treatments aimed at keeping cancer from returning, like radiation therapy).
Some people wonder, “Can you get implants after a lumpectomy and radiation?” The answer is, it depends. If you receive radiation therapy or chemotherapy after surgery, your doctor will likely recommend delaying reconstruction. This is because these treatments can slow healing and may lead to changes in the breast’s appearance and color.
You’ll also want to make sure you have the energy for all of the stages of breast reconstruction after a mastectomy or breast reconstruction after a lumpectomy. If treatment has left you feeling worn out, you may want to wait before starting reconstruction.
In the end, the timing of reconstruction is up to you and your oncologist. Some people choose to wait so they can heal from surgery. One MyBCTeam member shared, “The surgeon asked me about reconstruction. I told them no for now. My main concern is getting rid of the cancer first. Then maybe later on down the road.”
Once you decide to have breast reconstruction, your doctor will discuss your options with you. Several factors will decide which type of reconstruction is best for you, including:
Together, you and your doctor will choose the best option for you. There are two main types of breast reconstruction surgeries — implant reconstruction and tissue or flap reconstruction.
Within these main options, there are many choices to consider, depending on your goals and other factors. After the breast area heals, nipple reconstruction can also be done. Some people may also choose to have surgery on the other breast, such as a breast reduction or lift, to make both breasts look the same. This can be helpful for both appearance and comfort.
Reconstructions with implants make up around 80 percent of breast reconstruction surgeries. In this method, the breast tissue that was removed is replaced with a flexible silicone implant filled with either silicone gel or saline. Breast implants can be a good choice for people who:
During your mastectomy, your surgeon might place a tissue expander. This is an empty breast implant that’s slowly filled with air or water over six to eight weeks. The expander stretches the breast tissue around it. This prepares the body for a permanent implant later on.
When choosing a plastic surgeon for this procedure, it’s important to ask about their experience and the methods they use. Clear communication is key, especially when talking about your goals for reconstruction. Here are some questions you might want to ask:
While breast implants placed after mastectomy are similar in appearance to natural breasts, they tend to feel much different. They come in different shapes and sizes to help you achieve the look you want. All implants are made of silicone and are filled with either silicone gel or saline.
It’s important to know that breast cancer can return after a mastectomy and reconstruction. However, there is no evidence that the reconstruction process affects whether breast cancer returns. Studies also show that people with breast implants are not at a higher risk of developing breast cancer.
Silicone gel implants are prefilled with a gel and then inserted into the breast tissue. These implants tend to look and feel more like natural breast tissue than saline implants because they are softer.
There’s a small chance a silicone implant may start to leak over time, spilling silicone gel into the body. This rupture (tear) can be hard to notice because the implant often keeps its shape. If the implant leaks, you might develop symptoms like pain, irritation, or lumps, according to Mayo Clinic. A rupture may also affect how the breast looks or feels. Sometimes, though, there are very few signs of a leak, or none at all. This is called a silent rupture. Studies show that a silicone rupture does not cause serious health problems like reproductive issues or connective tissue disease.
The U.S. Food and Drug Administration (FDA) recommends that people with silicone implants get regular MRIs or ultrasounds to check for leaks. These should start five to six years after the implant is placed, and every two to three years after that.
If your implant ruptures, talk to your health care provider about whether you should wait to see if the leak gets worse or replace it right away.
Saline implants are inserted empty and then filled with salt water after the breast surgeon places them in the body. They usually feel firmer than silicone gel implants. Because they are filled with salt water, you don’t need regular screenings after getting saline implants.
If a saline implant bursts, your breast will “deflate,” and you’ll probably notice. The salt water is safe and will be absorbed by your body without causing health or safety issues. If this happens, you will need to have surgery to remove or replace the implant shell. Be aware of the signs so you know when to call your doctor if something seems wrong with your implants.
Another option for reconstruction is tissue reconstruction. This is also known as autologous or flap reconstruction. This method uses your own tissue to rebuild the breast shape.
Typically, a flap of skin and fat is taken from another part of your body — such as the back, inner thighs, buttocks, or belly.
Depending on your surgeon’s skills and experience, you may either have a free flap or a pedicled flap. A free flap is a piece of tissue that is completely separated from its original blood vessels and then moved to the breast. A pedicled flap keeps its blood vessels attached and is moved to your chest, where it is placed under the skin. There, it is formed into a breast shape. Pedicled flaps are more common because most surgeons have more experience with this technique. Also, the procedure doesn’t require reconnecting the blood supply to the tissue.
In some cases, a combination of techniques is required to achieve the desired look, so an autologous flap is made and breast implants are placed as well.
Many MyBCTeam members who’ve had tissue reconstruction have either had a transverse rectus abdominis (TRAM) flap, using skin from the abdomen, or a latissimus dorsi flap, using skin from the back.
Tissue reconstruction has some advantages over implants. Tissue tends to feel more like natural breasts compared to implants. Additionally, once the surgery is complete, the reconstructed breast will typically last a lifetime. Implants, on the other hand, need to be replaced every few decades. However, tissue reconstruction requires more surgery to remove the tissue flap.
After a mastectomy, some people also choose to have a nipple reconstruction. This is usually done a few months after breast reconstruction surgery, when the tissues have healed and settled into their final positions. The dark area around the nipple, called the areola, can also be tattooed to make the breast look more natural look.
Nipple reconstruction uses tissue from the reconstructed breast to create a nipple that sticks out. However, over time, the nipple can flatten, and additional surgery may be needed, extending recovery times. Some people choose to have nipple reconstruction, while others do not.
In recent years, more people have been choosing 3D nipple tattoos as an alternative to nipple reconstruction surgery.
In the U.S., insurance companies that cover mastectomies are also required to cover breast reconstruction surgery after mastectomy. The exact costs covered by insurance will depend on your specific plan. If you need extra help paying for reconstruction surgery, there are breast cancer support and awareness groups and organizations that offer grants to help with costs. A quick online search can help you find resources that may be available to you.
On MyBCTeam, the social network for people with breast cancer and their loved ones, more than 74,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Have you had breast reconstruction surgery? What type did you have, and what was your experience? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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A MyBCTeam Member
I had the flap procedure. I didn’t not want my healthy breast reduced. I was told it would only be by a little. I don’t feel I was adequately prepared for the outcome. All this “your doctor and you”… read more